About one in 500 women do not have a functioning uterus, which is necessary to carry a pregnancy. This condition, called absolute uterine infertility, occurs when a woman is born without a uterus, had to have it removed, or has a defective organ.
For women with this type of infertility who would like to become pregnant, researchers and clinicians have developed a new surgical procedure: uterus transplantation. In 2014, the first birth after this procedure took place in Sweden, with the first birth in the United States after uterus transplant three years later. Over the past decade, more than 70 babies have been born worldwide following this operation. Wombs come from both living and deceased donors.
Uterine transplant surgeon Liza Johannesson was part of the Swedish team that led to the first birth. She then moved to Baylor University Medical Center in Dallas, joining the group that later reported the first birth in the United States. She and her colleagues describe how women and babies have emerge after procedure in largest series of cases to datereported in the Journal of the American Medical Association on May 1st.
From 2016 to 2026 at Baylor, which has the the largest uterus transplant center Worldwide, 44 women have undergone this procedure. One month after the operation, 37 of them had a successful uterus transplant. As of April 2026, 33 of these women had had an embryo transfer. Thirty-one of these women became pregnant, of whom 27 have given birth so far. Eight of these women experienced complications, most commonly gestational diabetes or high blood pressure, which can occur during any pregnancy.
Of the 27 who gave birth, 23 had one child and four had two children each. All of the newborns had a health score, or Apgar score – which assigns points to health measures including heart rate and breathing immediately after birth – of at least 7 out of 10 at five minutes. Eleven of the newborns were admitted to the neonatal intensive care unit due to their premature birth, with stays ranging from a few days to almost two months.
“These women who are told they will never carry a pregnancy, to see them experience this pregnancy and this birth is extraordinary,” says Johannesson. She and her colleagues spoke to women about their motivations for undergoing a uterus transplant at Baylor, for a study published in 2021 in the American Journal of Surgery. Study participants spoke about their desire to carry a pregnancy and to help others who might benefit from the procedure. “I wanted to be able to look down and see my belly growing and feel my baby kicking,” one participant said. Another added: “Even if it doesn’t work for me, I wanted to be able to move forward with research” for other people suffering from absolute uterine infertility.
Scientific news spoke with Johannesson about the procedure, including how the field developed and what steps need to be taken for organ recipients and donors. The interview has been edited for length and clarity.
SN: How has uterus transplantation progressed over time?
Johansson: It works with increasing reliability. Most transplants are successful, and among patients whose uterus is functioning and viable 30 days after transplant, the majority give birth to a healthy baby. This is really the key change: once the uterus is taken, the chances of pregnancy and live birth are really high. We’ve gone from a very experimental procedure to something that we now offer clinically to patients.
SN: Who is eligible for a transplant?
Johansson: We transplant women who have absolute uterine infertility, which actually means the problem is the uterus, which is why they cannot carry a pregnancy or give birth. To be a candidate, you must also be in good health in general [and] between 18 and 40 years old. We’re not strict about quarantine, but we certainly don’t want to be over 45, because that adds a lot of extra stress and a lot of extra risk to the procedure.
SN: What would a patient’s experience be like, from transplant to pregnancy?
Johansson: It all starts with IVF [in vitro fertilization]. Patients create and freeze embryos before transplantation. We don’t want to transplant someone without the possibility of fertilization, because that’s the whole point. Next comes the transplant operation itself. It is a complex surgical procedure but, in short, involves connecting the uterus to the recipient’s blood vessels and vaginal canal. Even if you were born without a uterus, you have a vagina and all the pelvic vessels. I then give them a gynecological exam. If I didn’t know, I would never be able to tell that this uterus wasn’t there all along, because it looks completely normal.
Generally, [recipients] start having periods after a few months, which is the first sign that the uterus is functioning. From there, we move on to the first embryo transfer, approximately three months after the transplant itself. If a pregnancy occurs, it is closely monitored and we then deliver by cesarean section. [cesarean section]. Some recipients do not want another pregnancy or have not responded very well to immunosuppression or [there are] medical complications, then we remove the uterus. But many of them want to start a second or even a third pregnancy. The important thing is that we remove the uterus after the journey is over, because we don’t want them to be on immunosuppressive medications for the rest of their lives.
SN: Who are the donors?
Johansson: We have received both living and deceased donations. We thought we were going to do fifty-fifty, but when we started, a lot of living donors from all over the United States contacted us and really wanted to give their uterus to someone. So it turned out that we rely almost exclusively on living donors.
We interviewed these donors [about] what is this the motivation to do this. It was the common thread that ran through them all: pregnancy and childbirth was such an important thing in their own lives that they wanted to gift it to someone else. This is not an organ donation per se, but rather an experience for someone else.
SN: How do women fare after uterus transplantation, pregnancy and childbirth? And infants?
Johansson: Generally speaking, when a transplanted uterus is functioning, live birth rates are the same as those seen in IVF. We are currently seeing complication rates similar to IVF pregnancies. We monitor [the recipients] closely because we want to make sure the immunosuppression is correct. Then in terms of health of the baby, we have a very good result. No one had any malformations or anything related to the transplant itself. There is a somewhat higher risk of prematurity than in the general population, but no more than for IVF pregnancies or solid organ transplant patients in general.
SN: What is needed to continue to advance the field and increase availability?
Johansson: We work a lot to obtain a standardized protocol so that the results are consistent in the different centers. We need long-term data on mothers and children. The first baby born was born in 2014 in Sweden and the first in the United States. [was in] 2017, they are therefore reaching middle school age. We will continue monitoring.
We also need to make this procedure less resource-intensive. We must ensure that we can reach many women. In the beginning, many institutions paid for transplants. Eventually the money runs out. So far, insurance companies have no interest [in covering this]. Many insurance companies don’t cover IVF, so it’s not just about uterus transplants. We have a lot of work to do because right now it’s an expensive procedure and a lot of patients have to pay a lot for themselves and that’s the last thing we want. We don’t want it to be just for the rich.
