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PubMed This is a summary of 18 peer-reviewed journal articles Updated

Fertility Options & Family Planning

At a Glance

Individuals with MRKH Type 2 have functioning ovaries and can have biological children. The most established pathway is In-Vitro Fertilization (IVF) with gestational surrogacy, while uterine transplantation is an emerging option for carrying a pregnancy.

While a diagnosis of MRKH means you cannot carry a pregnancy yourself, it does not mean you cannot be a parent or have a biological child. Because your ovaries are present and functioning normally, they continue to produce your own eggs [1][2]. When you are ready to start a family, there are two primary medical pathways—one established and one emerging—that can help you have a child that is genetically your own.

Genetic Counseling Before Family Planning

Because MRKH is multifactorial and involves certain genetic variants (such as HOX, WNT, and GREB1L), it is highly recommended to consult with a genetic counselor before pursuing biological parenthood [3][4]. A counselor can review your specific genetic panel and discuss the potential risk of passing MRKH or associated Type 2 features to a biological child [5][6].

The Standard Pathway: IVF and Gestational Surrogacy

For many years, the primary way for individuals with MRKH to have biological children has been through gestational surrogacy using In-Vitro Fertilization (IVF) [1].

  • Egg Retrieval: A reproductive endocrinologist uses medication to stimulate your ovaries to produce multiple eggs. These eggs are then retrieved through a minor procedure. In MRKH Type 2, this can sometimes be more complex; for example, the presence of a pelvic kidney or highly placed ovaries may require specialized ultrasound or laparoscopic techniques to reach the eggs safely [7][8].
  • Embryo Creation: The retrieved eggs are fertilized with sperm in a laboratory to create embryos.
  • Gestational Carrier: One or more embryos are transferred into the uterus of another person (the surrogate), who carries the pregnancy and gives birth to the baby.

This pathway has a high success rate and is a well-established medical and legal process in many parts of the world [1].

An Emerging Option: Uterine Transplantation

Uterine transplantation (UTx) is a newer, more complex option that allows a person with MRKH to carry their own pregnancy. While it was once considered purely experimental, it has now resulted in successful live births globally [9][10].

It is important to understand the significant commitment this path requires:

  • Major Surgeries: You would undergo a surgery to receive the uterus (from either a living or deceased donor), a Cesarean section to deliver the baby, and eventually a third surgery to remove the uterus after your child-bearing (typically 1-2 pregnancies) is complete [11][12].
  • Immunosuppression: To prevent your body from rejecting the new organ, you must take anti-rejection medications daily until the uterus is removed [13][12].
  • Access: This procedure is currently available only at specialized medical centers and is often part of ongoing clinical research [10][14].

Considerations for MRKH Type 2

Because MRKH Type 2 often involves kidney (renal) differences, there are extra factors to consider when planning for the future:

  • Kidney Function: Maintaining healthy kidney function is vital, especially if you consider uterine transplant. The anti-rejection medications used in transplantation can sometimes be hard on the kidneys [15].
  • Anatomy: If you have a pelvic kidney or unique blood vessel patterns in your pelvis, a transplant surgery might be more complex. Your surgeons would need to carefully map your anatomy using MRI before any procedure [16][15].

Looking Forward

Family planning is a long-term journey. You do not need to make any decisions today. Whether you choose surrogacy, explore transplantation, or choose a path like adoption, there are many ways to build a family. Your medical team and specialized counselors are there to provide more information and support whenever you feel ready to explore these options [17][18].

Common questions in this guide

Can I have biological children if I have MRKH Type 2?
Yes, individuals with MRKH have functioning ovaries that naturally produce eggs. Because of this, you can have biological children using your own eggs through IVF and gestational surrogacy, or potentially through an emerging procedure like uterine transplantation.
How does a pelvic kidney affect egg retrieval for MRKH patients?
If you have a pelvic kidney or highly placed ovaries, standard transvaginal egg retrieval might be more difficult. Your reproductive endocrinologist may need to use specialized ultrasound or laparoscopic techniques to reach your eggs safely.
Is a uterine transplant an option for people with MRKH?
Yes, uterine transplantation is an emerging surgical option that has resulted in successful live births. However, it requires major surgeries, daily anti-rejection medications, and is currently only available at specialized medical centers.
Should I see a genetic counselor before having children with MRKH?
Yes, because MRKH Type 2 involves certain genetic variants, consulting a genetic counselor is highly recommended. A counselor can review your genetic panel and discuss the chances of passing MRKH or associated features to your child.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on my MRI, are my ovaries in a typical position for future egg retrieval?
  2. 2.How does my solitary or pelvic kidney affect my eligibility for transvaginal egg retrieval or future surgery?
  3. 3.What is my current 'ovarian reserve' or egg count, and when is the best time to check this?
  4. 4.Can you provide a referral to a reproductive endocrinologist who has experience specifically with MRKH patients?
  5. 5.Which medical centers in our region are currently performing uterine transplants or clinical trials for them?

