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Graphic by: Jody PotterAt age 17, Mallory was given a devastating diagnosis that would drastically change the way she could start a family one day.
Born with congenital absence of the uterus — a condition called Mayer-Rokitansky-Küster-Hauser syndrome — Mallory learned that she would never be able to biologically carry her own child; to become a mother, she would require the help of a surrogate or go through adoption to have a family one day.
“I had come to terms with knowing that, OK, I won’t be able to carry my own children; but for me, it always felt like something that was lacking,” Mallory recalled.
However, in May 2023, more than two decades after her MRKH diagnosis, Mallory defied the odds and experienced what was once thought to be medically impossible when she gave birth to a son at UAB Hospital through the gift of uterus transplantation.
On that day in May, both Mallory and her son made history at UAB and in the field of uterus transplantation — Mallory became the first patient to give birth via uterus transplant outside of a clinical trial, and her son was the first baby born out of the UAB Comprehensive Transplant Institute and UAB Medicine uterus transplant program.
“The birth of UAB’s first uterus transplant program baby is an incredible milestone not just for the patient and the field, but for our multidisciplinary team here at UAB, as this marks our ability as an institution to offer another option for patients who are experiencing uterine factor infertility,” explained Paige Porrett, M.D., Ph.D., the inaugural director for Vascularized Composite Allotransplantation in UAB’s Comprehensive Transplant Institute and associate professor in the Marnix E. Heersink School of Medicine Department of Surgery. “At UAB, we’re committed to bringing this emerging therapy forward to patients in need, making it as accessible, safe and simple as possible for women who have never had an option to bear their own biological child.”
To learn more about UAB’s uterus transplant program, or to find out whether you are eligible for transplant, click here.
“We are thrilled for Mallory and her husband, Nick, and humbled that they entrusted our UAB Medicine care team to guide them through this long, difficult — and exciting — journey of transplantation, pregnancy and childbirth,” said Anupam Agarwal, M.D., senior vice president for Medicine and dean of the Heersink School of Medicine. “Our goal and dream for this program is to make this routine for women who want to experience pregnancy and childbirth but can’t for a variety of health reasons. We have the expertise and the multidisciplinary teams in place here to help make this reality. Their work with Mallory and our other transplant recipients and pregnancies to date has just been phenomenal.”
Uterus transplantation: another option to cure infertility
One of only four uterus transplant programs in the United States and the first program in the world to open outside of a clinical research trial, UAB’s uterus transplant program and its success offer women across the country living with uterine factor infertility something they have seldom had as it relates to their journey to biologically carry a child — hope.
“Uterus transplant is another way that UAB is making a contribution here for patients who have longed for more options to building a family,” Porrett explained. “This critical program has value on so many levels: beyond the excitement generated by this birth, it’s important to realize how merely the existence of the program – independent of its outcomes – provides hope to patients in need. Uterus transplantation is the only medical treatment for uterine factor infertility, and despite the safety and efficacy of this treatment, it is largely inaccessible to patients around the world. UAB is committed to changing that reality, and this birth signifies that we are on our way.”
How uterus transplantation works
The process from transplant to successful birth varies from person to person but can take two to five years for many participants. It includes five phases:
1. Embryo generation. Before the uterus transplant surgery, an embryo is generated through in vitro fertilization. During the process of IVF, she is given fertility drugs to produce eggs, which are then removed from her ovaries and fertilized outside of her body. These embryos are then frozen for later use.
2. Transplantation. A uterus is removed from a donor and surgically placed into the recipient. The recipient begins taking immunosuppressive medications to prevent rejection of the transplant. These medications are taken while the transplant is in place, including during pregnancy.
3. Pregnancy. Several months after the transplant surgery, one of the recipient’s embryos will be thawed and placed directly into the uterus. If implantation is successful, the recipient will become pregnant. The health of both baby and mother is monitored very closely at frequent prenatal care visits with a high-risk obstetrician, known as a maternal-fetal medicine specialist.
4. Delivery. The child is born as close to term as is possible via a planned cesarean section. If the pregnancy has gone well and the recipient and her partner desire a second child, the uterus is left in place and immunosuppression medications are continued. Approximately six months after delivery, another embryo transfer can be attempted.
