What is Uterine Factor Infertility?

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026

Quick Answer

Uterine factor infertility is the inability to carry a pregnancy because of structural or functional problems with the uterus, and it may affect up to about 3% of women before menopause. Causes range from being born without a uterus to hysterectomy or scarring. Uterus transplantation now offers a temporary surgical option, while surrogacy or adoption remain primary pathways for many. [1]

What the research says

• Uterus transplants succeed in most recipients, but a live birth is less certain. A systematic review of 10 studies found a uterus transplant success rate of 74.0%, with clinical pregnancy and live birth rates per embryo transfer of 36.3% and 22.0%. No significant increase in congenital or neurological complications was observed in the babies (Pereira et al., Diseases, 2025). [3]

• Pregnancies after a uterus transplant are high-risk. A systematic review of 24 articles covering 40 live births found that all deliveries were by cesarean section and 47.5% were emergency cesareans. Of the 21 elective cesareans, 52.4% were performed before 37 weeks. Risks of placenta previa and preterm birth were notably high, although the certainty of the evidence was very low because it came from case reports and case series (Brännström et al., Acta Obstetricia et Gynecologica Scandinavica, 2025). [4]

• Gestational surrogacy gives people with MRKH syndrome a good chance of a baby. In a systematic review of assisted reproduction in women with congenital uterine anomalies (55 studies), studies of gestational surrogacy in women with MRKH syndrome reported live birth rates ranging from 37% to 54%, while uterus transplantation was described as promising but still experimental (Fedele et al., Archives of Gynecology and Obstetrics, 2024). [5]

Key Takeaways

What is uterine factor infertility?

Uterine factor infertility (UFI) occurs when the uterus—the organ where a fetus develops—is unable to support a pregnancy. This condition can be devastating for those wishing to carry a child, but understanding the underlying mechanisms is the first step toward exploring solutions. UFI is generally categorized into two types: congenital and acquired. [1]

Congenital Uterine Factor Infertility

Some individuals are born without a functioning uterus due to developmental issues during fetal growth. The most well-known form is Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, a rare disorder where the uterus and vagina are missing or underformed, even though the ovaries remain functional. Because the ovaries still produce hormones, individuals with MRKH may experience normal hormonal cycles but will not have menstrual periods. [1]

Acquired Uterine Factor Infertility

Acquired UFI develops during a person's lifetime. The most direct cause is a hysterectomy, the surgical removal of the uterus. This procedure may be necessary for life-saving reasons, such as severe hemorrhage, or to treat conditions like uterine cancer, severe endometriosis, or fibroids. Other acquired factors include radiation damage from cancer treatments or the formation of extensive scar tissue, known as Asherman’s syndrome, which can block the uterine cavity. [1]

What are the symptoms of uterine factor infertility, and how is it identified?

The signs of uterine factor infertility vary depending on the specific cause. For many with congenital conditions, the first indicator is primary amenorrhea, or the failure to start menstrual periods by the teenage years.

• Absence of Menstruation: Especially in congenital cases like MRKH. [1]

• Pelvic Pain or Pressure: Often associated with fibroids or other structural issues. [1]

• Difficulty Conceiving: In acquired cases where a uterus is present but non-functional.

Because these symptoms can overlap with other reproductive issues, a professional diagnosis is essential to distinguish UFI from other forms of infertility.

What causes uterine factor infertility, and who is at risk?

Uterine factor infertility is primarily driven by structural absence or damage. While some causes are unavoidable, others are linked to medical history and surgical outcomes.

Structural Abnormalities

Conditions that change the shape or environment of the uterus can prevent an embryo from implanting or growing. This includes:

• Uterine Fibroids and Polyps: Non-cancerous growths that can distort the uterine cavity. [1]

• Asherman’s Syndrome: Scar tissue often resulting from infections or procedures like dilation and curettage (D&C). [1]

• Congenital Malformations: Irregularly shaped uteri that may be present from birth. [1]

Surgical and Medical History

A history of pelvic surgery or radiation therapy is a significant factor in acquired UFI. A hysterectomy, while sometimes the only option for treating severe disease, results in permanent uterine factor infertility.

How is uterine factor infertility diagnosed and tested?

Diagnosing UFI involves a thorough review of medical history and advanced imaging to visualize the reproductive organs.

