The Royal Veterinary College was involved in pioneering research that ultimately led to the first baby delivered following a womb transplant. The birth of baby Amy, at Queen Charlotte’s and Chelsea Hospital, in February 2025, was the culmination of decades of research involving a number of institutions, including Imperial College, the University of Oxford and the RVC.

Professor Richard Smith, who co-leads the UK living donor programme, has a long-standing collaborative relationship with the RVC. Professor Smith is the founder and chair of the charity Womb Transplant UK, Consultant Gynaecological Surgeon at Imperial College NHS Trust and Professor of Practice at Imperial College.

Background

In 1995 Professor Smith was on sabbatical at New York University’s Medical Centre, where the team had started to develop a procedure called abdominal radical trachelectomy, which would enable young women with cervical cancer to retain their fertility. At the time it was thought that the uterus required uterine as well as ovarian vessels to be viable. The team recognised that they needed to anastomose (connect) uterine vessels and were concerned that those vessels would not expand in pregnancy.

Professor Smith contacted David Noakes, Professor of Veterinary Obstetrics and Diseases of Reproduction at the RVC, which began a 20-year collaborative journey together, ably assisted by highly talented animal technicians who cared for the animals involved in their studies. They discovered that uterine arteries and veins are capable of anastomosis and will expand and function in pregnancy. 

A series of uterine transplants in pigs unfortunately failed, as organs developed microvascular thrombosis. However, this led to the development of the macrovascular technique now used worldwide. This research was originally performed on cadavers of pigs, rabbits and humans.

The porcine research led to two series of rabbit uterine transplants. The first failed, with pulmonary emboli and other complications. However, with modifications to techniques, they achieved the third pregnancy in the world in a transplanted uterus.

The team subsequently undertook five transplants in sheep to demonstrate that they could perform the internal iliac to external iliac anastomoses required to move this technology into the human setting.

Applications, benefits and advances

That early collaboration at the RVC ultimately changed the face of infertility management for women with absolute factor uterine infertility. The animal research work conducted at the RVC led to Professor Smith’s team receiving ethics approval to perform uterine transplants in women in 2015. After many regulatory hurdles, the team finally performed the UK’s first uterine transplant in February 2023, followed by the delivery of the first baby, Amy, in February 2025.  

In addition to the birth of Amy and the other babies who will follow, the past three decades of womb transplant research have led to the development of a number of other surgical procedures. This includes abdominal radical trachelectomy, which has enabled fertility preservation of many thousands of women with early-stage cervical cancer. It also enabled the development of the modified Strassman Procedure, which has preserved the reproductive potential of women with placental site tumours and other conditions.  These procedures are now carried out worldwide.

Professor Noakes also helped Professor Smith’s team in the early days of investigating endometrial transplants for women with no functioning endometrium (Asherman’s syndrome).

Professor Smith states ‘We owe a huge debt to David Noakes and the RVC in assisting us to make this progress in the treatments we can offer women today’.