Introduction
I am sharing an example of a patient case study, with all identifying details removed to protect privacy. The goal is to highlight the unique medical challenges of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, explain how IVF and surrogacy can provide solutions, and inspire hope for those navigating similar journeys.
A Diagnosis That Changed Everything
As a teenager in China, Hua* waited for her first period like every other girl her age. But it never came. After a series of medical examinations, she was diagnosed with MRKH, a rare congenital condition in which women are born without a uterus and sometimes without part of the vagina. While surgery could help create a functional neovagina, pregnancy would never be possible without a uterus. For her, it felt as if her dream of becoming a mother had been taken away before her adult life had even begun.
*Name changed for privacy
How Common Is MRKH?
According to MedlinePlus, MRKH affects about 1 in 4,500 female newborns in the United States. The American College of Obstetricians and Gynecologists (ACOG) reports a similar frequency, between 1 in 4,500 and 1 in 5,000. Though rare, the condition carries profound consequences for fertility and emotional well-being.
Why Surrogacy Became the Only Path Forward
Although women with MRKH do not have a uterus, they usually have normal ovarian function and can produce eggs. This means that with in vitro fertilization (IVF), their eggs can be fertilized with their partner’s sperm to create embryos, which can then be carried by a surrogate.
In China, surrogacy is not permitted by law. Determined to build a family, she and her husband decided to travel to the United States, where surrogacy is legally recognized and supported by advanced fertility clinics.
The Unique Challenges of IVF in MRKH Patients
Women with MRKH face particular challenges during IVF that differ from other patients:
- Cycle Monitoring Without Menstruation
Since MRKH patients do not menstruate, doctors cannot use a monthly cycle as a guide for treatment. Instead, hormone levels—especially estrogen and progesterone—must be tracked through blood tests to determine when to begin ovarian stimulation. - Alternative Egg Retrieval Techniques
Standard egg retrieval uses transvaginal ultrasound guidance, but in cases where vaginal depth is limited, a transabdominal egg retrieval may be required. Fertility specialists carefully evaluate each patient’s anatomy to determine the safest and most effective approach.
These adjustments demand more planning and expertise but make IVF possible for women with MRKH.
A Journey Marked by Loss and Perseverance
After two egg retrievals, the couple had four embryos ready for transfer. Their surrogate underwent three embryo transfers that all ended in miscarriage.
For many families, this would have been the end of the road. But they chose to continue. The surrogate stood with them after every heartbreak, sharing their grief and offering words of encouragement. Her willingness to keep going after multiple losses reflected both compassion and courage. Together, they built a bond of deep trust, united in their determination to bring new life into the world.
Finally, on the fourth transfer, success came. In October 2020, their surrogate delivered a healthy baby girl. Holding their daughter for the first time was a moment of indescribable joy and gratitude—proof that their resilience, and the surrogate’s unwavering support, had made the dream of parenthood a reality.
Expert Insight: Why Surrogacy Works for MRKH
In MRKH, the absence of the uterus makes pregnancy impossible, but the presence of functioning ovaries allows for the creation of embryos. By combining IVF with gestational surrogacy, women with MRKH can have biological children.
This case illustrates not only the medical feasibility of surrogacy for MRKH patients but also the emotional and human strength it requires. The surrogate was more than a participant—she was an essential partner in turning years of despair into the joy of motherhood.
Conclusion
For women diagnosed with MRKH, the future may feel uncertain and overwhelming. Yet modern medicine and the generosity of others offer a path forward. This story is not just about science—it is about persistence, compassion, and the unyielding human desire to create a family.
Even when biology closes one door, hope and determination can open another.
Chris (Xuemei) Zhang is a bilingual (English and Mandarin) fertility professional and writer with over 20 years of experience in healthcare and reproductive medicine. At Ivy Surrogacy, she supports families navigating surrogacy and egg donation, combining professional expertise with compassion to share stories that inspire and encourage.