Uterus transplantation: achievements, challenges, and future perspectives

Absolute uterine factor infertility occurs in approximately one in 500 women of reproductive age and for a long-time left surrogacy or adoption as the only ways to have a child. Over the past two decades, uterus transplantation has evolved from experimental preclinical models to clinical practice, resulting in more than 140 operations and over 70 live births worldwide. This review presents a comprehensive analysis of the experimental foundations, clinical development, surgical techniques, integration with assisted reproductive technologies, long-term outcomes, ethical debates, economic aspects, and prospects for further development of uterus transplantation. Special attention is paid to donor and recipient safety, problems of prolonged immunosuppression, variability of obstetric outcomes, and bioethical issues. Although international experience indicates that uterus transplantation has entered a phase of intensive scientific and clinical development, unresolved problems — including surgical complexity, ethical controversies, and financial burden — continue to limit its widespread implementation.