Uterus transplantation

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A uterus transplantation is a surgical procedure that transplants a healthy uterus into someone whose uterus is absent, or diseased. As part of normal sexual reproduction, a diseased or absent uterus prevents a pregnancy. This form of infertility is known as absolute uterine factor infertility for which a uterine transplant may be able treat.

Contents

History

Studies

In 1896, Emil Knauer, a 29-year-old Austrian working in one of Vienna's gynecological clinics, published the first study of ovarian autotransplantation documenting normal function in a rabbit. This led to the investigation of uterine transplantation in 1918. [1] [2] In 1964 and 1966, Eraslan, Hamernik and Hardy, at the University of Mississippi Medical Center in Jackson, Mississippi, were the first to perform an animal (dog) autotransplantation of the uterus and subsequently deliver a pregnancy from that uterus. [3] In 2010 Diaz-Garcia and co-workers, at Department of Obstetrics and Gynecology, University of Gothenburg in Sweden, demonstrated the world's first successful allogenic uterus transplantation, in a rat, with healthy offspring. [4]

As of 2023, more than 100 womb transplants have taken place, with around 50 babies having been born worldwide. [5] [6]

Notable cases

Germany

Except perhaps in rare cases of intersex individuals, transgender women are born with a male reproductive system. While sex reassignment surgery can create a vagina for these women, the option of a uterus is unavailable to them, meaning they cannot carry a pregnancy and would need to take other routes to parenthood, whether it be a more traditional approach involving coitus or an alternative one such as adoption, egg donation, or a gestational carrier. Nonetheless, at least one uterine transplant for a trans woman occurred, for the Danish artist Lili Elbe (1882–1931). [7] Hoping to have children with her fiancé, she underwent a uterine transplant in 1931, in conjunction with vaginoplasty, in Germany at the age of 48. However, she developed a postsurgical infection and died from cardiac arrest just three months later. [8]

Saudi Arabia

The first modern day attempt at a uterine transplant occurred in 2000, in Saudi Arabia. [9] Wafa Fageeh [9] transplanted a uterus, taken from a 46-year-old patient, into a 26-year-old patient whose uterus had been damaged by hemorrhaging following childbirth. [10] Because the patient ultimately needed for the uterus to be removed after just 99 days, due to necrosis, whether or not the case is considered successful is disputed, but the uterus did function for a time, with the patient experiencing two menstrual cycles. [9] Members of the medical community have expressed concerns over the ethics of the procedure. [11]

Turkey

The first incidence of a uterine transplant involving a deceased donor occurred in Turkey on 9 August 2011; the surgery, performed by Ömer Özkan and Munire Erman Akar, at the Akdeniz University Hospital in Antalya, on Derya Sert, a 21-year-old patient who'd been born without a uterus. [12] [13] [14] [15] [16] [17] In this case, the patient enjoyed long-term success with the transplanted uterus, experiencing periods and, two years post-surgery, pregnancy. [18] [19] [20] During that pregnancy, Sert underwent an abortion in her first trimester, after her doctor was unable to detect a fetal heartbeat, but this is a common complication and may not have been related to the transplant. [21] Following another pregnancy that was initiated with in vitro fertilisation and sustained for 28 weeks, the patient finally delivered a baby on June 4, 2020. [22]

Sweden

In Sweden in 2012, the first mother-to-daughter [23] uterine transplant was done by Swedish doctors at Sahlgrenska University Hospital at Gothenburg University led by Mats Brännström. [23] [24] [25]

In October 2014, it was announced that, for the first time, a healthy baby had been born to a uterine transplant recipient, at an undisclosed location in Sweden. The British medical journal The Lancet reported that the baby boy had been born in September, weighing 1.8 kg (3.9 lb) and that the father had said his son was "amazing". The baby had been delivered prematurely at about 32 weeks, by cesarean section, after the mother had developed pre-eclampsia. The Swedish woman, aged 36, had received a uterus in 2013, from a live 61-year-old donor, in an operation led by Brännström, Professor of Obstetrics and Gynaecology at the University of Gothenburg. [26] [27] The woman had healthy ovaries but was born without a uterus, a condition that affects about one in 4,500 women. The procedure used an embryo from a laboratory, created using the woman's ovum and her husband's sperm, which was then implanted into the transplanted uterus. The uterus may have been damaged in the course of the caesarian delivery and it may or may not be suitable for future pregnancies. A regimen of triple immuno-suppression was used with tacrolimus, azathioprine, and corticosteroids. Three mild rejection episodes occurred, one during the pregnancy, but were all successfully suppressed with medication. Some other women were also reported to be pregnant at that time using transplanted uteri. [28]

