Study question: How is a women's self-image affected by uterus transplantation (UTx)?
Summary answer: Women experienced receiving a uterus in both positive and negative ways, but in general, their self-image was positively affected; regardless of whether they have given birth to a child or not, recipients describe themselves as being 'back to normal' after the hysterectomy to remove the transplanted uterus.
What is known already: UTx has repeatedly proved to be a successful treatment for absolute uterine factor infertility. However, there has been no previous qualitative long-term research into the self-image of women undergoing UTx.
Study design, size, duration: This complete, prospective cohort study included the nine recipients of the first UTxs performed in Sweden mostly in 2013. Interviews took place in the 5 years following surgery.
Participants/materials, setting, methods: Eight out of the nine recipients had congenital absence of the uterus, a characteristic of Mayer-Rokitansky-Küster-Hauser syndrome, and one recipient lacked a uterus after a radical hysterectomy due to cervical cancer. The mean age of participants was 31.5 years at inclusion and at this time they all lived in stable marital relationships. Post-transplantation, interviews were performed annually for 5 years, comprising a total of 43 interviews. The interview followed a semi-structured guide. All interviews (median duration of around 25 minutes) were recorded, transcribed verbatim and then analysed by thematic approach.
Main results and the role of chance: The joys and frustrations of becoming a 'complete' woman are seen as a master theme, which influences the three underlying subthemes, a changed self-perception, a changed body and a changed sexuality. Each of these subthemes have three underlying categories.
Limitations, reasons for caution: The small sample size is a limitation.
Wider implications of the findings: The results provide information that will be helpful in pre-operative screening procedures and in the psychological support offered both to women who experienced successful and unsuccessful outcomes following UTx.
Study funding/competing interest(s): Funding was received from the Jane and Dan Olsson Foundation for Science; the Knut and Alice Wallenberg Foundation; an ALF grant from the Swedish state under an agreement between the government and the county councils; the Swedish Research Council; a Ferring Pharmaceuticals scholarship in memory of Robert Edwards; and the Iris Jonzén-Sandblom and Greta Jonzén Foundation. The authors have no competing interests.
Trial registration number: NCT01844362.
Keywords: infertility; qualitative study; self-image; transplantation; uterus.
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