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PubMed This is a summary of 16 peer-reviewed journal articles Updated
Gynecology

Fertility and Family Building with MRKH

At a Glance

Individuals with MRKH syndrome can still have biological children because their ovaries typically function normally and produce eggs. The most common path is combining IVF with a gestational carrier (surrogacy). Uterine transplantation is also an emerging option for experiencing pregnancy.

One of the most common fears after an MRKH syndrome diagnosis is the belief that you cannot have a family. It is important to separate the absence of a uterus from the ability to be a parent. Because your ovaries typically function normally, they produce the same eggs and hormones as any other woman [1][2]. This means that having biological children is a very real possibility, though the path to getting there will look different.

Biological Options: IVF and Surrogacy

The most established way for a person with MRKH to have a biological child is through a combination of In Vitro Fertilization (IVF) and a gestational carrier (surrogacy) [3][4].

  • How it works: Doctors use medications to stimulate your ovaries to produce multiple eggs. These eggs are then retrieved through a minor procedure [5].
  • Fertilization: The eggs are fertilized with sperm in a laboratory to create embryos [5][6].
  • The Gestational Carrier: Since you do not have a uterus to carry the pregnancy, an embryo is transferred into the uterus of another woman (the gestational carrier), who carries the baby to term [5].

The child is 100% genetically yours (and your partner’s or a donor’s), even though someone else is providing the “home” for the baby to grow [5][6].

An Evolving Path: Uterine Transplantation (UTx)

For many years, surrogacy was the only biological option. Today, Uterine Transplantation has moved from experimental research into a clinical reality for some patients [7][8]. MRKH is actually the most common reason this procedure is performed [7].

What you should know about UTx:

  • The Surgery: It involves a major operation to transplant a uterus from either a living or deceased donor [9][10].
  • Immunosuppression: To prevent your body from rejecting the new organ, you must take powerful immunosuppressant drugs [11][12]. These are the same types of medications used for kidney or heart transplants.
  • Pregnancy: Once the transplant is successful, an embryo (created via IVF) is transferred into the new uterus [9].
  • Temporary Organ: After one or two successful births, the transplanted uterus is typically removed so that you can stop taking the immunosuppressant medications [13][14].

While UTx allows you to experience pregnancy and childbirth, it is a complex process with significant surgical risks [9]. It is still largely performed within clinical trials at specialized transplant centers, and involves significant logistical, emotional, and financial commitments [7][15]. Choosing between surrogacy and transplant is a deeply personal decision that involves balancing your desire for pregnancy against the medical intensity of the transplant process [7][15].

Other Paths to Parenthood

Many people, with or without MRKH, find that adoption is the right path for their family. Adoption allows you to build a family based on the shared bond of love and care rather than genetics [15][16].

Looking Forward

You do not need to make any of these decisions today. Science and medicine in this field are moving quickly, and the options available to you in five or ten years may be even more advanced than they are now [7]. The most important takeaway is that MRKH does not define your future as a parent. Whether through surrogacy, transplant, or adoption, there are multiple well-traveled roads to building a family [3][15]. Your care team, including fertility specialists and counselors, will be there to help you explore these options whenever you feel ready.

Common questions in this guide

Can I have biological children if I have MRKH syndrome?
Yes. Because most people with MRKH have normally functioning ovaries that produce healthy eggs, having biological children is highly possible. This is typically achieved by combining In Vitro Fertilization (IVF) with a gestational carrier or surrogacy.
How does IVF work for someone without a uterus?
During IVF, fertility medications stimulate your ovaries to produce multiple eggs. A specialist then retrieves these eggs and fertilizes them in a laboratory to create embryos. Because you do not have a uterus, an embryo is then transferred to a gestational carrier or a transplanted uterus.
Is a uterine transplant an option for MRKH?
Uterine transplantation is becoming a clinical reality for some patients with MRKH, allowing them to carry a pregnancy. However, it requires major transplant surgery, taking powerful immunosuppressant medications to prevent organ rejection, and careful monitoring at a specialized medical center.
Do I need to make decisions about my fertility immediately after diagnosis?
No, you do not need to make these decisions right away. Medical options for fertility and family building are continually advancing. When you are ready to start a family, your care team will help you explore the latest available options, whether biological or through adoption.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Have we confirmed that my ovaries are healthy and producing eggs at a typical level for my age?
  2. 2.When I am ready to explore IVF, how will the egg retrieval process work given my anatomy?
  3. 3.Can you refer me to a fertility specialist who has specific experience working with MRKH patients?
  4. 4.Is uterine transplantation currently being performed at this hospital or a nearby center of excellence?
  5. 5.What are the long-term health considerations of the immunosuppressant drugs required for a uterine transplant?

