Psychological well-being of women with uterine infertility before considering uterus transplantation as a treatment option

Jana Pittman; Brigitte Gerstl; Anna Walch; Mianna Lotz; Rebecca Deans; Natalie Morrison

doi:10.1111/ajo.13895

Psychological well-being of women with uterine infertility before considering uterus transplantation as a treatment option

Aust N Z J Obstet Gynaecol. 2024 Nov 12. doi: 10.1111/ajo.13895. Online ahead of print.

Authors

Jana Pittman^{1

2

3}, Brigitte Gerstl^{2

3}, Anna Walch^{2

3}, Mianna Lotz⁴, Rebecca Deans^{2

3}, Natalie Morrison^{1

5}

Affiliations

¹ Western Sydney University, Sydney, New South Wales, Australia.
² School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
³ The Royal Hospital for Women, Sydney, New South Wales, Australia.
⁴ Department of Philosophy, Macquarie University, Sydney, New South Wales, Australia.
⁵ Translational Health Research Unit, Western Sydney University, Sydney, New South Wales, Australia.

PMID: 39530245
DOI: 10.1111/ajo.13895

Abstract

Background: While uterus transplantation offers a promising treatment option for women with uterine factor infertility (UFI), the potential for graft failure and lack of organ availability could have subsequent psychological repercussions for women. Exploring baseline psychological well-being for women with UFI who could become uterine transplant recipients is essential to identify specific psychological challenges to be considered prior to transplantation. UFI can be congenital uterine absence, namely Mayer-Rokitansky-Küster-Hauser syndrome (MRKH), or acquired uterine absence (hysterectomy).

Objective: To analyse baseline psychological well-being among women with UFI.

Design and setting: A survey including demographic data and two internationally validated psychological questionnaires, Depression, Anxiety and Stress Scale (DASS-21),¹³ and Fertility Quality of Life (FertiQoL), was disseminated to women with UFI. Data from these instruments was compared between groups and then to data that uses these tools in the general infertility population.

Results/outcomes: The study included 39 women (mean age 29.54 years). Higher scores for moderate symptoms of depression, anxiety, and stress were reported for the entire UFI cohort. More women with congenital UFI showed 'severe' symptoms for depression/anxiety, compared to women with acquired UFI. Women with acquired UFI showed poorer FertiQoL scores compared to both women with congenital UFI and to the general infertility population scores in previously published data.

Conclusion: Clinicians should consider accessing increased psychological support for women with UFI when discussing fertility options including uterine transplant, and they may need to tailor this support depending on whether the patient has congenital or acquired UFI.

Keywords: MRKH; infertility; transplant; uterine infertility; uterus.