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PubMed This is a summary of 21 peer-reviewed journal articles Updated
Reproductive Endocrinology

Paths to Parenthood: Fertility and Family Building

At a Glance

Women with MRKH syndrome cannot carry a pregnancy due to the absence of a uterus, but they do produce healthy biological eggs. They can have biological children through In Vitro Fertilization (IVF) and gestational surrogacy, or pursue emerging options like uterine transplantation.

One of the most difficult parts of an MRKH diagnosis is the realization that you cannot carry a pregnancy. This condition is called Absolute Uterine Factor Infertility (AUFI) [1]. It is completely normal to feel a deep sense of grief, loss, or even anger about this.

However, it is important to separate the ability to carry a child from the ability to have a biological child. Because you have healthy ovaries, your body produces its own biological eggs [2][3]. This means that while your path to parenthood will look different, the door to family building is very much open.

Biological Motherhood: Gestational Surrogacy

The most established path to a biological child for women with MRKH is In Vitro Fertilization (IVF) used with a gestational carrier (surrogacy) [4][5].

  • The Process: A doctor uses hormones to stimulate your ovaries and then retrieves your eggs [6]. These eggs are fertilized in a lab with sperm (from a partner or donor) to create embryos. One or more embryos are then transferred into the uterus of a gestational carrier—a woman who carries the pregnancy for you.
  • The Result: The baby is 100% your biological child; the carrier has no genetic link to the baby [7].
  • Considerations: This process involves significant legal, financial, and emotional planning [7]. Gestational surrogacy requires substantial financial resources and is often not covered by health insurance, so setting realistic expectations is important. It is highly successful, though exact success rates depend on the quality of the eggs and embryos [8].

The Emerging Field: Uterine Transplantation

Uterine Transplantation (UTx) is a groundbreaking medical procedure where a uterus from a donor (either living or deceased) is surgically placed into your body [9][10].

  • Status: While no longer strictly “experimental,” it is still considered an evolving and complex procedure performed at specialized centers [11][12].
  • How it Works: After the transplant, you must take immunosuppressant medications to prevent your body from rejecting the organ [13]. Once the uterus is stable, an embryo (created previously through IVF) is transferred into it [4].
  • The Outcome: This is currently the only way a woman with MRKH can experience pregnancy and childbirth [14]. There have been many successful live births worldwide through this method [15][16].
  • Trade-offs: It is a major surgery with significant risks, and it is a temporary transplant—the uterus is usually removed after one or two successful pregnancies to stop the need for long-term anti-rejection drugs [13][17].

Adoption

Many families find that adoption is the most meaningful path for them. Adoption allows you to build a family based on the deep emotional bond of parenting rather than a genetic link or the experience of pregnancy. There are many different types of adoption (domestic, international, or through the foster care system), each with its own set of processes and considerations.

Preparing for the Future

You do not need to make any of these decisions today. However, knowing your options can help turn a sense of “never” into “someday.”

  1. Meet an Expert: Consider talking to a Reproductive Endocrinologist and Infertility (REI) specialist. They can look at your ovaries and discuss the possibility of fertility preservation (freezing your eggs) for the future [6][2]. Because your ovaries are healthy, egg retrieval can safely wait until you are an adult and ready to start a family; there is no immediate rush [3].
  2. Seek Support: The emotional impact of infertility can be heavy and may change over time [18]. Working with a counselor who specializes in reproductive health can provide a safe space to process these feelings [19][20].
  3. Stay Informed: The field of reproductive medicine is moving quickly. What is possible today may be even more accessible by the time you are ready to start a family [4][21].

