Finally a cure for Asherman’s syndrome?

OpCE17Human Reproduction Keynote lecture by Carlos Simon

For this honorary lecture again the most frequently downloaded original Human Reproduction paper of the preceding year was selected by the editors of the journal. For the first time this year also the paper’s AltMetrics score was taken into account, as a reflection of social media attention.

In a full auditorium (picture; 3499 seats taken, one left), Dr Carlos Simon presented the Human Reproduction Keynote lecture 2017. In this pilot study, the authors asked themselves whether bone marrow-derived stem cells could offer a safe and efficient therapeutic approach for patients with refractory Asherman’s syndrome, and a wish to conceive. In a group of ‘difficult’ patients resistant to conventional treatment they found that in the first 3 months, autologous cell therapy in conjunction with hormonal replacement therapy increased the volume and duration of menses as well as the thickness and angiogenesis processes of the endometrium while decreasing intrauterine adhesion scores. 11 Asherman patients completed the study. All exhibited an improved uterine cavity 2 months after stem cell therapy. Endometrial thickness increased from an average of 4 mm to 7 mm. The cell therapy increased the mature vessel density and the duration and intensity of menses in the first 3 months, with a return to the initial levels 6 months after the treatment. Three patients became pregnant spontaneously, resulting in one baby born, one ongoing pregnancy and one miscarriage. In addition, 7 pregnancies were recorded after 14 embryo transfers, resulting in 3 biochemical pregnancies, 1 miscarriage, 1 ectopic pregnancy, 1 baby born and 1 ongoing pregnancy. Observational studies like this one are the first step towards more rigorous, comparative studies. Dr Simon pointed out that limitations of this pilot study include the small sample size and the lack of controls, but he suggested that autologous bone marrow-derived stem cell therapy is a promising therapeutic option for patients with otherwise incurable endometrial pathologies and a desire to conceive. He finally mentioned the collaboration between the authors and the expert reviewers and editors of Human Reproduction. He applauded it, thanked the journal and characterized the review process as a time consuming but very rewarding experience.

 Hans Evers, Editor in Chief of Human Reproduction

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