Endometrial regeneration using autologous adult stem cells followed by conception by in vitro fertilization in a patient of severe Asherman′s syndrome

Abstract

In a woman with severe Asherman's syndrome, curettage followed by placement of intrauterine contraceptive device (IUCD) (IUCD with cyclical hormonal therapy) was tried for 6 months, for development of the endometrium. When this failed, autologous stem cells were tried as an alternative therapy. From adult autologous stem cells isolated from patient's own bone marrow, endometrial angiogenic stem cells were separated using immunomagnetic isolation. These cells were placed in the endometrial cavity under ultrasound guidance after curettage. Patient was then given cyclical hormonal therapy. Endometrium was assessed intermittently on ultrasound. On development of endometrium with a thickness of 8 mm and good vascularity, in vitro fertilization and embryo transfer was done. This resulted in positive biochemical pregnancy followed by confirmation of gestational sac, yolk sac, and embryonic pole with cardiac activity on ultrasound. Endometrial angiogenic stem cells isolated from autologous adult stem cells could regenerate injured endometrium not responding to conventional treatment for Asherman's syndrome.

Endometrial stem cells repair injured endometrium and induce angiogenesis via AKT and ERK pathways

“…Recently, a case report showed that intrauterine administration of autologous BMSCs could repair the injured endometrium and result in subsequent pregnancy in a woman with severe IUAs, which was not responding to TCRA followed by the placement of IUD and cyclical hormonal therapy (Nagori et al 2011). Another study presented that autologous stem cell transplantation led to endometrial regeneration reflected by restoration of menstruation in five out of six patients with refractory Asherman's syndrome (Singh et al 2014).…”

In vitro evidence that platelet-rich plasma stimulates cellular processes involved in endometrial regeneration

“…Recently, the use of biologics has been pursued to boost the regeneration process and/or minimize post-operative adhesions, including intrauterine infusion of autologous bone marrow-derived mesenchymal stem cells (BM-MSCs) [12], human amnion graft placement [13], or autologous peripheral blood CD133+ BM-MSC delivered into the uterine spiral arterioles by catheterization [14]. These have not been widely adopted likely due to the complexity of the techniques and conflicting outcomes [12][13][14].…”

Endometrial stem cells: the clinical application (a review)

“…Так, в исследовании C. Nagori и соавт. [53] пациентке 33 лет с первичным бесплодием и синдромом Ашермана в полость матки введены аутологичные МSC (CD9 + , CD90 + , CD133 + ), полученные из костного мозга. После трансплантации и гормональной терапии отмечено увеличение толщины и васкуляризации эндометрия.…”