Instead, the recipients will go through in vitro fertilization. Before the transplant, the woman will be given hormones to stimulate her ovaries to produce multiple eggs. Ten will be needed, so she may have to go through more than one cycle of hormone treatment. Doctors will collect the eggs, fertilize them with her partner’s sperm and freeze them. Once there are 10 embryos in the freezer, the woman will be put on the waiting list for a transplant.

When a donor with matching blood and tissue type becomes available, the transplant will take place.

The transplant surgery is expected to take about five hours. It requires connecting an artery and a vein on either side of the uterus to the recipient’s blood vessels. The organ will have part of the donor’s vagina attached, and that will be stitched to the recipient’s vagina. Supporting tissue attached to the uterus will be sewn into the recipient’s pelvis to stabilize the transplant. No nerves have to be connected.

The woman will wait one year to heal from the surgery and adjust the doses of anti-rejection medicine before trying to become pregnant.

Then doctors will implant one embryo at a time in the uterus, until the recipient becomes pregnant. The baby will be delivered by cesarean section before the due date, to protect the transplanted uterus from the strain of labor.

After giving birth, the mother can either keep the uterus so she can try to have one more baby (two is the limit, for safety reasons), or have it removed so she can stop taking the anti-rejection drugs. If she does not want to have surgery to have it removed, doctors said it may be possible to quit the drugs and let the immune system reject the uterus, which should then gradually wither away.

Initial Skepticism

One of the surgeons working with Dr. Tzakis will be Dr. Tommaso Falcone, the Cleveland Clinic’s chairman of obstetrics and gynecology. Dr. Falcone said he first heard of uterus transplants about 10 years ago in early research described at medical conferences. Initially, he was skeptical.