1. Despite rejection episodes and graft viability concerns, both recipients and their partners of uterine donation reported stable well-being during the first year after surgery.
2. At 3-month follow-up, transplant recipients reported a significant increase in pain and decrease physical functioning from baseline, both of which resolved by 6 months.
Evidence Rating Level: 3 (Average)
Study Rundown: In September 2014, the world welcomed the first baby born to a woman with a transplanted uterus, which created hope for the one in 500 reproductive-age women who struggle with uterine factor infertility. Uterine infertility has a range of causes, including uterine anomalies, intrauterine adhesions and even women who previously underwent hysterectomy who subsequently desire pregnancy. Despite advances in the treatment of the other major etiologies of female infertility such as ovulatory disorders and tubal disease, there remains no direct treatment available for women with uterine factor infertility aside from corrective surgery (e.g. metroplasty for women with an intrauterine septum or adhesiolysis for women with intrauterine adhesions). As a uterus transplant is an elective procedure for which there are safe and effective alternatives to transplantation, like adoption and gestational surrogacy, uterine transplantation is a topic of complex ethical debate. In contrast to other organ donation procedures, a uterus transplant involves 4 parties: donor, recipient, partner of the recipient, and the potential child. All 4 parties involved may experience not only medical but also psychological side effects following the procedure. Previous investigations of transplant recipients suggest that the outcome of any transplant is highly associated with the patient’s psychological well-being. In the present work, researchers examined the psychology and well-being of the 9 recipients who underwent uterus transplants in the world’s first clinical trial conducted in Europe.
During the first year following transplant, both recipients and their partners experienced mostly small changes with regards to mood, quality of life, fertility and relationship parameters, even when considering rejection episodes and concerns about graft viability. Strengths of this study included the novel subject matter and assessment of partners and recipients. There were notable limitations, however. Findings from this initial clinical trial are limited by small sample size which reduced statistical power and created opportunity for Type II error. Participants were highly motivated to succeed and had been cleared as mentally stable prior to their procedure such that the results of this work may not be generalizable to the greater population. Future studies might assess how the psychological well-being of participants undergoing uterus transplant differs before and after attempted pregnancy and assess for differences by fertility outcome.
Click to read the study in Fertility and Sterility
Relevant Reading: Live birth after uterus transplant
In-Depth [prospective observational study]: As part of the first clinical trial, 9 women with uterine factor infertility underwent uterus transplant from a live donor. At 1 year, 7 had graft survival with only mild rejection episodes, while 2 had graft failure requiring hysterectomy. Psychological evaluations were administered to both patients and their partners at baseline, 3, 6 and 12 months. The primary outcome was scoring on 4 questionnaires that assessed quality of life, mood, relationship and fertility quality of life. Results were compared to baseline and to a control group of couples undergoing In Vitro Fertilization (IVF) for the first time.
At baseline, participants and partners scored significantly lower on anxiety (4.0 vs. 5.7, p = 0.04), depression (1.2 vs. 2.9, p < 0.01), and burden of infertility (p < 0.001) than the control group of first time IVF couples. Throughout follow-up, both partners and participants had small variations in all four domains. At 3 months, participants with ongoing grafts reported lower physical functioning (p = 0.03) and increased pain (p = 0.03) compared to baseline, both of which resolved by 6-month follow-up.
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