1. Physical and Pelvic Exams: The initial step to check for structural abnormalities. [1]

2. Ultrasound: A common tool to assess the size, shape, and presence of the uterus. [1]

3. MRI (Magnetic Resonance Imaging): Provides detailed images to confirm if the uterus is missing or significantly malformed. [1]

4. Hysterosalpingogram (HSG): An X-ray test to check the shape of the uterine cavity and ensure there are no blockages.

What are the management options and modern treatments for uterine factor infertility?

For decades, the only paths to parenthood for those with UFI were adoption or gestational surrogacy. However, medical science has introduced a groundbreaking third option. [1]

Uterus Transplantation

Uterus transplantation is a complex, temporary procedure where a donor uterus is surgically placed into the recipient. [1]

• Process: The recipient undergoes IVF to create and freeze embryos before the transplant. [1]

• Temporary Nature: The transplanted uterus is intended only for one or two successful pregnancies. Afterward, it is removed via hysterectomy to avoid the long-term need for immunosuppressant drugs. [1]

• Donors: Uteri can come from living donors (often family members) or deceased donors. [1]

Surgical Repair

In some cases of acquired UFI, such as Asherman’s syndrome or certain fibroids, surgical intervention can remove scar tissue or growths, potentially restoring fertility without the need for a transplant.

What is the prognosis and outlook for uterine factor infertility?

The outlook for uterine factor infertility has improved dramatically with the advent of uterus transplants. While still a rare and highly specialized procedure, it has successfully allowed individuals who previously had no hope of carrying a child to experience pregnancy and childbirth. For those who do not choose or qualify for a transplant, surrogacy and adoption remain highly successful ways to build a family.

Conclusion

Uterine factor infertility presents unique challenges, but it is no longer an absolute barrier to parenthood. Whether through surgical restoration, the miracle of transplantation, or the selfless gift of surrogacy, there are more paths than ever before. Understanding your body and having open, honest discussions with fertility specialists are the most important steps you can take.

For more educational resources and visual guides on reproductive health, explore Rinnit's infographic templates.

Frequently Asked Questions

What is uterine factor infertility?

It is infertility caused by the absence of a uterus or a uterus that does not function correctly.

Can you be born without a uterus?

Yes, a condition called MRKH syndrome causes individuals to be born without a uterus.

What is MRKH syndrome?

A rare congenital disorder where the uterus and vagina are missing or underformed.

Do people with MRKH have ovaries?

Yes, the ovaries are typically present and functional.

What is acquired uterine factor infertility?

UFI that develops during life, often due to surgery or disease.

Can a hysterectomy be reversed?

No, a hysterectomy is the permanent removal of the uterus.

What is Asherman’s syndrome?

A condition where scar tissue forms inside the uterus, often causing infertility.

Can scar tissue be removed?

Yes, hysteroscopic surgery can often remove uterine scar tissue.

What is a uterus transplant?

A surgical procedure where a donor uterus is placed into a recipient.

Is a uterus transplant permanent?

No, it is removed after one or two successful pregnancies.

Who can donate a uterus?

Living donors (like a mother or sister) or deceased donors.

What is the main symptom of UFI?

In many cases, it is the absence of menstrual periods.

How is UFI diagnosed?

Primarily through ultrasound, MRI, and physical exams.

Does UFI affect the ovaries?

Not usually; the ovaries often function normally even if the uterus is missing.

What is gestational surrogacy?

When another person carries a pregnancy for the intended parents.

Can fibroids cause UFI?

Yes, if they are large enough to distort the uterine cavity.

What is primary amenorrhea?

Never starting menstrual periods by the teenage years.

Is UFI common?

The exact rate is not known. Estimates range from about 1 in 500 women of reproductive age up to 3% of women before menopause.

Can radiation cause UFI?

Yes, radiation for pelvic cancers can damage the uterus.

What is a D&C?

Dilation and curettage, a procedure that can sometimes lead to uterine scarring.

Are there risks to uterus transplants?

Yes, including organ rejection and the need for immunosuppressant drugs.

Do you need IVF for a uterus transplant?

Yes, embryos are created and frozen before the transplant.

Can you have a baby after a hysterectomy?

Only through a uterus transplant, surrogacy, or adoption.

What are uterine polyps?

Small growths in the lining of the uterus that can interfere with pregnancy.