Back to Main Guide

Common questions in this guide

Can I have biological children if I have MRKH syndrome?
Yes. Because women with MRKH syndrome have healthy, functioning ovaries, they produce their own biological eggs. Through In Vitro Fertilization (IVF), your eggs can be retrieved, fertilized, and transferred to a gestational surrogate.
What is a uterine transplant and how does it work for MRKH?
A uterine transplant is an evolving surgical procedure where a healthy uterus from a donor is placed into your body. This allows a woman with MRKH to temporarily carry a pregnancy, though it requires major surgery and immunosuppressive medications.
When should I freeze my eggs if I have MRKH syndrome?
Because your ovaries function normally, there is no immediate medical rush to freeze your eggs. Many patients safely wait to pursue egg retrieval and fertility preservation until they are adults and actively planning a family.
What does Absolute Uterine Factor Infertility (AUFI) mean?
Absolute Uterine Factor Infertility means you are unable to carry a pregnancy yourself due to the absence or significant abnormality of the uterus. It is the specific type of infertility experienced by women with MRKH syndrome.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.When is the best age to meet with a Reproductive Endocrinologist to discuss egg freezing?
  2. 2.How does the position of my ovaries affect the process of egg retrieval?
  3. 3.Can you explain the current success rates for gestational surrogacy in patients with MRKH?
  4. 4.Are there specific clinical trials for uterine transplantation that you recommend I follow?
  5. 5.What are the typical costs and legal requirements for gestational surrogacy in our area?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (21)
  1. 1

    Motivations for uterus transplantation in women with absolute uterine factor infertility: A systematic review of the literature.

    Leis L, Tustumi F, Soares-Jr JM, et al.

    Clinics (Sao Paulo, Brazil) 2025; (80()):100646 doi:10.1016/j.clinsp.2025.100646.

    PMID: 40228433
  2. 2

    Mayer-Rokitansky-Kuster-Hauser Syndrome: From Radiological Diagnosis to Further Challenges-Review and Update.

    Schiau C, Csutak C, Ciurea AI, et al.

    Diagnostics (Basel, Switzerland) 2026; (16(1)) doi:10.3390/diagnostics16010138.

    PMID: 41515635
  3. 3

    Mayer-Rokitansky-Kuster-Hauser Syndrome: A rare case report from Nepal.

    Ray U, Adhikari S, Dhital R, et al.

    Annals of medicine and surgery (2012) 2022; (82()):104725 doi:10.1016/j.amsu.2022.104725.

    PMID: 36268332
  4. 4

    Uterus transplantation: from research, through human trials and into the future.

    Brännström M, Racowsky C, Carbonnel M, et al.

    Human reproduction update 2023; (29(5)):521-544 doi:10.1093/humupd/dmad012.

    PMID: 37328434
  5. 5

    Uterus Transplantation: A Rapidly Expanding Field.

    Brännström M, Dahm Kähler P, Greite R, et al.

    Transplantation 2018; (102(4)):569-577 doi:10.1097/TP.0000000000002035.

    PMID: 29210893
  6. 6

    Ultrasound-guided follicle aspiration at time of laparotomy in a patient with Mayer-Rokitansky-Küster-Hauser syndrome.

    Eskew AM, Broughton DE, Schulte MB, et al.

    Fertility and sterility 2018; (109(5)):940 doi:10.1016/j.fertnstert.2018.02.007.

    PMID: 29778392
  7. 7

    Differences in the utilization of gestational surrogacy between states in the U.S.

    Perkins KM, Boulet SL, Levine AD, et al.

    Reproductive biomedicine & society online 2018; (5()):1-4 doi:10.1016/j.rbms.2017.08.002.

    PMID: 29774269
  8. 8

    The reproductive potential of patients with Mayer-Rokitansky-Küster-Hauser syndrome using gestational surrogacy: a systematic review.

    Friedler S, Grin L, Liberti G, et al.

    Reproductive biomedicine online 2016; (32(1)):54-61.

    PMID: 26626805
  9. 9

    Mayer-Rokitansky-Küster-Hauser syndrome patients' interest, expectations and demands concerning uterus transplantation.

    Sousa C, Carton I, Jaillard S, et al.

    Journal of gynecology obstetrics and human reproduction 2023; (52(10)):102674 doi:10.1016/j.jogoh.2023.102674.