5. Uterus removal. After childbearing is complete, the transplanted uterus is removed, and immunosuppressive medications are stopped.
Uterine factor infertility may affect as many as 5 percent of reproductive-age women worldwide and was a previously irreversible form of female infertility. A woman with uterine factor infertility cannot carry a pregnancy to term because she either was born without a uterus or has had the uterus surgically removed during a hysterectomy.
With just around a hundred uterus transplants performed to date worldwide, women with uterine factor infertility would formerly have had to identify other ways to expand their families, whether through adoption or surrogacy. With uterus transplantation now proved to be a viable option for pregnancy and childbirth at UAB, women and couples now have another option they can explore to treat their specific infertility experience.
“UAB Medicine’s commitment to making this program a reality has truly come full circle with the birth of the first baby from from our Comprehensive Transplant Institute’s uterus transplant program,” said Dawn Bulgarella, CEO of the UAB Health System. “Our goal moving forward is to continue to make this procedure accessible to even more women by working with insurance plans and payers. Our hope is that UAB Medicine becomes a destination for women seeking additional options to cure infertility.”
In Mallory’s specific journey to motherhood, her sister successfully served as a gestational surrogate and carried her and husband Nick’s first child, a daughter. Recognizing that asking her to undergo another pregnancy would risk her sister’s own health, it was then that Mallory became aware of uterus transplant and started the process of candidacy, knowing that fulfilling a dream of pregnancy was potentially attainable.
“There are all different ways to grow your family if you have uterine factor infertility, but this [uterus transplantation] is what I feel like I knew that I was supposed to do,” Mallory explained. “I will forever advocate for UAB and uterus transplant in general, as it gave me the opportunity to be pregnant and finally become a family of four.”
Multidisciplinary care at UAB from transplantation to birth
Upon receiving her uterus transplant from a deceased donor through Legacy of Hope, Mallory, Nick and their daughter relocated to Birmingham — a necessary part of enrolling in UAB’s uterus transplant program due to the extensive level of medical oversight and clinical care. From the organ transplantation to implantation of their embryo and the eventual birth of their child, every step of the near 18-month process solidified a once unachievable dream for Mallory.
“Even through some of the tough stuff, I really embraced pregnancy as I knew it would be the only time I was going to be able to do it, and I knew how lucky I was to be able to experience it,” Mallory recalled. “Sharing that journey with our daughter was so special, too, with her being able to feel my belly. I just had so much gratitude to experience this.”
Notably, the end goal of having a baby born successfully from a uterus transplant involves the specialized care and rigorous involvement of several medical departments at UAB including the Departments of Surgery, Obstetrics & Gynecology, Radiology, Pathology, Medicine, Anesthesiology, and Pediatrics. Dozens of physicians from the divisions of Transplantation, Gynecologic Oncology, Maternal Fetal Medicine, Reproductive Endocrinology and Infertility, Infectious Diseases, as well care for a uterus transplant recipient. Additional key members of the uterus transplant team include nurses, social workers, pharmacists, psychologists, and embryologists. Altogether, more than 50 medical providers throughout the institution are needed to provide the specialty care to make this miracle happen for patients in need.
At all points during her experience, the patient is fully under the care of specialized transplant surgeons and obstetricians to ensure a successful transplantation and safe pregnancy and birth for mother and baby.
The partnership between physicians and surgeons across different medical disciplines is what makes UAB’s uterus transplant program unique; for instance, gynecologic oncologists lend their expertise of the reproductive organ in transplant surgery, while anesthesiologists collaborate with maternal-fetal medicine physicians to ensure the safest possible birth outcome for mother and baby.
“One of the major successes was working with the other specialties that we don’t typically work this closely with, and the ability to collectively take care of a patient with a single goal and offer our unique perspectives; to me, that was the real success — that we ended up with a healthy mom and baby,” shared Brian Brocato, D.O., assistant professor in the Division of Maternal-Fetal Medicine and Mallory’s obstetrician. “Mallory was born without reproductive organs, and that is amazing to me. That what used to be thought of as a diagnosis that equaled you wouldn’t be able to bear your own children — the ability to take patients with that devastating condition and for them to experience typical pregnancy — I think is important. When I think about this case, I still feel in awe of the expertise and all the work and thought that’s been put into this program.”
