Uterus transplants in the U.S. show technique largely successful in allowing women to achieve live birth

A decade of uterus transplantation in the United States has resulted in dozens of healthy births and steadily improving surgical outcomes, according to a new national review led by researchers from the Perelman School of Medicine at the University of Pennsylvania. The study found that 70 percent of uterus transplant recipients achieved at least one live birth (or were still pregnant beyond 20 weeks when the study closed), demonstrating that the procedure has matured from an experimental intervention into a replicable clinical therapy for women born without a uterus or those whose uteruses cannot support pregnancy.

The findings, published in Obstetrics & Gynecology, summarize outcomes from 60 uterus transplants performed between 2016 and 2025 at the four U.S. centers that have offered the procedure. The analysis represents nearly the entire U.S. experience with uterus transplantation and includes surgical, reproductive, neonatal, and early childhood developmental outcomes.

"One of the reasons I went into obstetrics was to help give more women opportunities to start a family, and I’m proud of the work my colleagues and I have done at Penn to advance this treatment," said senior study author Kathleen E. O'Neill, MD, MSTR, an assistant professor of Obstetrics and Gynecology at Penn and the director of the Penn Uterus Transplant Program. "The data from this analysis show that uterus transplant is an effective way for women to achieve pregnancy and have children. It should be part of the conversation alongside adoption and gestational surrogacy, and these data give patients and their doctors the information they need to decide whether it's the right path for them."

Absolute uterine factor infertility—the absence of a uterus either from birth or after hysterectomy—affects roughly 3 percent of women. Most transplant recipients in the study had Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, a congenital condition in which the uterus does not develop. Others had undergone hysterectomy or had a uterus unable to support pregnancy.

Penn pioneers uterus transplantation

Under the leadership of O’Neill, Penn’s first birth from a uterus transplant happened in November 2019 with the arrival of baby Benjamin Gobrecht. His mother, born without a uterus, received a new organ from a deceased donor through the Gift of Life as part of Penn’s UNTIL uterus transplant trial.

Since then, Penn has had eight babies born from seven transplants, mostly from living donors. And three of those transplant recipients, all of whom have delivered a healthy baby, are trying to get pregnant again.

Success rates rise as surgical outcomes improve

Researchers found that 51 of the 60 transplanted uteruses survived beyond the critical first 30 days after surgery. Among the women who received those organs, more than 82 percent ultimately achieved at least one live birth or were still pregnant at 20 weeks or later when the study closed. And since 2020, only one surgical graft failure has occurred among 31 transplants performed nationwide, reflecting major improvements in surgical techniques and patient care.

Across the study period, 48 babies were born to uterus transplant recipients in the United States. Nine recipients delivered two children, demonstrating that transplanted uteruses can support multiple pregnancies before the organ is removed.

Among living donors, major complications requiring additional intervention declined from 33 percent in 2016-2017 to 8 percent in 2024-2025, and no recipient or living donor experienced a life-threatening complication or death related to the procedure.

Children thrive as obstetric challenges persist

While reproductive outcomes were encouraging, pregnancy after uterus transplantation remains complex. More than half of babies, 58 percent, were born prematurely, and pregnancy complications such as preeclampsia, gestational diabetes, and hypertension were relatively common.

Researchers also tracked the health and development of children born following uterus transplantation. All children demonstrated normal development at hospital discharge and at six months of age. Among 29 children evaluated at age 3, researchers observed normal growth and no cases of failure to thrive. Two children had been diagnosed with autism spectrum disorder, while no other developmental disorders were identified.

Both recipients and babies will continue to be followed, said O’Neill, and research is being done to better understand why pregnancy complications are occurring.

Researchers call for wider access

The authors noted that access remains one of the field's greatest challenges. Uterus transplantation is available at only a handful of centers nationwide, including Penn, and is generally not covered by insurance, making treatment inaccessible for many eligible patients.

“I hope this analysis does show insurance companies, and those who can invest in making this procedure more widely available, that we have a technique that has allowed more women to be able to become moms,” said O’Neill. “Women deserve access and options when it comes to how to start a family.”