Female infertility causes significant emotional distress. One of the causes of female infertility is Asherman’s syndrome. It occurs due to scar tissue formation in the uterine cavity and gradual thinning of the endometrium. Endometrium constitutes the uterine lining, which undergoes cyclic growth and detachment during the menstrual cycle. Lowering the endometrial thickness reduces its ability for embryo implantation, leading to infertility.
The present treatment modalities are associated with considerable rates of recurrence. The key aspect of Asherman syndrome is to repair and restore the endometrial thickness and thus improving fertility and reducing recurrence. It has prompted the search for a cure in the field of regenerative medicine. Stem cells present at the core of regenerative treatments have been at the forefront of therapeutic interventions for several disorders. Therefore, their potential has been explored in the Treatment of Infertility.
Female Infertility From Asherman Syndrome
Asherman syndrome, also known as intrauterine synechiae or adhesions, results from the buildup of scar tissue (also known as adhesions) in the uterine cavity. The scar develops as a result of injury or trauma to the endometrium layer or removal of the basal layer of the endometrium. They trigger an inflammation cascade as a part of repair pathways, creating adhesive bands extending from the side of the uterine cavity to the other.The causes of injury that lead to the syndrome include dilatation & curettage surgery (D&C), infections and abnormalities in placenta formation.
These adhesions diminish the space of the cavity, obstructing menstrual flow. Therefore, patients typically experience low menstrual bleeding or no bleeding at all (accompanied by pain). The injury can result in thinning of the uterine lining, reducing its ability for embryo implantation and thus leading to preterm labor, low birth weight, loss of pregnancy and even infertility.
Treatment Modalities for Asherman Syndrome
Treating the syndrome involves the removal of the adhesions or scar tissue by a minor operative procedure. The procedure requires meticulous handling to avoid further injury to the endometrial lining. Although the operative procedure removes adhesions, it cannot repair endometrial scarring or improve its thickness. Therefore, post-operative treatment such as hormone therapy is advised in order to promote regeneration of the endometrium.
Additionally, insertion of stents, intrauterine devices, or gels can also prevent the recurrence of adhesions. Monitoring of these devices alleviates the risk of damage to the uterine wall.However, despite these interventions, the recurrence rate of adhesions is 66% and remains the biggest challenge in the treatment of the syndrome. Therefore, another treatment modality is an urgent need, particularly for preventing the recurrence and promoting endometrial repair for successful pregnancy outcomes.
Stem Cell Treatment for Female Infertility
Stem cell therapy is the pioneer in the field of regeneration. Stem cells are progenitors that can transform into specific tissue cells, repairing the tissue. The notion of employing stem cells for Asherman syndrome emerged in 2004. Taylor et al. showed that the endometrium of patients who have previously received stem cells has regenerated. It spurred the research on stem cell application in the syndrome, particularly using mesenchymal stem cells (MSCs). It revealed that MSCs have the following effects on the endometrium-
- The number of endometrial cells increases due to the paracrine effects of MSCs.
- MSCs also protect the endometrium from damage.
- Stem cells elevate the expression of LIF and integrin, which regulate embryo implantation in the endometrium.
- They reverse quiescence in the endometrium, thereby increasing its regeneration by downregulating ΔNp63.
- These cells also enhance vascularization of the uterine lining by releasing angiogenic factors.
- MSCs improve endometrial thickness by their immunomodulatory effects.
- They reduce chronic inflammation and fibrosis that worsen uterine scarring.
Can Stem Cells Cure Infertility?
The positive results of stem cells for Asherman syndrome in preclinical studies have propelled its evaluation in patients. In 2011, a woman responded poorly to post-operative IUD and hormone therapy, resulting in infertility. Interestingly, stem cell therapy led to a successful pregnancy in that woman. In 2014, five out of six patients suffering from recurring syndrome resumed menstruation after stem cell treatment.