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 (16)
  1. 1

    Laparoscopic intervention for solid pelvic tumours in Mayer-Rokitansky-Küster-Hauser syndrome: a case of bilateral uterine adenomyomas of the rudimentary uterus.

    Shimizu H, Kobayashi H, Shimizu Y, Adachi H

    BMJ case reports 2023; (16(5)) doi:10.1136/bcr-2022-254262.

    PMID: 37156565
  2. 2

    Neovaginoplasty With Nile Tilapia Skin: Cytological and Microbiota Evaluation.

    Teófilo CR, Peixoto RAC, Eleutério RMN, et al.

    Journal of lower genital tract disease 2023; (27(3)):275-279 doi:10.1097/LGT.0000000000000740.

    PMID: 37192410
  3. 3

    Methods for neovagina creation in women with Mayer-Rokitansky-Küster-Hauser syndrome for subsequent uterus transplantation.

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

    Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia 2021; (165(4)):360-366 doi:10.5507/bp.2021.049.

    PMID: 34446938
  4. 4

    Optimizing care for MRKH patients: From malformation screening to uterus transplantation eligibility.

    Cospain A, Dion L, Bidet M, et al.

    Acta obstetricia et gynecologica Scandinavica 2025; (104(3)):514-521 doi:10.1111/aogs.14985.

    PMID: 39382201
  5. 5

    Oocyte Retrieval during Laparoscopic Vaginoplasty to Reduce Invasiveness in the Treatment of Mayer-Rokitansky-Küster-Hauser Syndrome.

    Candiani M, Vanni VS, Papaleo E, et al.

    Journal of minimally invasive gynecology 2020; (27(1)):74-79 doi:10.1016/j.jmig.2019.02.023.

    PMID: 31129299
  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

    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
  8. 8

    Uterine Transplantation: Advances, Challenges, and Future Perspectives.

    Pereira A, Ribeiro F, Soares S, Ferreira H

    Diseases (Basel, Switzerland) 2025; (13(5)) doi:10.3390/diseases13050152.

    PMID: 40422584
  9. 9

    Uterus transplantation: advantages and disadvantages of a deceased donor.

    Kisu I, Banno K, Matoba Y, Aoki D

    Archives of gynecology and obstetrics 2019; (299(5)):1213-1214 doi:10.1007/s00404-019-05138-4.

    PMID: 30941557
  10. 10

    Awareness and Interest in Uterus Transplantation over Time: Analysis of Those Seeking Surgical Correction for Uterine-Factor Infertility in the US.

    Johannesson L, Testa G, Beshara MM, et al.

    Journal of clinical medicine 2023; (12(13)) doi:10.3390/jcm12134201.

    PMID: 37445236
  11. 11

    Immunosuppression after uterus transplantation.

    Martin F, Tullius SG

    Current opinion in organ transplantation 2021; (26(6)):627-633 doi:10.1097/MOT.0000000000000925.

    PMID: 34581290
  12. 12

    Reproductive Technology Considerations in Uterus Transplant.

    Walter JR, O'Neill KE

    Clinical obstetrics and gynecology 2022; (65(1)):68-75 doi:10.1097/GRF.0000000000000684.

    PMID: 35045027
  13. 13

    Hysterectomy after uterus transplantation and detailed analyses of graft failures.

    Karlsson CC, Dahm-Kähler P, Kvarnström N, et al.

    Acta obstetricia et gynecologica Scandinavica 2022; (101(3)):355-363 doi:10.1111/aogs.14304.

    PMID: 34907538
  14. 14

    Feasibility of Near-Infrared Spectroscopy for Monitoring Tissue Oxygenation During Uterus Transplantation and Hysterectomy.

    Applebaum J, Zhao D, Latif N, O'Neill K

    Journal of clinical medicine 2025; (14(14)) doi:10.3390/jcm14144832.

    PMID: 40725523
  15. 15

    How do women with Rokitansky syndrome and healthcare professionals reflect on the provision of uterine transplantation? Insights from an interview study in France, Norway, and Sweden.

    Carton I, Dion L, Lavoué V, Hofmann BM

    Acta obstetricia et gynecologica Scandinavica 2025; (104(3)):502-513 doi:10.1111/aogs.15016.

    PMID: 39775594
  16. 16

    Multiorgan system structural malformations associated with Mayer-Rokitansky-Küster-Hauser Syndrome (MRKHS) type 2: avoiding pitfalls in diagnosis, counseling and treatment.

    Ghosh N, Moon JH, Henderson JA, Kauffman RP

    BMJ case reports 2018; (2018()) doi:10.1136/bcr-2018-225977.

    PMID: 30065057

This page provides educational information about fertility and family-building options for MRKH syndrome. Always consult a reproductive endocrinologist or fertility specialist to discuss the best medical paths for your specific situation.

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