Gynecological aspects that may affect the risk of preterm birth and the success of embryo transfers after uterus transplantation.

Absolute uterine factor infertility is conditioned by the congenital or acquired absence of the uterus or the presence of a nonfunctioning uterus in women who wish to become biological mothers. Uterine transplantation along with assisted reproductive techniques can provide this option for women without a uterus. In the early research period, to minimize the risk of preterm birth and other pregnancy-related complications, the uterus of a donor with a history of one to three successfully completed pregnancies was recommended for transplantation. We believe that insisting on a singleton pregnancy is necessary to reduce the risk of premature birth in uterus recipients, rather than insisting on donating a uterus from a woman with a history of at least one birth. Mild post-transplant narrowing of the vaginal-neovaginal anastomosis was expected; however, the first severe vaginal stricture revealed soon after transplantation was an unpleasant surprise. To prevent post-transplant vaginal stricture, gynecologic surgeons should evaluate the shape and size of the donor's cervix, compare it with the size of the recipient's neovagina and vaginal vault, and perform a vaginal-neovaginal anastomosis to ensure free access for post-transplant cervical biopsies to reveal signs of subclinical rejection and smooth insertion of the embryo transfer catheter into the uterine cavity.