United States

The first uterine transplant performed in the United States took place on 24 February 2016 at the Cleveland Clinic. [29] The team was led by Dr Andreas Tzakis. The transplant failed due to an undisclosed complication on 8 March, and the uterus was removed. [30] In April, they reported a yeast infection had spread to one of the arteries the surgeons had connected to provide blood flow to the transplanted uterus, which damaged the artery and caused blood clots to form. [31]

In November 2017, the first baby was born after a uterus transplantation in the US. [32] The birth occurred at Baylor University Medical Center in Dallas, Texas, by Drs Liza Johannesson and Giuliano Testa, after a uterus donation from a non-directed living donor. [33] The first baby born after a deceased donor uterus transplant in the US was at the Cleveland Clinic in June 2019. [34]

India

The first uterine transplant performed in India took place on 18 May 2017 at the Galaxy Care Hospital in Pune, Maharashtra. The 26-year-old patient had been born without a uterus, and received her mother's womb in the transplant. [35] [36] India's first uterine transplant baby, weighing 1.45 kg, was delivered through a Caesarean section [37] at Galaxy Care Hospital in Pune in October 2018. [38] The surgery was performed by a team of doctors at Pune's Galaxy Care Hospital and led by the hospital's medical director, Shailesh Puntambekar. [39]

Brazil

The first uterine transplant performed in Brazil took place on 2016 at the Hospital das Clínicas da USP in São Paulo. The 32-year-old patient had Müllerian agenesis, and therefore born without an uterus, and received a deceased donor's womb in the transplant. [35] Brazil's first uterine transplant baby was delivered through a Caesarean section [37] at Hospital das Clínicas da USP in December 2017. The surgery was performed by a team of doctors at Hospital das Clínicas da USP and led by Dani Ejzenberg, the head of the Human Reproductive Center at the hospital. Results of this procedure, the first to be performed in Latin America, were published in the medical journal The Lancet, in December 2018. [39]

Spain

In Spain, the first uterine transplant was performed in October 2020, at the Hospital Clínico de Barcelona, with two sisters as donor and recipient. [40] The recipient was 34 years old, she had Müllerian agenesis, therefore, she could not get pregnant. Two months after surgery, the patient had her period for the first time and her recovery was normal. She became pregnant, but had an abortion in the 8th week of gestation. After a few months, a new fertilization was able to be carried out and she became pregnant. The cesarean section was performed without any complications and the baby was born weighing 1,125 grams. [41]

United Kingdom

On August 23, 2023, doctors at the Churchill Hospital Oxford in the U.K. conducted the country's first uterus transplant. They removed the uterus from a 40-year-old woman and transplanted it to her 34-year-old sister, who had a rare condition that affected her ability to reproduce. [42] A team of experts performed the surgery for 17 hours in total. [43] Prof Richard Smith, a gynaecological surgeon who led the organ retrieval team, has spent 25 years researching womb transplantation, said that the surgery was a "massive success". [44]

Australia

On 15 December 2023, the first baby (male) was born in Australia to a mother who received a transplanted uterus. Kristy Bryant received the uterus in January 2023 at the Royal Hospital for Women in Sydney, and fell pregnant within three months through embryo transfer. The donor was her mother, Michelle. [45]

Current status

The transplant is intended to be temporary – recipients will have to undergo a hysterectomy after one or two successful pregnancies. This is done to avoid the need to take immunosuppressive drugs for life with a consequent increased risk of infection. [46]

The procedure remains the last resort: it is a relatively new and somewhat experimental procedure, performed only by certain specialist surgeons in select centres, it is expensive and unlikely to be covered by insurance, and it involves risk of infection and organ rejection. Some ethics specialists consider the risks to a live donor too great, and some find the entire procedure ethically questionable, especially since the transplant is not a life-saving procedure. [47] [48] [49]

