OPINION Uterus transplantation – substantial progress in research but not yet ready for the clinic Mats Brännström * Caiza Almén Wranning * Janusz Marcickiewicz * Anders Enskog † Ashraf Hanafy ‡ Departments of Obstetrics & Gynecology and Anesthesiology & Intensive Care, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden and Department of Obstetrics & Gynecology, Griffith University, Meadowbrook, Queensland, Australia INTRODUCTION The very rapid advancements in assisted reproductive techniques (ART) during the last decades have been driven by a general progress in medical research but also by a great desire of the society to be able to fulfill the basic human need to reproduce. Since the birth of the first IVF-baby in 1978, new techniques such as intra-cytoplasmic sperm injection (ICSI), pregestational diagnosis (PGS) and ovarian cryopreservation have been introduced. The vast majority of infertile couples can now become parents with the aid of new sophisticated treatment modalities. The last hurdle to overcome in the effort to treat infertility is absolute uterine infertility. The women with absolute uterine infertility are those that either are born with no uterus, women that have lost the uterus through hysterectomy, or women that have a deficient uterus in regards to implantation or pregnancy. * Departments of Obstetrics & Gynecology, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden † Anesthesiology & Intensive Care, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden ‡ Department of Obstetrics & Gynecology, Griffith University, Meadowbrook, Queensland, Australia Correspondence: Mats Bränström MD, PhD, Department of Obstetrics and Gynecology, The Sahlgrenska Academy at Göteborg University, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden, mats.brannstrom@obgyn.gu.se, Fax: +46 31 418717 About one in every 4500 girls is born with the Mayer- Rokitansky-Kuster-Hauser (MRKH) syndrome (1). These girls have a total absence of the uterus and the vagina. The MRKH girls develop into female adults, with well functioning sexual life after surgical creation of a neovagina. The causes for hysterectomy in women of fertile age are emergency obstetric complications (uterine atony, uterine rupture), malignancy (cervical cancer, uterine malignancy) or benign uterine disease (symptomatic leiomyoma). Patients with intrauterine adhesions, iatrogenic after curettage or secondary to intrauterine infections, and those with leiomyoma that are large or otherwise distort the uterine cavity do also fall into the group of women with absolute uterine infertility. It is estimated that only in the UK, around 15000 women (3% of infertile women) are infertile due to uterine factor (2). To treat uterine infertility, the ways to progress would be either to develop techniques for successful transplantation of the uterus from one woman (living or cadaveric donor) to another or to extend in vitro techniques that would allow for fetal development entirely outside the body (ectogenesis). Research on such artificial womb has been ongoing for the last 10 years (3) but it seems that it will be very difficult to develop this methodology further. Uterine transplantation may be a more feasible option to allow for women without a uterus to have their own genetic children, also in the light of that the clinical field of organ Middle East Fertility Society Journal Vol. 12, No. 2, 2007 Copyright © Middle East Fertility Society 86 Brännström et al. Uterine transplantation MEFSJ