Autologous bone marrow-derived nucleated cell (aBMNC) transplantation improves endometrial function in patients with...

The purpose was to evaluate the effect of intrauterine injection of aBMNC on the endometrial function in patients with refractory Asherman's syndrome (AS) and/or thin and dysfunctional endometrium (TE).

This is a prospective, experimental, non-controlled study MATERIAL AND METHODS: The study was carried out between December 2018 and December 2020 on 20 patients, who were of age < 45 years and had oligo/amenorrhea and primary infertility due to refractory AS and/or TE. One hundred ml BM was extracted. aBMNC cells were separated according to generic volume reduction protocol by using the Cell Separation System SEPAX S-100 table top centrifuge system. We have evaluated CD34+, mononuclear cell (MNC), and total nucleated cell (TNC) counts. The transplantation aBMNC was performed by two intrauterine injections at an interval of one week, transvaginally into the endometrial-myometrial junction by an ovum aspiration needle. Midcyclic endometrial thickness (ET) and gestations after transplantation were evaluated.

The mean TNC, MNC, and CD34+ cells were 11.55 ± 4.7 × 10⁸, 3.85 ± 2.01 × 10⁸, and 7.00 ± 2.88 × 10⁶ at first injection, respectively, and 6.85 ± 2.67 × 10⁸, 2.04 ± 1.11 × 10⁸, and 3.44 ± 1.31 × 10⁶ at second injection, respectively. The maximum posttransplantation ET was significantly higher than the maximum pretransplantation ET: 2.97 ± 0.48 vs. 5.76 ± 1.19 (mean ± standard deviation, p < 0.01). Twelve patients had frozen-thaw embryo transfers after the study. In 42% (n = 5 of 12) of the patients, pregnancy was achieved. One of the five patients delivered a healthy baby at term.

Autologous BMNC transplantation may contribute to endometrial function in patients with AS and/or TE.