Description

Ideal candidates

Uterine transplant has been carried out on women with fertility problems such as Müllerian agenesis, which affects one of 5,000 women. These women are already born without a uterus and without fallopian tubes. About the vagina, depending on the degree of affection, some of them can have it incompletely or directly they don’t have it. The causes of Müllerian agenesis are not fully understood. It is due to a failure in early embryonic development, around weeks 4 and 12 of gestation. The Müllerian ducts of the female fetus don’t develop, and as a result, the uterus and tubes don’t form properly. Instead, the ovaries develop from a different structure than the Müller ducts and are normally shaped and functional in women with Müllerian agenesis. Although, this procedure has also been carried out on women for other reasons such as illnesses or injuries in the female reproductive system. [50]

Procedures

Uterine transplantation starts with the uterus retrieval surgery on the donor. Working techniques for this exist for animals, including primates and more recently humans. [51] [52] [53] [54] [55] [56] The recovered uterus may need to be stored, for example for transportation to the location of the recipient. Studies on cold-ischemia reperfusion indicate an ischemic tolerance of more than 24 hours. [52]

The recipient has to look at potentially three major surgeries. First of all, there is the transplantation surgery. If a pregnancy is established and carried to viability a cesarean section is performed. As the recipient is treated with immuno-suppressive therapy, eventually, after completion of childbearing, a hysterectomy needs to be done so that the immuno-suppressive therapy can be terminated.[ citation needed ]

Assisted reproduction and uterus transplantation:

Assisted reproductive technology must be proposed to all women before the uterine transplant surgery. After the uterus transplantation there are 2 important steps that we must keep in mind to achieve a pregnancy:

Ovarian stimulation (OS):

The objective of OS is to have enough high potential embryos to increase the chance of conception after the Uterus transplantation is performed. One or several courses of OS may be necessary to obtain enough oocytes. [57]

Endometrial preparation:

One to two months after transplantation, the lining of the new uterus begins to thicken and shed in a cyclical manner, and menstruation occurs. Menstruation is a signal that the uterus is functioning well and may be able to support a pregnancy. Endometrial preparation for embryo transfer first involves an estrogen preparation step, to prepare and thicken the endometrium, and subsequently progesterone is prepared, to return the endometrium receptive. [58]

Risks and complications

Surgical Issues of Uterine Transplant:

Uterine transplant from a living donor is a challenging surgical procedure requiring up to 10–13 h to be completed, mostly due to the difficulty in handling the complex venous system around the uterus. Some of the problems that may arise are the following:hemorrhage, damage to nearby organs, infection, thrombosis, postoperative pain. [59]

The most frequent complication in uterine transplant is intravascular thrombosis, and also an infection, hemorrhage, damage to nearby organs. A late complication of uterine transplant, which typically occurs several months after the procedure, is vaginal stricture over the suture line, which may affect up to 72% of recipients. During transplant surgery, the surgeon must join the cervix of the transplanted uterus to the vagina using stitches. Over time, during the healing process, this area can form excessive scar tissue that narrows the vaginal canal and reduces the flexibility and diameter of the vagina, causing stenosis. [60]

Side effects of immunosuppressants:

Weaker immune system (increased risk of contracting diseases), renal and hepatic toxicity, high blood pressure, osteoporosis, long-term cancer. [61]

With proper selection of medications and strict medical monitoring, the risk to the fetus is low and many pregnancies in transplant patients have had successful outcomes. What usually happens in most cases is premature birth and also that the baby is born with low weight. [62]

Ethics

Montreal criteria

Aside from considerations of costs, uterine transplantation involves complex ethical issues. The principle of autonomy supports the procedure, while the principle of non-maleficence argues against it. In regard to the principles of beneficence and justice the procedure appears equivocal. [11] To address this dilemma the "Montreal Criteria for the Ethical Feasibility of Uterine Transplantation" were developed at McGill University and published in Transplant International in 2012. [11] The Montreal Criteria are a set of criteria deemed to be required for the ethical execution of the uterine transplant in humans. These findings were presented at the International Federation of Gynecology and Obstetrics' 20th World Congress in Rome in October 2012. [63] In 2013 an update to "The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation" was published in Fertility and Sterility and has been proposed as the international standard for the ethical execution of the procedure. [64]

The criteria set conditions for the recipient, the donor, and the health care team, specifically:

  1. The recipient is a genetic female, with the ability to consent, with no medical contraindications to transplantation, has uterine disease that has failed other therapy, and has "a personal or legal contraindication" to other options (surrogacy, adoption). The recipient needs to be considered suitable for motherhood, deemed to be psychologically fit on evaluation, is likely to be compliant with treatment and the medical team, and understands the risks of the procedure. In 2021, a revision to the Montreal Criteria was published in Bioethics with an ethical framework for consideration of genetic XY individuals to be eligible for uterine transplants. [65]
  2. The donor is a female of reproductive age with no contraindication to the procedure who has concluded her childbearing or consented donating her uterus after her death. There is no coercion and the donor is responsible and capable of making informed decisions.
  3. The health care team belongs to an institution that meets Moore's third criterion [66] regarding institutional stability and has provided informed consent to both parties. There is no conflict of interests, and anonymity can be protected unless recipient or donor waive this right.

