Women suffering from absolute uterine factor infertility (AUFI) had no hope of childbearing until clinical feasibility of uterus transplantation (UTx) was documented in 2014 with the birth of a healthy baby. This landmark accomplishment followed extensive foundational work with a wide range of animal species including higher primates. In the present review, we provide a summary of the animal research and describe the results of cases and clinical trials on UTx. Surgical advances for graft removal from live donors and transplantation to recipients are improving, with a recent trend away from laparotomy to robotic approaches, although challenges persist regarding optimum immunosuppressive therapies and tests for graft rejection. Because UTx does not involve transplantation of the Fallopian tubes, IVF is required as part of the UTx process. We provide a unique focus on the intersection between these two processes, with consideration of when oocyte retrieval should be performed, whether, and for whom, preimplantation genetic testing for aneuploidy should be used, whether oocytes or embryos should be frozen and when the first embryo transfer should be performed post-UTx. We also address the utility of an international society UTx (ISUTx) registry for assessing overall UTx success rates, complications, and live births. The long-term health outcomes of all parties involved-the uterus donor (if live donor), the recipient, her partner and any children born from the transplanted graft-are also reviewed. Unlike traditional solid organ transplantation procedures, UTx is not lifesaving, but is life-giving, although as with traditional types of transplantation, costs, and ethical considerations are inevitable. We discuss the likelihood that costs will decrease as efficiency and efficacy improve, and that ethical complexities for and against acceptability of the procedure sharpen the distinctions between genetic, gestational, and social parenthood. As more programs wish to offer the procedure, we suggest a scheme for setting up a UTx program as well as future directions of this rapidly evolving field. In our 2010 review, we described the future of clinical UTx based on development of the procedure in animal models. This Grand Theme Review offers a closing loop to this previous review of more than a decade ago. The clinical feasibility of UTx has now been proved. Advancements include widening the criteria for acceptance of donors and recipients, improving surgery, shortening time to pregnancy, and improving post-UTx management. Together, these improvements catalyze the transition of UTx from experimental into mainstream clinical practice. The procedure will then represent a realistic and accessible alternative to gestational surrogacy for the treatment of AUFI and should become part of the armamentarium of reproductive specialists worldwide.

中文翻译：

---

子宫移植：从研究、人体试验到未来。

患有绝对子宫因素不孕症 (AUFI) 的女性没有生育的希望，直到 2014 年子宫移植 (UTx) 的临床可行性得到证实并产下健康婴儿。这一具有里程碑意义的成就是在对包括高等灵长类动物在内的多种动物物种进行广泛的基础工作之后取得的。在本综述中，我们总结了动物研究，并描述了 UTx 的病例和临床试验结果。尽管在最佳免疫抑制疗法和移植排斥反应测试方面仍然存在挑战，但活体供体移植物切除和移植给受者的外科手术进展正在改善，最近的趋势是从剖腹手术转向机器人方法。由于 UTx 不涉及输卵管移植，因此 IVF 是 UTx 过程的一部分。我们特别关注这两个过程之间的交叉点，考虑何时应该进行卵母细胞取出，是否以及为谁使用非整倍体植入前基因检测，是否应该冷冻卵母细胞或胚胎，以及何时进行第一个胚胎传输应在 UTx 后进行。我们还讨论了国际 UTx 协会 (ISUTx) 注册中心在评估 UTx 总体成功率、并发症和活产率方面的效用。还审查了所有相关方（子宫捐献者（如果是活体捐献者）、受体、她的伴侣以及移植后出生的孩子）的长期健康结果。与传统的实体器官移植手术不同，UTx 不是拯救生命，而是赋予生命，尽管与传统类型的移植一样，成本和伦理考虑是不可避免的。我们讨论了随着效率和功效的提高而成本降低的可能性，以及支持和反对该程序可接受性的伦理复杂性加剧了遗传、妊娠和社会亲子关系之间的区别。随着越来越多的项目希望提供该程序，我们提出了建立 UTx 项目的方案以及这个快速发展的领域的未来方向。在 2010 年的回顾中，我们根据动物模型程序的开发描述了临床 UTx 的未来。这篇大主题评论为十多年前的这篇评论提供了一个闭环。UTx的临床可行性现已得到证实。进步包括扩大捐赠者和接受者的接受标准、改进手术、缩短怀孕时间以及改善 UTx 后管理。这些改进共同促进了 UTx 从实验到主流临床实践的转变。该程序将成为治疗 AUFI 的妊娠代孕的一种现实且易于使用的替代方案，并应成为全球生殖专家的医疗设备的一部分。