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

Chaitanya B Nagori, Sonal Y Panchal, Himanshu Patel, Chaitanya B Nagori, Sonal Y Panchal, Himanshu Patel

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.

Keywords: Adult stem cells; Asherman's syndrome; endometrial regeneration; endometrial thickness; hormone replacement therapy.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Hysteroscopic picture - Endometrial adhesions
Figure 2
Figure 2
Postadhesiolysis hysteroscopic picture
Figure 3
Figure 3
Thin endometrium after removal of IUCD in preovulatory period
Figure 4
Figure 4
Well-developed endometrium with low-resistance vascularity reaching zone 4
Figure 5
Figure 5
Gestational sac, yolk sac, and embryonic pole after embryo transfer and positive β-hCG test
Figure 6
Figure 6
M-mode of cardiac activity of embryo
Figure 7
Figure 7
3D picture of 8 weeks scan

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