See also

Related Research Articles

Dilationand curettage (D&C) refers to the dilation of the cervix and surgical removal of sections and/or layers of the lining of the uterus and or contents of the uterus such as an unwanted fetus, remains of a non-viable fetus, retained placenta after birth or abortion as well as any abnormal tissue which may be in the uterus causing abnormal cycles by scraping and scooping (curettage). It is a gynecologic procedure used for treatment and removal as well as diagnostic and therapeutic purposes, and is the most commonly used method for first trimester abortion or miscarriage.

<span class="mw-page-title-main">Uterus</span> Female sex organ in mammals

The uterus or womb is the organ in the reproductive system of most female mammals, including humans, that accommodates the embryonic and fetal development of one or more fertilized eggs until birth. The uterus is a hormone-responsive sex organ that contains glands in its lining that secrete uterine milk for embryonic nourishment.

<span class="mw-page-title-main">Caesarean section</span> Surgical procedure to deliver a baby through an incision in the mothers abdomen

Caesarean section, also known as C-section, cesarean, or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen. It is often performed because vaginal delivery would put the mother or child at risk. Reasons for the operation include obstructed labor, twin pregnancy, high blood pressure in the mother, breech birth, shoulder presentation, and problems with the placenta or umbilical cord. A caesarean delivery may be performed based upon the shape of the mother's pelvis or history of a previous C-section. A trial of vaginal birth after C-section may be possible. The World Health Organization recommends that caesarean section be performed only when medically necessary.

Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgical field.

<span class="mw-page-title-main">Ectopic pregnancy</span> Female reproductive system health issue

Ectopic pregnancy is a complication of pregnancy in which the embryo attaches outside the uterus. Signs and symptoms classically include abdominal pain and vaginal bleeding, but fewer than 50 percent of affected women have both of these symptoms. The pain may be described as sharp, dull, or crampy. Pain may also spread to the shoulder if bleeding into the abdomen has occurred. Severe bleeding may result in a fast heart rate, fainting, or shock. With very rare exceptions, the fetus is unable to survive.

A hysterotomy is an incision made in the uterus. This surgical incision is used in several medical procedures, including during termination of pregnancy in the second trimester and delivering the fetus during caesarean section. It is also used to gain access and perform surgery on a fetus during pregnancy to correct birth defects, and it is an option to achieve resuscitation if cardiac arrest occurs during pregnancy and it is necessary to remove the fetus from the uterus.

<span class="mw-page-title-main">Müllerian agenesis</span> Congenital malformation of female reproductive organs

Müllerian agenesis, also known as Müllerian aplasia, vaginal agenesis, or Mayer–Rokitansky–Küster–Hauser syndrome, is a congenital malformation characterized by a failure of the Müllerian ducts to develop, resulting in a missing uterus and variable degrees of vaginal hypoplasia of its upper portion. Müllerian agenesis is the cause in 15% of cases of primary amenorrhoea. Because most of the vagina does not develop from the Müllerian duct, instead developing from the urogenital sinus, along with the bladder and urethra, it is present even when the Müllerian duct is completely absent. Because ovaries do not develop from the Müllerian ducts, affected people might have normal secondary sexual characteristics but are infertile due to the lack of a functional uterus. However, biological motherhood is possible through uterus transplantation or use of gestational surrogates.

<span class="mw-page-title-main">Artificial womb</span> Device that would allow for extracorporeal pregnancy

An artificial womb or artificial uterus is a device that would allow for extracorporeal pregnancy, by growing a fetus outside the body of an organism that would normally carry the fetus to term. An artificial uterus, as a replacement organ, would have many applications. It could be used to assist male or female couples in the development of a fetus. This can potentially be performed as a switch from a natural uterus to an artificial uterus, thereby moving the threshold of fetal viability to a much earlier stage of pregnancy. In this sense, it can be regarded as a neonatal incubator with very extended functions. It could also be used for the initiation of fetal development. An artificial uterus could also help make fetal surgery procedures at an early stage an option instead of having to postpone them until term of pregnancy.

