Stem cell therapy in thin endometrium and Asherman's syndrome: a systematic review and meta-analysis

To evaluate the efficacy and safety of mesenchymal stem cell (MSC)-based therapies in improving endometrial thickness and reproductive outcomes in women with refractory thin endometrium or Asherman's syndrome.

Following PRISMA 2020 guidelines, a systematic search of PubMed, Cochrane Library, Embase, Scopus, ClinicalTrials.gov, and Google Scholar through June 2025 was performed. Eighteen clinical studies involving 323 patients were included. MSCs derived from umbilical cord, bone marrow, adipose tissue, endometrium, or menstrual blood were administered via intrauterine infusion, transmyometrial injection, or scaffold-assisted delivery. The primary outcome was change in endometrial thickness; secondary outcomes included clinical pregnancy rate, live birth rate, and miscarriage rate.

Meta-analysis demonstrated a significant increase in endometrial thickness following MSC therapy compared to baseline or control (mean difference = 2.35 mm; 95 % CI, 1.97-2.74; p < 0.00001). Subgroup analysis showed the largest gains in endometrial- and adipose-derived MSC groups. Randomized controlled trials confirmed higher clinical pregnancy (OR = 2.72; p = 0.002) and live birth rates (OR = 2.27; p = 0.01), with a reduced miscarriage rate (OR = 0.24; p = 0.004). No serious adverse events were reported.

While MSC therapy appears to be safe, its efficacy must be confirmed by large-scale randomized trials before it can be presented to the public or recommended as an effective approach for endometrial regeneration.