Uterus transplantation has proved to be a feasible treatment for uterine factor infertility. Herein, we report on recipient outcome in the robotic uterus transplantation trial of 2017–2019. The eight recipients had congenital uterine aplasia. The donors were six mothers, one sister, and one family friend. Donor surgery was by robotic-assisted laparoscopy. Recipient surgery was by laparotomy and vascular anastomoses to the external iliacs. The duration (median (ranges)) of recipient surgery, blood loss, measured (left/right) uterine artery blood flow after reperfusion, and length of hospital stay were 5.15 h (4.5–6.6), 300 mL (150–600), 43.5 mL/min (20–125)/37.5 mL/min (10–98), and 6 days (5–9), respectively. Postoperative uterine perfusion evaluated by color Doppler showed open anastomoses but restricted blood distribution in two cases. Repeated cervical biopsies in these two cases initially showed ischemia and, later, necrosis. Endometrial growth was not seen, and hysterectomy was later performed, with pathology showing partly viable myometrium and fibrosis but necrosis towards the cavity. The other six patients acquired regular menstrual cyclicity. Surgery was performed in two patients to correct vaginal stenosis. Reversible rejection episodes were seen in two patients. In conclusion, the rate of viable uterine grafts during the initial 6-months of the present study (75%) leaves room for improvement in the inclusion/exclusion criteria of donors and in surgical techniques. Initial low blood flow may indicate subsequent graft failure.

Background: The first live birth after uterus transplantation took place in Sweden in 2014. It was the first ever cure for absolute uterine factor infertility. We report the surgery, assisted reproduction, and pregnancy behind the first live birth after uterus transplantation in the Middle East, North Africa, and Turkey (MENAT) region. A 24-year old woman with congenital absence of the uterus underwent transplantation of the uterus donated by her 50-year-old multiparous mother. In vitro fertilization was performed to cryopreserve embryos. Both graft retrieval and transplantation were performed by laparotomy. Donor surgery included isolation of the uterus, together with major uterine arteries and veins on segments of the internal iliac vessels bilaterally, the round ligaments, and the sacrouterine ligaments, as well as with bladder peritoneum. Recipient surgery included preparation of the vaginal vault, end-to-side anastomosis to the external iliac arteries and veins on each side, and then fixation of the uterus. Results: One in vitro fertilization cycle prior to transplantation resulted in 11 cryopreserved embryos. Surgical time of the donor was 608 min, and blood loss was 900 mL. Cold ischemia time was 85 min. Recipient surgical time was 363 min, and blood loss was 700 mL. Anastomosis time was 105 min. Hospital stay was 7 days for both patients. Ten months after the transplantation, one previously cryopreserved blastocyst was transferred which resulted in viable pregnancy, which proceeded normally (except for one episode of minor vaginal bleeding in the 1st trimester) until cesarean section at 35 + 1 weeks due to premature contractions and shortened cervix. A healthy girl (Apgar 9-10-10) weighing 2620 g was born in January 2020, and her development has been normal during the first 6 months. Conclusions: This is the first report of a healthy live birth after uterus transplantation in the MENAT region. We hope that this will motivate further progress and additional clinical trials in this area in the Middle East Region, where the first uterus transplantation attempt ever, however unsuccessful, was performed already three decades ago.

Fertility preservation methods for prepubertal women about to undergo gonadotoxic chemo and/or radiation therapy are limited. Therefore, the aim of this study was to investigate the feasibility to develop an alternative fertility preservation method based on an ex vivo perfusion platform for whole ewe ovaries. Thirteen ewe ovaries were divided into two groups (group 1 and 2) that were perfused in a bioreactor for up to 7 days. Group 1 (n = 3) were stimulated with human menopausal gonadotropin (hMG) administered in single daily dose, while group 2 (n = 10) were stimulated continuously for 24 h. The perfused ovaries in group 1 showed no significant differences in follicular density, sub-follicular morphology and oocyte quality after ischaemia and after ex vivo perfusion compared with non-perfused control ovaries. The perfused ovaries in group 2 showed a significant decrease in the follicular reserve and oocyte quality compared with the control group. In total, 16 GV–MI oocytes were retrieved from both groups. This study describes for the first time the ex vivo maintenance of viable follicles of ewe ovaries with oocyte integrity and the retrieval of oocytes after ex vivo hormonal perfusion with two different protocols for up to 7 days.

