Intrauterine infusion of autologous endometrial stem cells for the treatment of moderate and severe intrauterine adhesions: a before-and-after study.

BACKGROUND

Intrauterine adhesions (IUAs) can easily cause female infertility or recurrent abortion, but there is still no effective treatment to improve the pregnancy and live birth rates in patients with IUAs. In recent years, great advances have been made in stem cell therapy; however, additional clarity is needed on the clinical efficacy of endometrial stem cells in the treatment of IUAs.

MATERIALS AND METHODS

Fifteen patients with moderate-to-severe IUAs were included in the study at Xiangtan Central Hospital from 2018 to 2020. Patients were treated with endometrial stem cells and sodium hyaluronate gel by intrauterine perfusion in combination with estrogen and acetylsalicylic acid support therapy. Then, data on the pregnancy and live birth status was collected within two years after treatment. To explore the underlying mechanism, primary endometrial stem cells from healthy individuals and IUA patients, as well as fifth-generation endometrial stem cells from IUA patients, were further conducted with RNA sequencing to screen for differentially expressed genes, which were subsequently used for functional enrichment analysis.

RESULTS

After endometrial stem cell transplantation into the uterine cavity, the American Fertility Society scores of all patients decreased, and hysteroscopy revealed an improvement in the uterine condition and a reduction in adhesion symptoms. The total pregnancy rate of the 15 patients was 60.0% and the live birth rate was 53.3%. In addition, RNA sequencing analysis revealed that the cytokine - cytokine receptor interaction was associated with endometrial repair by endometrial stem cells.

CONCLUSIONS

Intrauterine infusion of autologous endometrial stem cells is highly effective for patients with moderate-to-severe IUA, and is a promising treatment strategy.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, CHICTR1800016769, Registered 22 June 2018- Retrospectively registered, https://www.chictr.org.cn/showproj.html?proj=27042 .