According to the World Health Organization (WHO), data from Demographic and Health Surveys and WHO revealed that one of 4 couples reported an issue of infertility. Female infertility pattern was seen from 1990 to 2020 from 190 countries.
So how exactly is the term infertility defined, “Infertility is the failure to achieve any pregnancy (including a miscarriage) for at least 12 months”, according to Zhao et al, 2019. In females, infertility is caused by many conditions such as endometriosis, disorders in ovulation such as polycystic ovary syndrome or the presence of tumours or polyps in the uterus or cervix. In certain conditions of female infertility, though the effectiveness of hormone replacement therapy has been shown, a major risk is cancer (Vermeulen et al, 2019). Other approaches to treat infertility include assisted reproductive technologies that however show a risk of multiple pregnancies (Practice Committee of American Society for Reproductive Medicine, 2012).
While looking at other options, Mesenchymal Stem Cells (MSCs) that can be isolated from many tissues such as bone marrow, umbilical cord, adipose tissue, etc. enter the scene. A team led by Abd-Allah reported in Cytotherapy (2013) that the number of follicles and estrogen levels were increased in rabbit models of infertility when bone marrow stromal cells from male rabbits were administered.
For the treatment of Asherman syndrome, a cause of infertility due to lack of a normal opening of the female reproductive tract or the fallopian tubes to the vagina, MSCs have shown promise. Zhao and team (2019) in Stem cells International discussed that the endometrium was restored in Asherman syndrome patients by introducing bone marrow stromal cells. The introduction of MSCs derived from adipose tissue along with estrogen regenerated the endometrium in a rat model of Asherman syndrome (Kilic et al, J Assist Reprod Genet, 2014).
Seven patients with severe Asherman syndrome were administered autologous menstrual blood mesenchymal stem cells (MB-MSCs) in a 2016-published human trial. When coupled with hormone stimulation, the endometrium increased in thickness and fertility was restored: a spontaneous pregnancy in one and embryo transfer-based pregnancy in 2 (Tan et al, Hum Reprod, 2016).
These results show the promise of MSCs in treating female infertility: making the dream of most couples come true-to become parents!
Zhao, Y. X., Chen, S. R., Su, P. P., Huang, F. H., Shi, Y. C., Shi, Q. Y., & Lin, S. (2019). Using Mesenchymal Stem Cells to Treat Female Infertility: An Update on Female Reproductive Diseases. Stem cells international, 2019, 9071720. https://doi.org/10.1155/2019/9071720.
Vermeulen RFM, Korse CM, Kenter GG, Brood-van Zanten MMA, Beurden MV. Safety of hormone replacement therapy following risk-reducing salpingo-oophorectomy: systematic review of literature and guidelines. Climacteric. 2019 Aug; 22(4):352-360.
Practice Committee of American Society for Reproductive Medicine. Multiple gestation associated with infertility therapy: an American Society for Reproductive Medicine Practice Committee opinion. Fertil Steril. 2012 Apr; 97(4):825-34.
Abd-Allah SH, Shalaby SM, Pasha HF, et al. Mechanistic action of mesenchymal stem cell injection in the treatment of chemically induced ovarian failure in rabbits. Cytotherapy. 2013 Jan; 15(1):64-75
Kilic S, Yuksel B, Pinarli F, Albayrak A, Boztok B, Delibasi T. Effect of stem cell application on Asherman syndrome, an experimental rat model. J Assist Reprod Genet. 2014 Aug; 31(8):975-82.
Tan J, Li P, Wang Q, Li Y, Li X, Zhao D, Xu X, Kong L. Autologous menstrual blood-derived stromal cells transplantation for severe Asherman’s syndrome. Hum Reprod. 2016 Dec; 31(12):2723-2729.