Uterine autotransplantation in cynomolgus macaques: the first case of pregnancy and delivery

Makoto Mihara, Iori Kisu, Hisako Hara, Takuya Iida, Jun Araki, Timothy Shim, Mitsunaga Narushima, Takumi Yamamoto, Hisashi Moriguchi, Yojiro Kato, Makoto Tonsho, Kouji Banno, Daisuke Aoki, Nobuhiko Suganuma, Noriko Kagawa, Yuji Takehara, Osamu Kato, Isao Koshima

Research output: Contribution to journalArticlepeer-review

88 Citations (Scopus)


background: For women with congenital uterine infertility, or for those who have undergone hysterectomy, uterine transplantation is one of the potential treatments to regain fertility. In this study, we utilized a primate model of uterine transplantation, and evaluated the patency of our microsurgical anastomoses, and the perfusion of the transplanted uterus. methods: Two female cynomolgus monkeys underwent surgery.We anastomosed two arteries and one vein in Case 1 and two arteries and two veins in Case 2. The arteries used were the uterine arteries and the anastomosis was done to the external iliac artery.We used one of the ovarian veins in both animals, but resected the ovary from the Fallopian tube. Uterine arterial blood flow and uterine size were determined by intraoperative indocyanine green (ICG) angiography and ultrasonography. The biopsy of the uterine cervix was performed after surgery. results: ICG angiography showed that the unilateral uterine artery perfused the bilateral uterine bodies and cervix. In Case 1, ICG angiography showed the occlusion of one of the anastomosed arteries during the operation and the uterus appeared atrophied 2 months after operation. In Case 2, the transplanted uterus survived and normal menstruation occurred. The animal achieved a natural pregnancy and was delivered by the Caeserean section due to early separation of the placenta. The newborn suffered fetal distress. conclusions: These results show the anastomosis of at least the bilateral uterine arteries and the unilateral ovarian vein is required for uterus transplantation. This is the first report of a natural pregnancy in a primate following uterine autotransplantation.

Original languageEnglish
Pages (from-to)2332-2340
Number of pages9
JournalHuman Reproduction
Issue number8
Publication statusPublished - 2012 Aug


  • Autotransplantation
  • Cynomolgus macaque
  • ICG
  • Indocyanine green angiography
  • Uterine transplantation

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology


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