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Objective:To summarize our institutional experiences of screening and selecting potential recipients and living donors for uterine transplantation at a single center.Methods:A total of 102 patients were diagnosed as absolute uterine factor infertility (AUFI). Depending upon the outcomes of previous trials, 8 modules were selected for surveying. A registration form was distributed for subjects at outpatient clinics or through telephone consultations for clinical trials of uterus transplantation between November 2018 and October 2019. The relevant information was collected and entered into a dedicated system for data processing.Results:The number of eligible subjects was 84 and the number of recipients with potential donors 37. The average age of potential recipients was 26.0(18-47) years. Among potential recipients, 76(90.5%) had congenital AUFI and 8(9.5%) acquired AUFI. For potential donors with available organs, the average age was 47.5(32-64) years and the proportion of menopausal or peri-menopausal status 56.8%.Conclusions:Currently large demands and sufficient supports for conducting clinical trials of uterine transplantation are available in China. However, inherent deficiencies persist in organ donor population reserves and preoperative screening protocols, such as donor age and subjective/objective factors of participants. During clinical trials of uterine transplantation, preoperative screening should be performed for expanding the screening scope, extending the screening time and popularizing the screening knowledge to boost the success rate.
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Objective@#To explore the therapeutic feasibility of uterus transplantation for uterine infertility.@*Methods@#Retrospective analysis was performed for the diagnosis, treatment and pregnancy course of the first domestic case of uterus transplantation and the relevant literature reviewed. The recipient was a 22-year-old woman with a congenital absence of uterus and vagina. Previously she underwent vaginal reconstruction and the donor was her mother. The specific procedures included donor/recipient screening, ethical argumentation, assisted reproductive technology of obtaining frozen embryos, Vinci robot-assisted uterine procurement, orthotopic replacement & fixation of retrieved uterus, revascularization; immunoregulation & monitoring of transplanted uterine recipient, assisted reproductive technology after transplantation and gestational management.@*Results@#The durations of donor and recipient surgeries were 360 and 530 min respectively. No complications of recipient or donor occurred during the perioperative period. First menstruation occurred at 40 days post-transplantation and regularly thereafter. Pregnancy occurred after embryo transfer at 31 months post-transplantation. No rejection episodes occurred after transplantation or during gestation. Caesarean delivery occurred near gestational week 34. The boy weighed 2000 grams at birth and the mother remained well.@*Conclusions@#In conjunctions with literature review, uterine infertility may be treated by modified uterus transplantation. And a new path is paved for healthy pregnancy of women with uterine infertility.
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OBJECTIVE: This study reports the first four cases of a uterine transplant procedure conducted in sheep in Latin America. The aim of this study was to evaluate the success of uterine transplantation in sheep. METHOD: The study was conducted at Laboratory of Medical Investigation 37 (LIM 37) at the University of São Paulo School of Medicine. Four healthy mature ewes weighing 40-60 kg were used as both the donor and recipient for a transplant within the same animal (auto-transplant). Institutional guidelines for the care of experimental animals were followed. RESULTS: The first two cases of auto-transplant were performed to standardize the technique. After complete uterine mobilization and isolation of the blood supply, the unilateral vascular pedicle was sectioned and anastomosed on the external iliac vessels. After standardization, the protocol was implemented. Procurement surgery was performed without complications or bleeding. After isolation of uterine arteries and veins as well as full mobilization of the uterus, ligation of the distal portion of the internal iliac vessels was performed with subsequent division and end-to-side anastomosis of the external iliac vessels. After vaginal anastomosis, the final case presented with arterial thrombosis in the left uterine artery. The left uterine artery anastomosis was re-opened and flushed with saline solution to remove the clot from the artery lumen. Anastomosis was repeated with restoration of blood flow for a few minutes before another uterine artery thrombosis appeared on the same side. All four animals were alive after the surgical procedure and were euthanized after the experimental period. CONCLUSION: We describe the success of four uterine auto-transplants in sheep models.