    PMID: 37805077
  10. 10

    Meeting Report: First State-of-the-Art Meeting on Uterus Transplantation.

    Tummers P, Göker M, Dahm-Kahler P, et al.

    Transplantation 2019; (103(3)):455-458 doi:10.1097/TP.0000000000002561.

    PMID: 30747845
  11. 11

    Uterus Transplantation as a Surgical Innovation.

    Pérez-Blanco A, Seoane JA, Pallás TA, et al.

    Journal of bioethical inquiry 2023; (20(3)):367-378 doi:10.1007/s11673-023-10272-5.

    PMID: 37382845
  12. 12

    Uterine Transplantation: Evolving Data, Success, and Clinical Importance.

    Ricci S, Bennett C, Falcone T

    Journal of minimally invasive gynecology 2021; (28(3)):502-512 doi:10.1016/j.jmig.2020.12.015.

    PMID: 33348011
  13. 13

    Evolving clinical challenges in uterus transplantation.

    Ayoubi JM, Carbonnel M, Racowsky C, et al.

    Reproductive biomedicine online 2022; (45(5)):947-960 doi:10.1016/j.rbmo.2022.06.020.

    PMID: 35999148
  14. 14

    Comparing gestational carrier with uterine transplantation in uterine-factor infertility: a cost-effectiveness analysis.

    Combs JC, Yamasaki MU, Dougherty M, et al.

    Fertility and sterility 2025; (124(1)):134-143 doi:10.1016/j.fertnstert.2025.01.012.

    PMID: 39848421
  15. 15

    How Surgical Research Gave Birth to a New Clinical Surgical Field: A Viewpoint from the Dallas Uterus Transplant Study.

    Johannesson L, Testa G, da Graca B, Wall A

    European surgical research. Europaische chirurgische Forschung. Recherches chirurgicales europeennes 2023; (64(2)):158-168 doi:10.1159/000528989.

    PMID: 36623496
  16. 16

    Clinical pregnancy after deceased donor uterus transplantation: Lessons learned and future perspectives.

    Chmel R, Pastor Z, Novackova M, et al.

    The journal of obstetrics and gynaecology research 2019; (45(8)):1458-1465 doi:10.1111/jog.13992.

    PMID: 31062518
  17. 17

    Which Donor for Uterus Transplants: Brain-Dead Donor or Living Donor? A Systematic Review.

    Lavoué V, Vigneau C, Duros S, et al.

    Transplantation 2017; (101(2)):267-273 doi:10.1097/TP.0000000000001481.

    PMID: 27607535
  18. 18

    Personality traits and coping styles in women with Mayer-Rokitansky-Küster-Hauser syndrome.

    Bargiel-Matusiewicz K, Kroemeke A

    Archives of medical science : AMS 2015; (11(6)):1244-9 doi:10.5114/aoms.2015.56350.

    PMID: 26788086
  19. 19

    ACOG Committee Opinion No. 728 Summary: Müllerian Agenesis: Diagnosis, Management, And Treatment.

    Obstetrics and gynecology 2018; (131(1)):196-197 doi:10.1097/AOG.0000000000002452.

    PMID: 29266072
  20. 20

    The need to integrate mental health treatment into the care of Mayer-Rokitansky-Küster-Hauser.

    Davoudian T, Hills E

    F&S reports 2025; (6(2)):116-119 doi:10.1016/j.xfre.2025.03.008.

    PMID: 40620385
  21. 21

    Uterus Transplantation: the Translational Evolution of a Clinical Breakthrough.

    Brännström M, Adashi EY, Wu JH, et al.

    Physiology (Bethesda, Md.) 2024; (39(6)):0 doi:10.1152/physiol.00011.2024.

    PMID: 38954427

This page provides educational information on fertility and family-building options for women with MRKH syndrome. Always consult a Reproductive Endocrinologist to discuss the safest and most appropriate medical path for your specific situation.

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