[Current status of intrauterine adhesion treatment and research progress in stem cell therapy]

Intrauterine adhesions (IUA) are gynecological disorders mainly characterized by menstrual abnormalities and infertility. At present, hysteroscopic adhesiolysis is the primary treatment for IUA; however, the postoperative recurrence rate remains high in patients with moderate to severe disease. In clinical practice, postoperative adjuvant therapies, including pharmacological treatment and intrauterine placement of physical barriers, are commonly applied to promote endometrial regeneration and reduce the risk of re-adhesion. These approaches show certain efficacy in patients with mild IUA, but their effects on restoring endometrial structure and improving pregnancy outcomes in moderate to severe cases remain limited. In recent years, stem cell therapy has demonstrated promising potential in endometrial repair, among which mesenchymal stem cells (MSCs) are considered the stem cell type with the greatest potential for clinical translation. MSCs can not only participate in tissue regeneration through differentiating into endometrial-related cells, but also exert indirect reparative effects through the secretion of extracellular vesicles (EVs), including anti-inflammatory, immunomodulatory, anti-fibrotic, pro-proliferative, and pro-angiogenic activities, thereby effectively promoting endometrial regeneration and improving pregnancy outcomes. However, most existing studies remain at the basic research or early clinical stage, and current clinical evidence is still insufficient. Their precise mechanisms of action and optimal application strategies also require further clarification. Future studies should focus on identifying potential therapeutic targets, systematically elucidating the mechanisms by which MSCs and their EVs contribute to IUA treatment, and promoting the standardized clinical translation of related research, with the ultimate goal of providing more effective therapeutic strategies for improving the endometrial environment and female reproductive function.