This Views and Reviews article examines the key complexities and challenges of uterus transplantation (UTx) as a treatment for absolute uterine factor infertility, covering donor selection, recipient risks, immunosuppression, pregnancy outcomes, ethical considerations, and access disparities compared with gestational surrogacy.
The multidisciplinary expert panel concludes that UTx is an effective and ethically acceptable infertility treatment, while highlighting persistent challenges: high historical graft failure rates, immunosuppression risks, pregnancy complications, geographic and socioeconomic access gaps, and unresolved ethical tensions around acceptable risk in a non-life-saving procedure.
This is a narrative review and expert opinion piece, not a systematic review or original trial — no new primary data or quantitative outcomes are reported. Conclusions rest on accumulated clinical experience and registry data rather than controlled evidence.
Clinicians considering UTx referrals should counsel patients on the procedure's significant complexity, financial barriers, and risk profile relative to gestational surrogacy. Ongoing registry participation and multidisciplinary team infrastructure remain essential before broader clinical integration.
Explore related topics