A study was conducted on a five-year follow-up after the stem cell treatment. They exhibited that stem cells improved endometrial thickness, reduced the severity levels, and restored menstrual flow. The effects were retained after five years, resulting in a successful pregnancy. The study also documented that no adverse effects occurred as a result of the therapy, whether immediately post-treatment or after 5 years. These results prove not only the efficacy of the Stem Cell Treatment for Infertility, but also emphasize the absence of any complications due to the treatment.
Future Perspectives
The effectiveness of stem cell treatment has encouraged scientists to improve its therapeutic efficacy. Two approaches have been particularly popular in this regard.
Biomaterials: One of the key obstacles in stem cell treatment is the poor survival of MSCs after infusion. Biomaterials or extracellular matrix (ECM) offer a substrate for attachment and proliferation of MSCs, ensuring their survival. For instance, MSCs within Matrigel boosted scar recovery. A clinical trial showed that individuals at a severe stage of syndrome and experiencing infertility had satisfactory pregnancy after receiving stem cells seeded on a collagen scaffold. A research group employed a degradable collagen scaffold with umbilical cord MSCs, which enhanced endometrial proliferation by prolonging contact between MSCs and the damaged site.
Exosomes: Along with growth factors, MSCs also release extracellular vesicles called exosomes. They are rich in diverse biomolecules and confer the effects of MSCs in a cell-free way. Studies demonstrated that MSC-derived exosomes induce TGFβ1, increase the proliferation of uterine tissue, decrease fibrosis, and augment vascularization. Some reports also suggest that exosomes display results in shorter time periods than MSCs.
Stem Cell Therapy for Infertility in India
India is gradually turning into a hub for innovative treatments, including regenerative medicine. A state-of-the-art therapeutic option for infertility in India is stem cell therapy, particularly for ailments like Asherman syndrome. It increases the chances of conception for women who have exhausted conventional fertility treatments.
In contrast to Western nations, patients contemplating stem cell fertility therapies in India have the advantages of individualized care and cutting-edge technology at reasonable prices. By producing premium, ethically obtained stem cells, Advancells in India is bridging the gap between regenerative medicine research and practical use in infertility therapies. The company strictly adheres to GMP regulations to guarantee the consistency of every batch of stem cells. Therefore, India has a vast and efficient ecosystem promoting stem cell treatment for Asherman Syndrome.
Conclusion
Stem cell therapy represents an advancement over the conventional treatments of Asherman’s Syndrome. It restores uterine function by promoting regeneration. This therapy offers renewed hope to many facing the infertility issue due to uterine scarring and endometrial thinning.
Clinical evidence has validated the safety and efficacy of the therapy in restoring menstruation and enabling pregnancies. While more long-term studies are still needed, stem cell therapy has been the closest to a cure for infertility from Asherman syndrome. Advancells is contributing to this therapy with its quality-assured stem cells.
FAQ’s
Q-How does Asherman’s Syndrome affect fertility?
The syndrome occurs when scar tissue forms within the uterine cavity. This scar tissue reduces the space within the uterine cavity. It is also associated with the thinning of the uterine wall responsible for embryo implantation. As a result, it can cause infertility, recurrent miscarriages, and menstrual irregularities.
Q-What are the common causes of Asherman’s Syndrome?
The most frequent causes include dilatation and curettage (D&C) procedures, uterine infections, or complications in placenta formation. These events can damage the endometrial layer, leading to inflammation and scar tissue buildup within the uterus.
Q-How does stem cell therapy treat Asherman’s Syndrome?
Stem cells promote the regeneration of the damaged endometrial tissue. The therapy helps increase endometrial thickness, reduce fibrosis, improve blood vessel formation, and restore normal uterine function. Clinical studies have reported improvement in menstrual flow and successful pregnancies following this therapy.
Q-Why should India be preferred for infertility treatments?
As compared to Western nations, India provides cutting-edge facilities, regenerative treatments, and expert specialists at more reasonable prices thereby making it a suitable destination for infertility treatment, particularly for Asherman Syndrome.
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