Absolute uterine factor infertility (AUFI) is defined as the absence of a uterus or the presence of a non‐functional uterus. Before the first live birth from a uterus transplant in 2014, the only fertility options for women with AUFI were surrogacy and adoption. In November 2019, our team was granted approval for the first uterus transplant trial in Australia using known living donors. Our program is based on that of our overseas collaborators in Dallas, Texas; this team will also be proctoring us for our first two cases.

Background: Absolute Uterine Factor infertility (AUFI) can be congenital such as Mayer-Rokitansky Küster syndrome (MRKH), or acquired resulting from conditions rendering the uterus non-functional or hysterectomy. Prior to the year 2014, women with AUFI had limited opportunities to have a child with the options being either surrogacy or adoption. In 2014 the first successful uterus transplant (UT) was achieved in Sweden. RPA was the first site in Australia to receive ethical approval for a UT trial. Objectives: To determine if UT is an effective, safe, and operationally viable option for women with AUFI in order to achieve live birth. Methodology: Potential donor/recipient pairs will undertake a comprehensive screening process to assess suitability. The process will then involve: 1. Creation of embryos via IVF; 2. Donor Hysterectomy and Recipient Transplant; 3. Recovery with immunosuppression; 4. Embryo transfer; 5. Pregnancy care and delivery; 6. Post-delivery, potential second pregnancy, and explant with follow-up. Conclusion: UT is a novel and promising procedure for women with AUFI to achieve parenthood. The process involves a comprehensive workup to assess suitability. A multidisciplinary team within a tertiary centre is essential for establishing a successful UT program. Due to the infancy of UT all centres need to be diligent in reporting clinical outcomes to establish the feasibility of UT as a future treatment option for AUFI.

Background: Absolute Uterine Factor infertility (AUFI) can be congenital such as Mayer-Rokitansky Küster syndrome (MRKH), or acquired resulting from conditions rendering the uterus non-functional or hysterectomy. Prior to the year 2014, women with AUFI had limited opportunities to have a child with the options being either surrogacy or adoption. In 2014 the first successful uterus transplant (UT) was achieved in Sweden. RPA was the first site in Australia to receive ethical approval for a UT trial. Objectives: To determine if UT is an effective, safe, and operationally viable option for women with AUFI in order to achieve live birth. Methodology: Potential donor/recipient pairs will undertake a comprehensive screening process to assess suitability. The process will then involve: 1. Creation of embryos via IVF; 2. Donor Hysterectomy and Recipient Transplant; 3. Recovery with immunosuppression; 4. Embryo transfer; 5. Pregnancy care and delivery; 6. Post-delivery, potential second pregnancy, and explant with follow-up. Conclusion: UT is a novel and promising procedure for women with AUFI to achieve parenthood. The process involves a comprehensive workup to assess suitability. A multidisciplinary team within a tertiary centre is essential for establishing a successful UT program. Due to the infancy of UT all centres need to be diligent in reporting clinical outcomes to establish the feasibility of UT as a future treatment option for AUFI.

Background: Absolute Uterine Factor infertility (AUFI) can be congenital such as Mayer-Rokitansky Küster syndrome (MRKH), or acquired resulting from conditions rendering the uterus non-functional or following a hysterectomy. In 2014 the first successful uterus transplant (UT) was achieved in Sweden. This sparked widespread interest, and many countries have established UT trials. In 2019 Royal Prince Alfred hospital was the first site in Australia to receive ethical approval for a UT protocol. As part of this trial research outcomes will be collected. Aim: • To determine if UT is an effective, safe, and operationally viable option for women with AUFI in order to achieve live birth. • To collect research outcomes which will contribute to an international bio-bank for future research opportunities. Method: Approved donor/recipient pairs will be invited to participate in the research components of the trial. This will involve completing various questionnaires to assess clinical outcomes before and after the procedure, as well as providing additional blood and cervical tissue samples which will be stored for future research projects. Conclusion: UT is a relatively new procedure, with significant scope for basic research opportunities. Due to the infancy of UT it is pivotal that all centers are diligent in collecting research outcomes and contributing to an international data registry to aid in proving the necessity of UT as a clinical treatment for woman with AUFI.