Overview
Secondary uterine infertility refers to the inability to conceive due to uterine abnormalities or conditions affecting uterine function beyond primary causes like ovulatory disorders. This often necessitates surgical interventions or transplantation in severe cases 1.Diagnosis
Imaging Studies: Transvaginal ultrasound and MRI to assess uterine anatomy and identify structural abnormalities 1.
Hysteroscopy: Direct visualization of the uterine cavity to diagnose intrauterine pathologies 1.
Hormonal Assessment: Evaluate for underlying hormonal imbalances that may affect uterine function 1.Management
Surgical Correction: Procedures such as myomectomy, metroplasty, or reconstructive surgery for congenital anomalies to restore uterine anatomy 1.
Uterus Transplantation: For irreversible uterine damage, transplantation offers a potential solution; requires lifelong immunosuppression 1.
Immunosuppressive Therapy: Post-transplant, typically includes calcineurin inhibitors (e.g., tacrolimus) and corticosteroids to prevent rejection 1.Special Populations
Pregnancy Post-Transplant: Infants born after uterus transplantation have shown normal neonatal outcomes with no identified malformations or organ dysfunction, though longer follow-up is needed 1.
Immunosuppression Considerations: Mothers require careful management of immunosuppressive regimens to balance rejection risk and fetal safety 1.Key Recommendations
Consider Uterus Transplantation for Severe Uterine Infertility: For patients with irreversible uterine damage, uterus transplantation can be a viable option for achieving pregnancy (Evidence: Moderate 1).
Rigorous Monitoring of Immunosuppressive Therapy: Essential to prevent rejection while ensuring fetal safety during pregnancy post-transplant (Evidence: Moderate 1).
Comprehensive Neonatal Follow-Up: Infants born following uterus transplantation should undergo thorough follow-up assessments to monitor long-term health outcomes (Evidence: Weak 1).References
1 York JR, Testa G, Gunby RT, Putman JM, McKenna GJ, Koon EC et al.. Neonatal Outcomes after Uterus Transplantation: Dallas Uterus Transplant Study. American journal of perinatology 2023. link