Purpose: Fertility preservation for pre-pubertal girls undergoing gonadotoxic cancer treatments and women with systemic cancers at high risk for ovarian metastasis remains limited. Current options, such as ovarian cortex transplantation, risk reintroducing malignant cells. This study presents a novel approach focusing on ex vivo folliculogenesis and mature oocyte retrieval for cryopreservation, mitigating this risk. Methods: This experimental study optimized an ex vivo ovarian perfusion system in sheep, refining gonadotropin stimulation to yield mature oocytes. Eleven ovaries were divided into two experimental subgroups: Group 1 (n = 5) and Group 2 (n = 6). Both groups were perfused in a bioreactor for 4 to 8 days under distinct perfusion protocols, differing in gonadotropin administration overnight—Group 1 did not receive overnight gonadotropin stimulation, whereas Group 2 received basal gonadotropin stimulation overnight. Assessments included follicular proliferation, oocyte maturity, apoptosis, ovarian function-related gene expression, and the levels of hormones, metabolites, and electrolytes in the culture medium, compared across subgroups. Results: The protocol without overnight ovarian stimulation yielded mature MII oocytes, despite fewer secondary follicles and overexpression of the pro-apoptotic BAX gene. Conversely, ovaries with overnight stimulation yielded mostly GV-MI oocytes and exhibited reduced secondary follicle proliferation and higher HIF1A expression. Hormone levels, metabolites, and electrolytes remained stable across groups and time. Conclusions: This study is the first to report the successful harvesting of MII oocytes following extended ex vivo perfusion of intact ewe ovaries, highlighting the potential of the perfusion model to support advanced follicular development. Further investigations are warranted to elucidate underlying mechanisms and refine protocol efficiency.

Purpose: Human papillomavirus (HPV), the most common sexually transmitted infection, has been proposed as a potential factor in male infertility. This study aimed to assess the prevalence of HPV in semen samples from men undergoing in vitro fertilization (IVF) in Sweden and evaluate its association with semen parameters and embryological outcomes. Methods: This prospective cohort study was conducted at Sahlgrenska University Hospital, Gothenburg, Sweden, between January 2023 and February 2024. Men (n = 246) undergoing IVF provided fresh semen samples for HPV DNA testing using real-time PCR. Semen analysis followed WHO guidelines, and fertilization and embryo quality assessments were conducted according to the Istanbul Consensus. Machine learning (ML) models were employed to predict fertilization and blastocyst formation outcomes. Results: HPV was detected in 8.9% of semen samples. No significant differences in semen parameters were found between HPV-positive and HPV-negative men. However, in the non-male infertility subgroup, HPV-positive men had significantly higher total motility (median 65 vs. 60%, p = 0.021) and progressive motility (median 65 vs. 55%, p = 0.016). Similarly, in the unexplained infertility subgroup, progressive motility was higher in HPV-positive men (median 60 vs. 50%, p = 0.033). No significant differences were found in fertilization or blastocyst formation rates, and ML analysis confirmed that HPV presence did not influence predictive model accuracy. Conclusion: HPV is detectable in the semen of a notable number of men undergoing IVF, but its presence does not significantly impact fertilization or embryo development. These findings suggest that routine HPV screening in semen may not be necessary for predicting IVF outcomes. Trial registration: The study was registered on ClinicalTrials.gov (ID: NCT06161727).

Introduction: Ovarian tissue cryopreservation (OTC) has emerged as an important fertility preservation option for women and girls at risk of treatment-induced ovarian failure. However, long-term data on clinical utilization and reproductive outcomes remain limited. This study provides a 30-year regional overview of OTC practice in Western Sweden. Material and Methods: This retrospective observational cohort study included 60 patients who underwent OTC between 1995 and 2025 within a publicly funded regional fertility preservation program. Data on patient characteristics, indications, surgical approach, cryopreservation techniques, and reproductive outcomes were collected from medical records, tissue bank data, and fertility preservation registries. Results: Malignant diagnoses accounted for 51 cases (85%) of indications, most commonly hematologic malignancies and breast cancer, while 9 patients (15%) had benign conditions requiring gonadotoxic therapy. During follow-up, only one patient (1.7%) underwent ovarian tissue transplantation (OTT), resulting in recovery of endocrine function and a spontaneous twin pregnancy. Overall, 15 women (25%) achieved at least one pregnancy. Of these, 8 (13.3%) occurred spontaneously without prior transplantation, 4 (6.7%) were achieved through oocyte donation, 1 (1.7%) occurred after OTT, and 1 patient (1.7%) had both spontaneous and donor-egg pregnancies. Most women (45/60, 75%) had no documented pregnancy or fertility treatment during follow-up. Conclusions: Over three decades, OTC has been successfully implemented as part of a regional fertility preservation program. However, the low rate of tissue utilization and the predominance of spontaneous pregnancies highlight the gap between tissue preservation and clinical use. These findings underscore the need for improved patient selection, structured long-term follow-up, and individualized risk assessment to optimize the clinical impact of OTC.