This unprecedented achievement was observed with keen interest by transplant surgeons and fertility experts the world over, who hope that transplants might soon become a viable option for women who lose a uterus to cancer, are born without a uterus, or who are unable to conceive or carry due to uterine defects or anomalies. While surrogacy is the more well-known method of helping women with infertility have biological children, it has drawbacks. The most obvious one is that a woman doesn’t gestate her own child, but surrogacy also carries an array of legal and ethical dilemmas, including the concerns that poor surrogates might enter the arrangement solely because of the financial incentive, or that a surrogate might become attached to the baby. Surrogacy is illegal in some European countries, including Germany and France; other countries, like Australia and Canada, permit “altruistic surrogacy,” a legal framework that permits surrogacy but prohibits payment.

“A surrogate takes a large risk by going through a pregnancy for someone else, because pregnancy can cause various adverse medical conditions,” says Mats Hellström, an assistant professor at the Laboratory for Transplantation and Regenerative Medicine at the University of Gothenburg, and a member of the research group that achieved the birth via transplant. “The whole ethical part of surrogate motherhood is why many countries don’t permit it. The successful uterus transplants have shown that there is an alternative to surrogacy.”

Now that the hurdle of the transplanted uterus has been overcome, researchers have turned to a technology borrowed straight from sci-fi: a bioengineered uterus. Doctors in the burgeoning field of regenerative medicine produce organs and parts of organs in a few different ways. One is by taking a small number of stem cells from a patient’s blood or bone marrow, and then amplifying and shaping the growth of those cells. Another involves taking a moderate number of the patient’s own uterine cells, and then de-differentiating them, meaning that they are converted from highly specialized uterine cells back into less specialized cells to allow cellular growth (called “cellular amplification”) in the lab. The cells are then applied to a uterus-shaped scaffold. When transplanted, they re-differentiate back into specialized uterine cells.

“Once you get the correct cell numbers, you place them on the correct scaffold, and at that point you have tissue that is not immunologically different from the host,” says Dr. Roger C. Young, professor of obstetrics and gynecology and director of biomedical innovation at the University of Tennessee Health-Science Center. “This is the beginning of the era of regenerative medicine, which will, at least in some part, replace organ transplants.”

Bioengineered organs have a number of practical advantages over donor transplants, including the fact that recipients wouldn’t need to take immunosuppressants for the rest of their lives, as transplant recipients typically do to prevent their bodies from rejecting the new organ. “A bio-regenerated uterus allows you to avoid immunosuppression, and you get rid of the risks of surgery for the person donating the uterus,” says Dr. Arthur Caplan, director of the Division of Medical Ethics at the NYU Langone Medical Center. “The failure rates of transplanted organs are high, and we don’t have enough organs. Bioengineered organs are definitely the long-term solution.”