<span class="mw-page-title-main">Uterine malformation</span> Female birth defect in which the uterus forms abnormally

A uterine malformation is a type of female genital malformation resulting from an abnormal development of the Müllerian duct(s) during embryogenesis. Symptoms range from amenorrhea, infertility, recurrent pregnancy loss, and pain, to normal functioning depending on the nature of the defect.

<span class="mw-page-title-main">Abdominal pregnancy</span> Abnormal development of a fetus in the abdomen rather than the uterus

An abdominal pregnancy is a rare type of ectopic pregnancy where the embryo or fetus is growing and developing outside the uterus, in the abdomen, and not in a fallopian tube, an ovary, or the broad ligament.

<i>Fetal surgery</i> Growing branch of maternal-fetal medicine

Fetal surgery, also known as antenatal surgery or prenatal surgery, is a growing branch of maternal-fetal medicine that covers any of a broad range of surgical techniques that are used to treat congenital abnormalities in fetuses who are still in the pregnant uterus. There are three main types: open fetal surgery, which involves completely opening the uterus to operate on the fetus; minimally invasive fetoscopic surgery, which uses small incisions and is guided by fetoscopy and sonography; and percutaneous fetal therapy, which involves placing a catheter under continuous ultrasound guidance.

<span class="mw-page-title-main">Uterine atony</span> Loss of tone in the uterine musculature

Uterine atony is the failure of the uterus to contract adequately following delivery. Contraction of the uterine muscles during labor compresses the blood vessels and slows flow, which helps prevent hemorrhage and facilitates coagulation. Therefore, a lack of uterine muscle contraction can lead to an acute hemorrhage, as the vasculature is not being sufficiently compressed. Uterine atony is the most common cause of postpartum hemorrhage, which is an emergency and potential cause of fatality. Across the globe, postpartum hemorrhage is among the top five causes of maternal death. Recognition of the warning signs of uterine atony in the setting of extensive postpartum bleeding should initiate interventions aimed at regaining stable uterine contraction.

<span class="mw-page-title-main">Uterine prolapse</span> Medical condition

Uterine prolapse is a form of pelvic organ prolapse in which the uterus and a portion of the upper vagina protrude into the vaginal canal and, in severe cases, through the opening of the vagina. It is most often caused by injury or damage to structures that hold the uterus in place within the pelvic cavity. Symptoms may include vaginal fullness, pain with sexual intercourse, difficulty urinating, and urinary incontinence. Risk factors include older age, pregnancy, vaginal childbirth, obesity, chronic constipation, and chronic cough. Prevalence, based on physical exam alone, is estimated to be approximately 14%.

<span class="mw-page-title-main">Unicornuate uterus</span> Birth defect in which only one uterine horn fully develops

A unicornuate uterus represents a uterine malformation where the uterus is formed from one only of the paired Müllerian ducts while the other Müllerian duct does not develop or only in a rudimentary fashion. The sometimes called hemi-uterus has a single horn linked to the ipsilateral fallopian tube that faces its ovary.

A uterine septum is a congenital uterine malformation where the uterine cavity is partitioned by a longitudinal septum; the outside of the uterus has a normal typical shape. The wedge-like partition may involve only the superior part of the cavity resulting in an incomplete septum or a subseptate uterus, or less frequently the total length of the cavity and the cervix resulting in a double cervix. The septation may also continue caudally into the vagina resulting in a "double vagina".

<span class="mw-page-title-main">Uterus didelphys</span> Birth defect in which two uteri form

Uterus didelphys represents a uterine malformation where the uterus is present as a paired organ when the embryogenetic fusion of the Müllerian ducts fails to occur. As a result, there is a double uterus with two separate cervices, and possibly a double vagina as well. Each uterus has a single horn linked to the ipsilateral fallopian tube that faces its ovary.

Tubal reversal, also called tubal sterilization reversal, tubal ligation reversal, or microsurgical tubal reanastomosis, is a surgical procedure that can restore fertility to women after a tubal ligation. By rejoining the separated segments of the fallopian tube, tubal reversal can give women the chance to become pregnant again. In some cases, however, the separated segments cannot actually be reattached to each other. In some cases the remaining segment of tube needs to be re-implanted into the uterus. In other cases, when the end of the tube has been removed, a procedure called a neofimbrioplasty must be performed to recreate a functional end of the tube which can then act like the missing fimbria and retrieve the egg that has been released during ovulation.

