In Vitro Fertilization Practice in Patients with Absolute Uterine Factor Undergoing Uterus Transplant in the United States

Jessica R Walter; Liza Johannesson; Tommaso Falcone; J Michael Putnam; Giuliano Testa; Elliott G Richards; Kathleen E O'Neill

doi:10.1016/j.fertnstert.2024.04.017

In Vitro Fertilization Practice in Patients with Absolute Uterine Factor Undergoing Uterus Transplant in the United States

Fertil Steril. 2024 Apr 15:S0015-0282(24)00245-0. doi: 10.1016/j.fertnstert.2024.04.017. Online ahead of print.

Authors

Jessica R Walter¹, Liza Johannesson², Tommaso Falcone³, J Michael Putnam⁴, Giuliano Testa², Elliott G Richards³, Kathleen E O'Neill⁵

Affiliations

¹ Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL.
² Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX.
³ Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH.
⁴ Fertility Center of Dallas, Baylor University Medical Center, Dallas, TX.
⁵ Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA. Electronic address: kathleen.o'neill2@pennmedicine.upenn.edu.

PMID: 38631504
DOI: 10.1016/j.fertnstert.2024.04.017

Abstract

Objective: Report detailed, pooled multicenter experiences and outcomes after IVF among patients undergoing uterus transplantation in the United States.

Design: Cohort study SUBJECTS: Patients undergoing uterus transplant from the three longest running uterus transplant clinical trials in the United States.

Intervention: In vitro fertilization among uterus transplant patients MAIN OUTCOME MEASURES: Reproductive outcomes pre- and post-transplant ovarian stimulation RESULTS: 31 uterus transplant recipients were included in this cohort (mean age at transplant was 31 years, standard deviation 4.7). Prior to transplant, recipients completed a mean of 2 oocyte retrievals (range 1-4), banking a mean of 8 untested embryos (range 3-24) or 6 euploid embryos (range 2-10). Post-transplant retrieval cycles were required in 19% of recipients (n=6/31): a total of 16 cycles (range 2-4 cycles per recipient). All post-transplant retrievals were performed vaginally without complication. Preimplantation genetic testing was used by 74% of subjects (n=23/31). 72 autologous single embryo transfers occurred in 23 patients who completed at least one embryo transfer. Two embryo transfers followed a fresh IVF cycle and the remainder were frozen embryo transfers (n=70). Endometrial preparation during was more commonly performed with programmed protocols (n=61) (exogenous administration of estrogen/progesterone) compared to natural cycle protocols (n=9). The overall live birth rate for this cohort was 35% (n=25/72) per embryo transfer. Among those patients who had an embryo transfer leading to a live birth (n=21), a mean of 2.2 embryo transfers was performed. The overall live birth rate after the first embryo transfer was 57% (n=13/23) and rose to 74% after a second embryo transfer (n=17/23). There was no difference in rate of preeclampsia, live birth, neonatal birth, or placental weights among programmed versus natural cycle frozen embryo transfers. There were no differences in the live birth rate between living or deceased donor uteri (37% versus 32%, p=0.6).

Conclusions: Post-transplant ovarian stimulation was required in 26% (n=6/23) of recipients undergoing at least one embryo transfer despite high rates of preimplantation genetic testing and pre-transplant embryo cryopreservation. Post-transplant retrievals were performed transvaginally, without complication. Future reporting of IVF experience will be essential to optimize reproductive outcomes after uterus transplant.

Keywords: Uterus transplant; absolute uterine factor infertility; in vitro fertilization; infertility.