INvestigational Study Into Transplantation of the Uterus (INSITU); a cross-sectional survey amongst women with uterine factor infertility in the UK assessing background, motivations and suitability

Importance: The study summarises the selection pre-screen criteria currently used in the UK for a uterus transplant and highlights the number of women who are suitable to proceed. Objectives: To assess the demographics, motivations, reasons and suitability amongst women with AUFI to undergo uterus transplantation (UTx). Design: A cross sectional survey Setting: An electronic questionnaire was sent via email to women with AUFI who had previously been referred to the UTx research team or approached the Womb Transplant UK Charity. The questions assessed suitability to undergo UTx based on demographic information, perceptions to adoption and surrogacy and reasons why UTx was preferable. Responses were assessed against the study selection criteria. Participants: Women with AUFI Results: 210 women completed the questionnaire. The most common aetiology of AUFI in our cohort was MRKH (68%; n=143) whereas 29% (n=62) had previously undergone hysterectomy. 63% (n=132) of the cohort had previously considered adoption, 5% (n=11) had attempted it, and two (1%) had successfully adopted. The most common reason cited to undergo UTx over adoption was to experience gestation (n= 63; 53%), while 37% (n=44) wanted a biologically related child. 76% (n=160) of participants had previously considered surrogacy, 22 (10%) had attempted it and two (1%) had successfully become mothers using a surrogate. The most common reason to undergo UTx over surrogacy was to experience gestation (n=77; 54%). 15% n=21) were concerned about the legal implications, 14% (n=20) identified the financial cost as a barrier and 8% (n=12) could not consider it due to religious reasons. On adhering to the selection criteria, 65 (31%) women were suitable to proceed with the trial. Conclusion: The study demonstrates that implementing commonly used selection criteria for a UTx led to an attrition rate of more than two thirds of women who requested to initially undergo the process. As more studies present outcomes following UTx, critical assessment of the selection criteria currently utilised is warranted to ensure potential recipients are not being unnecessarily excluded