Is UFI the same as ovarian failure?

No, UFI involves the uterus, while ovarian failure involves the ovaries.

Can pelvic infections cause UFI?

Yes, severe infections can lead to scarring (Asherman’s syndrome).

What is a directed donor?

A known person, like a family member, who chooses to donate an organ.

What is a non-directed donor?

An anonymous person who chooses to donate an organ.

How long does a uterus transplant last?

Only until the recipient has completed their family (1-2 babies).

Is UFI preventable?

Congenital UFI is not, but some acquired cases can be managed by avoiding unnecessary surgery.

What is an HSG test?

An X-ray that looks at the inside of the uterus and fallopian tubes.

Can uterine factor infertility cause pain?

Yes, conditions like fibroids or adenomyosis can be painful.

Does UFI affect hormone levels?

Usually not, as the ovaries produce the hormones.

What is adenomyosis?

A condition where the uterine lining grows into the muscular wall of the uterus.

Can UFI be diagnosed in children?

It is usually diagnosed in the teenage years when periods don't start.

Is surrogacy legal?

Laws vary by country and state; it is important to check local regulations.

How successful are uterus transplants?

While still new, success rates are increasing at specialized centers.

What are immunosuppressants?

Drugs that prevent the body from rejecting a transplanted organ.

Can uterine malformations be fixed?

Some, like a uterine septum, can be corrected surgically.

What is a uterine septum?

A wall of tissue that divides the uterus, which can cause infertility.

Does UFI cause early menopause?

Not by itself; the ovaries usually keep functioning. If the ovaries were removed during surgery, menopause begins.

What is the corpus of the uterus?

The main body of the uterus.

Can endometriosis cause UFI?

Severe cases can lead to scarring or the need for a hysterectomy.

What is a living non-directed donor?

An anonymous person who donates their uterus.

How many uterus transplants have been done?

By 2024, more than 80 uterus transplants had been reported worldwide, resulting in more than 30 live births.

Is UFI covered by insurance?

Coverage for infertility treatments varies widely by plan.

What is the first step if I suspect UFI?

Consult a reproductive endocrinologist or gynecologist.

Can UFI cause miscarriages?

Yes, structural issues can make it difficult to maintain a pregnancy.

What is a bicornuate uterus?

A heart-shaped uterus, which is a type of congenital malformation.

Where can I find support?

Infertility support groups and specialized medical centers offer resources.

Related Reading

Uterus Transplant: Who Qualifies, Procedure, Pregnancy and Risks explains how a donated uterus can make pregnancy possible, from donor matching and IVF to C-section birth and removal of the uterus.

References

1. Cleveland Clinic. Uterine Factor Infertility: Causes, Diagnosis & Treatment. Cleveland Clinic Health Library. Last updated May 11, 2023. https://my.clevelandclinic.org/health/diseases/17738-uterine-factor-infertility

2. Hur C, Rehmer J, Flyckt R, et al. Uterine factor infertility: a clinical review. Clin Obstet Gynecol. 2019;62(2):257-270. PMID 31021928. https://doi.org/10.1097/GRF.0000000000000448

3. Pereira A, Ribeiro F, Soares S, et al. Uterine transplantation: advances, challenges, and future perspectives. Diseases. 2025;13(5):152. PMID 40422584. https://doi.org/10.3390/diseases13050152

4. Brännström M, Bokström H, Hagberg H, et al. Maternal and perinatal outcomes of live births after uterus transplantation: a systematic review. Acta Obstet Gynecol Scand. 2025;104(3):559-578. PMID 39579025. https://doi.org/10.1111/aogs.15003

5. Fedele F, Bulfoni A, Parazzini F, et al. Assisted reproductive technology outcomes in women with congenital uterine anomalies: a systematic review. Arch Gynecol Obstet. 2024;310(5):2315-2332. PMID 39227392. https://doi.org/10.1007/s00404-024-07666-0

6. Pecorino B, Scibilia G, Ferrara M, et al. Deceased donor uterus transplantation: a narrative review of the first 24 published cases. Medicina (Kaunas). 2024;60(8):1348. PMID 39202629. https://doi.org/10.3390/medicina60081348

Disclaimer

The information provided in this article is for educational purposes only and is not intended as medical advice. Always seek the advice of a qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.