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RCOG World Congress 2025

June 23 - 25, 2025 | ExCeL London, UK

EP.1167

Uterine Transplantation Surgical Framework: How to progress beyond the experimental

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Poster Presenter

Margherita Bielli

Authors

Margherita Bielli, Ariadne L'Heveder, Saaliha Vali, Srdjan Saso, Timothy Bracewell-Milnes, Meen Yau Thum, James Nicopoullos, Isabel Quiroga, Liza Johannesson, J Richard Smith, Benjamin P Jones

Affiliations

Imperial College London, Oxford University Hospitals NHS Foundation Trust, Lister Fertility Clinic, Imperial College NHS Healthcare Trust, Annette C. and Harold C. Simmons Transplant Institute Baylor University Medical Center

Part of Topic

Hot topics (emerging research/issues) in gynaecology

Uterine transplantation surgical framework: How to progress beyond the experimental

Margherita Bielli1,2, Ariadne L’Heveder1,2,3, Srdjan Saso1,2, Bracewell-Milnes T6, Thum MY,2,6, Nicopoullos6, Liza Johannesson4, Isabel Quiroga5, J Richard Smith1,2, Benjamin P Jones1,2,6

1 Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, W12 OHS London, UK., 2 Department of Metabolism, Digestion and Reproduction, Imperial College London, Du Cane Road, London W12 0NN, UK., 3 Cutrale Perioperative and Ageing Group, Department of Engineering, Imperial College London, St Mary’s Campus, London W2 1PG 4 Baylor University Medical Centre, 75246-2088, Dallas, Texas. 5 The Oxford Transplant Centre, The Churchill Hospital, Oxford University Hospitals NHS Trust, Old Road, Oxford, OX3 7LE. 6 Lister Fertility Clinic, The Lister Hospital, Chelsea Bridge Road, London, SW1W 8RH

INTRODUCTION

Uterine transplantation (UTx) has been increasingly performed worldwide with over 100 UTx and 50 livebirths worldwide .

For UTx to be made more widely available to individuals with absolute uterine factor infertility (AUFI), it needs to progress from an experimental research procedure to an established clinical treatment.

OBJECTIVES

•Examine how UTx fits within IDEAL framework for surgical innovation

•Test the hypothesis that UTx meets the criteria for an innovative treatment, as defined by Provost et al.'s framework for novel fertility interventions

METHODS

•Assessment of UTx using the IDEAL framework

•Evaluation of UTx according to the criteria outlined in Provost et al's framework for novel fertility interventions.

•Literature review comparing UTx outcomes with in-vitro fertilisation (IVF)

RESULTS

Ideal Framework

For UTx to move to stage 2b and beyond it requires involvement in randomised controlled trials.

Neither adoption nor surrogacy present a comparable alternative for those with AUFI.

UTx therefore lacks a suitable control group, rendering the IDEAL framework unsuitable for guiding UTx's clinical transition.

Provost framework

UTx meets the Provost framework criteria to qualify as an innovative fertility treatment

IVF outcomes: Native UTERUS vs. UTx

UTx outcomes appear to be better than native uterine IVF.

While UTx is more invasive and carries higher risks than traditional fertility treatments, these risks are deemed acceptable due to the lack of alternative reproductive options for people with AUFI.

The safety profile of UTx is expected to improve as the procedure evolves and more data becomes available.

CONCLUSION

The results support the categorisation of UTx as an innovative treatment under Provost et al.'s framework. UTx offers a viable reproductive option for AUFI, with a clear pathway toward becoming an established fertility treatment.

Ongoing research, clinical trials, and standardisation efforts will likely improve UTx outcomes, advancing its clinical adoption and benefiting those who wish to experience gestation and biological parenthood.