The University of Alabama at Birmingham  and UAB Medicine have established the first uterus transplant program in the Southeast and the fourth such program in the United States. The program, which is a partnership between the Department of Obstetrics and Gynecology, the Division of Transplantation and the Comprehensive Transplant Institute, will provide women with uterine factor infertility an innovative option for child-bearing using deceased donor organs.

UAB is the first program in the United States to offer uterus transplantation outside of a clinical research trial and is one of very few centers in the world accepting new patients.

“Our program is the only one in the Southeast and it represents the remarkably strong programs in women’s health and solid organ transplantation at UAB,” said Warner Huh, M.D., chair of the UAB Department of Obstetrics and Gynecology.

Patients will receive care from the Division of Gynecologic Oncology, the Division of Maternal-Fetal Medicine and the Division of Reproductive Endocrinology and Infertility, which are all housed within the Department of Obstetrics and Gynecology.

“Our patients will receive care from our renowned healthcare providers throughout the entire process,” Huh said. “From preparing for the transplant to the delivery of the child and then removal of the uterus, our physicians and nurses will be with them for every step of the way.”

The Division of Gynecologic Oncology will work with patients who are candidates for the uterine transplant, while those in the Division of Reproductive Endocrinology and Infertility Services will work with the patient on embryo generation ahead of the surgery.

After the transplant and once the patient is pregnant, she will be cared for by Maternal-Fetal Medicine specialists until birth.

Paige Porrett, M.D., Ph.D., associate professor of surgery in the UAB Division of Transplantation and Comprehensive Transplant Institute, will lead the program.

Uterine factor infertility may affect as many as 5 percent of reproductive-age women worldwide and was a previously irreversible form of female infertility. A woman with UFI cannot carry a pregnancy to term either because she was born without a uterus, has had the uterus surgically removed during a hysterectomy, or has a uterus in place that does not function properly. Congenital absence of the uterus is a condition called Mayer-Rokitansky-Küster-Hauser syndrome (MRKH), which affects approximately one out of every 4,500 females, and makes it impossible for a woman to get pregnant.

Most uterus transplants performed to date in the world have been in women with MRKH syndrome. However, women who have undergone a hysterectomy and had the uterus removed surgically are also potential candidates for uterus transplantation.

“We are tremendously excited to announce that UAB is expanding access to uterus transplantation and offering hope to couples unable to get pregnant,” Porrett said. “Our doors are open to both providers and patients anywhere who want to learn more about this exciting new therapy.”

How uterus transplantation works

The process from transplant to successful birth varies from person to person but can take two to five years for many participants. It includes five phases:

1. Embryo generation. Before the uterus transplant surgery, a woman generates embryos through in vitro fertilization (IVF). During the process of IVF, she is given fertility drugs to produce eggs, which are then removed from her ovaries and fertilized outside of her body. These embryos are then frozen for later use.

2. Transplantation. A uterus is removed from a donor and surgically placed into the recipient. The recipient begins taking immunosuppressive medications to prevent rejection of the transplant. These medications are taken while the transplant is in place, including during pregnancy.

3. Pregnancy. Several months after the transplant surgery, one of the recipient’s embryos will be thawed and placed directly into the uterus. If implantation is successful, the recipient will become pregnant. The health of both baby and mother is monitored very closely at frequent prenatal care visits with a high-risk obstetrician, known as a maternal fetal medicine specialist.

4. Delivery. The child is born as close to term as is possible via a planned Cesarean section. If the pregnancy has gone well and the recipient and her partner desire a second child, the uterus is left in place and immunosuppression medications are continued. Approximately six months after delivery, another embryo transfer can be attempted.

5. Uterus removal. After childbearing is complete, the transplanted uterus is removed and immunosuppressive medications are stopped.

Am I a candidate?

Candidates for uterine transplants should be generally healthy and without a uterus — either born without one or have had one surgically removed. As part of an intensive evaluation, candidates are educated about the risks of uterus transplantation and counseled about alternatives to uterus transplantation for family building.

To learn more about this program or to find out if you are a candidate, click here or please contact 833-UAB-CTI1.