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THE first womb transplant was performed two years ago on a 26-year-old woman in Saudi Arabia, it’s been revealed. But there are still major hurdles to be overcome before a baby is born this way.

“Our results with the first human uterine transplantation confirm the feasibility and safety of this procedure,” say the team of surgeons at the King Fahad Hospital and Research Center in Jeddah. The transplanted womb appeared to function properly, but had to be removed after three months because of major clotting in associated blood vessels. The surgeons say refinements to the surgical procedure should overcome the blood supply problems.

But others are unconvinced. “The uterus is a very dynamic and complex organ, and it is hugely blood-flow dependent,” says David Barlow of the assisted reproduction unit at the John Radcliffe Hospital in Oxford and editor of the journal Human Reproduction. The four blood vessels that supply it are very small by transplant standards, making clotting more likely. These vessels would have to cope with a massive increase in blood flow during pregnancy, Barlow says.

The donor uterus came from a 46-year-old who had a hysterectomy because of ovarian cysts. The recipient had had her own uterus removed when she was 20, following severe bleeding after a caesarean. She had to take immunosuppressants to stop her body rejecting the organ. But women given womb transplants wouldn’t have to take these drugs for life—they could simply have the womb removed after having children.