Transgender pregnancy is the gestation of one or more embryos or fetuses by transgender people. As of 2024, the possibility is restricted to those born with female reproductive systems. However, transition-related treatments may impact fertility. Transgender men and nonbinary people who are or wish to become pregnant face social, medical, legal, and psychological concerns. As uterus transplantations are currently experimental, and none have successfully been performed on trans women, they cannot become pregnant.

Müllerian duct anomalies are those structural anomalies caused by errors in Müllerian duct development as an embryo forms. Factors contributing to them include genetics and maternal exposure to substances that interfere with fetal development.

<span class="mw-page-title-main">Use of assisted reproductive technology by LGBT people</span>

Lesbian, gay, bisexual, and transgender people people wishing to have children may use assisted reproductive technology. In recent decades, developmental biologists have been researching and developing techniques to facilitate same-sex reproduction.

References

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  2. ↑ Nugent, D.; Meirow, D.; Brook, P. F.; Aubard, Y.; Gosden, R. G. (1997). "Transplantation in reproductive medicine: Previous experience, present knowledge and future prospects". Human Reproduction Update. 3 (3): 267–80. doi: 10.1093/humupd/3.3.267 . PMID   9322102.
  3. ↑ Eraslan, S.; Hamernik, R. J.; Hardy, J. D. (1966). "Replantation of uterus and ovaries in dogs, with successful pregnancy". Archives of Surgery. 92 (1): 9–12. doi:10.1001/archsurg.1966.01320190011002. PMID   5948103.
  4. ↑ Díaz-García, César; Akhi, Shamima N.; Wallin, Ann; Pellicer, Antonio; Brännström, Mats (2010). "First report on fertility after allogeneic uterus transplantation". Acta Obstetricia et Gynecologica Scandinavica. 89 (11): 1491–1494. doi: 10.3109/00016349.2010.520688 . PMID   20879912. S2CID   1188699.
  5. ↑ Brännström, Mats; Racowsky, Catherine; Richards, Elliott G.; Flyckt, Rebecca; Stillman, Robert J.; O’Brien, Jeanne E.; Ryan, Ginny L.; de Ziegler, Dominique (June 2023). "Absolute uterine infertility a cornelian dilemma: uterine transplantation or surrogacy?". Fertility and Sterility. 119 (6): 918–929. doi: 10.1016/j.fertnstert.2023.04.005 . PMID   37037300.
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  23. 1 2 Brännström, Mats; Johannesson, Liza; Dahm-Kähler, Pernilla; Enskog, Anders; Mölne, Johan; Kvarnström, Niclas; Diaz-Garcia, Cesar; Hanafy, Ash; Lundmark, Cecilia; Marcickiewicz, Janusz; Gäbel, Markus; Groth, Klaus; Akouri, Randa; Eklind, Saskia; Holgersson, Jan; Tzakis, Andreas; Olausson, Michael (2014). "First clinical uterus transplantation trial: a six-month report". Fertility and Sterility. 101 (5): 1228–1236. doi: 10.1016/j.fertnstert.2014.02.024 . PMID   24582522.
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  39. 1 2 Ejzenberg, Dani; Andraus, Wellington; Baratelli Carelli Mendes, Luana Regina; Ducatti, Liliana; Song, Alice; Tanigawa, Ryan; Rocha-Santos, Vinicius; MacEdo Arantes, Rubens; Soares, José Maria; Serafini, Paulo Cesar; Bertocco De Paiva Haddad, Luciana; Pulcinelli Francisco, Rossana; Carneiro d'Albuquerque, Luiz Augusto; Chada Baracat, Edmund (2018). "Livebirth after uterus transplantation from a deceased donor in a recipient with uterine infertility". The Lancet. 392 (10165): 2697–2704. doi:10.1016/S0140-6736(18)31766-5. PMID   30527853 . Retrieved 2022-07-13.
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  43. ↑ "Woman donates her womb to younger sister; Britain's first successful uterus transplant". www.indiatvnews.com. 2023-08-24. Retrieved 2023-09-28.
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  45. ↑ Australia's first uterus transplant recipient Kirsty Bryant gives birth to healthy baby boy, Emma Siossian , ABC News Online, 2023-12-19
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