Unresponsive thin endometrium caused by Asherman syndrome treated with umbilical cord mesenchymal stem cells on collagen scaffolds: a pilot study

Abstract Background Unresponsive thin endometrium caused by Asherman syndrome (AS) is the major cause of uterine infertility. However, current therapies are ineffective. This study to evaluate effect transplantation with collagen scaffold/umbilical cord mesenchymal stem cells (CS/UC-MSCs) on this refractory disease. Methods Eighteen infertile women unresponsive endometrium, whose frozen–thawed embryo transfers (FETs) were cancelled due reduced endometrial thickness (ET ≤ 5.5 mm), enrolled in before and after self-control prospective study. Hysteroscopic examination was performed confirm no intrauterine adhesions, then twenty million UC-MSCs loaded onto a CS transplanted into cavity two consecutive menstrual cycles. Then assessed through hysteroscopy transplants. FETs following cycle. Pregnancy outcomes followed up. Endometrial thickness, receptivity angiogenesis, proliferation hormone response compared treatment. Results Sixteen patients completed No treatment-related serious adverse events occurred. Three months transplantation, average ET increased from 4.08 ± 0.26 mm 5.87 0.77 ( P < 0.001). 15 FET got pregnant, whom 2 gave birth successfully 1 had miscarriage at 25 weeks’ gestation. One without natural pregnancy normally transplantation. Immunohistochemical analysis showed micro-vessel density, upregulated expression Ki67, estrogen receptor alpha, progesterone receptor, indicating an improvement proliferation, hormones. Conclusion CS/UC-MSCs promising potential approach for treating AS. Trial registration ClinicalTrials.gov NCT03724617 . Registered 26 October 2018—prospectively registered, https://register.clinicaltrials.gov/