*Purpose: To describe aggregated pregnancy outcomes after uterus transplantation from a single, experienced center.

*Methods: This prospective study reports on live births among 20 women who received a uterus transplant from 2016 to 2019 at Baylor University Medical Center at Dallas. These live births occurred between November 2017 and September 2020. This study is ongoing. The main measures were live birth, maternal complications, and fetal and newborn outcomes.

*Results: There were 6 graft failures (4 surgical complications and 2 with poor perfusion postoperatively). Of the 14 technically successful transplants, at least one live birth occurred in 11 patients. Thus far, the success rate per patient per transplant is 55%, and the live birth rate per patient per technically successful transplant is 79%. Ten uteri were from nondirected living donors and one uterus was from a deceased donor. In vitro fertilization was performed to achieve pregnancy. Ten recipients delivered one neonate and one recipient delivered two neonates. One organ rejection episode was detected during pregnancy and resolved with steroids. The median birthweight was 2890 g (range 1770-3140 g [median 68th percentile]). Maternal weight gain was higher than Institute of Medicine recommendations. Maternal medical complications were observed in five recipients (elevated creatinine, gestational diabetes, gestational hypertension [n=2], and preeclampsia). In five recipients, maternal medical or obstetric complications led to an unplanned preterm delivery (elevated creatinine, preeclampsia; preterm labor [n=3]). The median gestational age at delivery was 36w6d (range 30w6d-38w). All neonates were liveborn, with Apgar scores ≥8 at 5 min.

*Conclusions: Thus far, our program experienced a success rate per patient per transplant of 55% and live birth rate per patient per technically successful transplant of 79%. In our experience, uterus transplantation resulted in a third-trimester live birth in all cases where pregnancies reached 20 weeks’ gestation. Maternal medical and obstetrical complications can occur; however, these were manageable by applying principles of generally accepted obstetric practice.

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