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 (18)
  1. 1

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

    Obstetrics and gynecology 2018; (131(1)):e35-e42 doi:10.1097/AOG.0000000000002458.

    PMID: 29266078
  2. 2

    A rare case of 46,XX gonadal dysgenesis, Mayer-Rokitansky-Kuster-Hauser syndrome, pituitary and thyroid hypoplasia.

    Ambachew R, Gulilat A, Aberra T, et al.

    Endocrinology, diabetes & metabolism case reports 2022; (2022()).

    PMID: 35142292
  3. 3

    Syndrome Mayer-Rokitansky-Küster-Hauser - uterine and vaginal agenesis: current knowledge and therapeutic options.

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

    Ceska gynekologie 2019; (84(5)):386-392.

    PMID: 31826637
  4. 4

    Mayer-Rokitansky-Küster-Hauser syndrome type II. Case report.

    Calle JJR

    JBRA assisted reproduction 2025; (29(4)):827-833 doi:10.5935/1518-0557.20250057.

    PMID: 41165215
  5. 5

    Genetics of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome: advancements and implications.

    Herlin MK

    Frontiers in endocrinology 2024; (15()):1368990 doi:10.3389/fendo.2024.1368990.

    PMID: 38699388
  6. 6

    GREB1L variants in familial and sporadic hereditary urogenital adysplasia and Mayer-Rokitansky-Kuster-Hauser syndrome.

    Jacquinet A, Boujemla B, Fasquelle C, et al.

    Clinical genetics 2020; (98(2)):126-137 doi:10.1111/cge.13769.

    PMID: 32378186
  7. 7

    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
  8. 8

    Spectrum of MRI Appearance of Mayer-Rokitansky-Kuster-Hauser (MRKH) Syndrome in Primary Amenorrhea Patients.

    Boruah DK, Sanyal S, Gogoi BB, et al.

    Journal of clinical and diagnostic research : JCDR 2017; (11(7)):TC30-TC35 doi:10.7860/JCDR/2017/29016.10317.

    PMID: 28893003
  9. 9

    Uterus Transplant in Women With Absolute Uterine-Factor Infertility.

    Testa G, McKenna GJ, Wall A, et al.

    JAMA 2024; (332(10)):817-824 doi:10.1001/jama.2024.11679.

    PMID: 39145955
  10. 10

    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
  11. 11

    Immunologic and Infectious Concerns in Uterus Transplantation.

    Porrett PM, Nellore A

    Clinical obstetrics and gynecology 2022; (65(1)):37-43 doi:10.1097/GRF.0000000000000686.

    PMID: 35045023
  12. 12

    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
  13. 13

    Immunosuppression in Uterus Transplantation: Experience From the Dallas Uterus Transplant Study.

    Wilson NK, Schulz P, Wall A, et al.

    Transplantation 2023; (107(3)):729-736 doi:10.1097/TP.0000000000004437.

    PMID: 36445981
  14. 14

    Uterus transplantation-questions and answers about the procedure that is expanding the field of solid organ transplantation.

    Wall AE, Testa G, Axelrod D, Johannesson L

    Proceedings (Baylor University. Medical Center) 2021; (34(5)):581-585 doi:10.1080/08998280.2021.1925064.

    PMID: 34456477
  15. 15

    Living-Donor Kidney Transplant in a Patient With Type B Mayer-Rokitansky-Küster-Hauser Syndrome, Reconstructed Vagina, and Abnormal Pelvic Vessels: A Case Report.

    Campise M, Ferraresso M, Favi E, et al.

    Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation 2019; (17(2)):266-268 doi:10.6002/ect.2016.0220.

    PMID: 28540840
  16. 16

    Genetic Screening and Teratogenic Exposures: Considerations in Caring for the Uterus Transplant Patient.

    Wang EY, Perni UC, Gregg AR

    Clinical obstetrics and gynecology 2022; (65(1)):76-83 doi:10.1097/GRF.0000000000000677.

    PMID: 35045028
  17. 17

    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
  18. 18

    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

This page explains fertility and family planning options for individuals with MRKH Type 2 for educational purposes only. Always consult a reproductive endocrinologist or genetic counselor about your specific medical situation.

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