Upon receiving and healing from her uterus transplant, Mallory — as did other patients in the program — moved through care with ongoing monitoring from transplantation to reproductive endocrinology and infertility to undergo embryo implantation. Once successfully pregnant, she remained under frequent specialized care of maternal-fetal medicine obstetricians until her scheduled cesarean section birth.
“It’s immensely rewarding to share in this extraordinary milestone with our patient and her family,” said Deidre Downs Gunn, M.D., medical director of the IVF Program in the Division of Reproductive Endocrinology & Infertility. “Thanks to our exceptional multi-disciplinary team, UAB has emerged as a global leader in uterine transplantation. As an infertility specialist, I am privileged to be able to offer this groundbreaking treatment for my patients with uterine factor infertility.”
Humbly, Mallory and Nick feel that the birth of their son is a shared success with their care team.
“The whole team of doctors — Dr. Deidre Gunn, Dr. Brian Brocato, Dr. Paige Porrett and so many others — this is their accomplishment too. I feel like I just did what they told me to do, and I carried him; but they all knew what to do and how to get us to the finish line.”
Am I a candidate?
Candidates for uterine transplants should be generally healthy and without a uterus — either born without one or have had one surgically removed. As part of an intensive evaluation, candidates are educated about the risks of uterus transplantation and counseled about alternatives to uterus transplantation for family building. UAB encourages any women interested in uterus transplantation to contact the program for more information. This includes both providers and potential candidates.
A future of potential for patients, families
For Porrett, the birth of UAB’s first baby from a uterus transplant signifies something that cements the procedure as a critical additional option for infertility.
“This birth is evidence that reassures us that this emerging technology — this innovative therapy — that’s been needed for so long really, truly works,” Porrett said. “Within the whole process of uterus transplantation, there are multiple milestones along the way, and you don’t reach the second milestone until you’ve cleared the first. Although I’m extremely optimistic about uterus transplantation and its recognized multitude of benefits, it is a complex process, and the ultimate goal is a successful, healthy live birth; it’s this milestone that counts above all else. Mallory and Nick achieved this, and I just can’t be excited enough for them.”
In looking ahead at the program’s success, UAB’s collaborative team is currently caring for multiple other uterus transplant patients at all stages of the experience, including those who are pregnant as well as those that are early in the process and just undergoing evaluation. With patients inquiring from all over the country and the world, UAB’s key goal is making uterus transplant an accessible, standard care for infertility.
“In my more than 20 years at UAB, the uterine transplantation program represents the pinnacle of complex, highly coordinated, and multi-disciplinary clinical care,” said Warner Huh, M.D., chair of the Department of Obstetrics and Gynecology. “The successful coordination of this should not be overlooked, as few institutions have the expertise and capacity to care for patients with uterine factor infertility. I am so thrilled about the first birth related to this program and positively impacting Mallory’s family, and proud of the team of incredible experts across three divisions in OBGYN who supported the larger care team in this feat.”
“It’s been a privilege for our division to work closely with the UAB Comprehensive Transplant Institute to not only support the development of the uterine transplantation program, but also the provision of clinical care for women that have entrusted this super unique medical intervention to our team,” said Charles Leath, III, M.D., MSPH, director of UAB’s Division of Gynecologic Oncology. “In concert with experts from other several other medical disciplines, it’s been an exceptional opportunity to collaborate and provide shared surgical knowledge and expertise.”
Click here to register to become an organ donor through Legacy of Hope.
To Mallory and Nick, years of manifesting a complete family through a lot of hard work, determination, medical support and perseverance is finally a reality. The moment they waited years for — a moment that propelled them through organ transplantation, in vitro fertilization, relocation, high-risk pregnancy and more — came true.
“I mean just hearing the cry at first was just, you know, mind blowing,” Mallory remembered with tears in her eyes. “When Dr. Porrett visited us in our hospital room and saw our son, it just felt so surreal, it was full circle. We did it.”