The first live term birth following uterus transplantation in Australia

Abstract

Objective: To report the first live birth following uterus transplantation in Australia.

Study design: Case report.

Setting, participant: The first participant in the uterus transplantation research study program at the Royal Hospital for Women, the Prince of Wales Hospital, and Westmead Hospital in Sydney.

Main outcome measures: Clinical course after uterus transplantation; course of the subsequent pregnancy until delivery.

Results: The immunosuppression regimen following uterus transplantation on 10 January 2023 was similar to that used for low immunologic risk kidney transplantation. It included induction therapy (basiliximab on days 0 and 4, methylprednisolone on days 0 and 1), followed by maintenance therapy with oral tacrolimus, prednisolone, and mycophenolate mofetil (MMF). The prednisolone dose was steadily tapered over twelve weeks to a low maintenance dose (from 25 mg to 5 mg daily); MMF was replaced with azathioprine during week 9, and tacrolimus was continued throughout the pregnancy. There was no evidence of rejection. A frozen grade 1 blastocyst was transferred during a natural ovulatory cycle 101 days (fifteen weeks) after transplantation; clinical pregnancy was successfully initiated. The woman developed gestational diabetes at 20 weeks and was treated with insulin. A healthy boy was born by planned caesarean delivery at 37 weeks; he weighed 2990 g, with Apgar scores of 7 at one minute and 9 at five minutes. Intrapartum haemorrhage (estimated 2500 mL) led to iron infusion after delivery. The woman and her infant were discharged from the hospital five days after the birth. The infant was breastfed, but the woman experienced recurrent episodes of mastitis that were managed with oral antibiotics, and intravenous antibiotics during two hospital admissions. Eight weeks after birth she commenced weaning the infant. Neither the woman nor her infant experienced serious complications.

Conclusion: The first live birth following uterus transplantation in Australia indicates that the procedure could be adopted here as an assisted reproductive technology for women with uterine factor infertility.

Trial registration: Australian and New Zealand Clinical Trials registry, ACTRN12622000917730.

Keywords: Birth weight; Immunosuppression; Infertility; Pregnancy; Transplantation.