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Autologous bone marrow-derived nucleated cell (aBMNC) transplantation improves endometrial function in patients with refractory Asherman’s syndrome or with thin and dysfunctional endometrium

  • Reproductive physiology and disease
  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose

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).

Study design

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.

Results

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.

Conclusions

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

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Acknowledgments

We thank Professor Erdal Karaoz (PhD) for his comments on previous and final versions of the manuscript and Ayşenur Kocaoglu and Beril Mensure Karakan, for their technical asistance.

Funding

Partial financial support (for equipment and supplies only) was received from Yeniyüzyil University, Gaziosmanpasa Hospital.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Altinbaş University, Medical Park Bahçelievler Hospital, Kültür Sok. No. 1 E5 Yolu, 34160 Bahçelievler, Istanbul, Turkey

    Gurkan Arikan, Volkan Turan & Meryem Kurekeken

  2. Istanbul Health and Technology University, Faculty of Medicine, Istanbul, Turkey

    Volkan Turan

  3. Reproductive Medicine and Infertility Center, Hisar Intercontinental Hospital, Istanbul, Turkey

    Meryem Kurekeken

  4. Department of Hematology, Yeni Yuzyil University Gaziosmanpaşa Hospital, Istanbul, Turkey

    Hasan Sami Goksoy

  5. Bone Marrow Transplantation Center, Yeni Yuzyil University Gaziosmanpaşa Hospital, Istanbul, Turkey

    Zeynep Dogusan

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  1. Gurkan Arikan
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  2. Volkan Turan
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  3. Meryem Kurekeken
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  4. Hasan Sami Goksoy
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Contributions

All authors contributed to the study conception and design. The study was conducted by Gurkan Arikan. The transplantations of aBMNC were performed by Gurkan Arikan, Volkan Turan, and Meryem Kurekeken. The BM aspirations were performed by Hasan Sami Göksoy. The Cell laboratory was run by Zeynep Dogusan. Statistical analyses was performed by Volkan Turan and Meryem Kurekeken. All authors made substantial contributions to the conception and design of the work or to the acquisition, analysis, and interpretation of the data. The first draft of the manuscript was written by Gurkan Arikan and Volkan Turan, and all authors commented on previous versions of the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Gurkan Arikan.

Ethics declarations

Ethics approval, consent to participate, and consent to publish

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional ethics committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Bioethics Committee of the Medical University of Yeniyüzyil University (TRN 047, 26.12.2018). Informed consents for participation and for publication of the data were obtained from all patients.

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The authors declare no competing interests.

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Arikan, G., Turan, V., Kurekeken, M. et al. Autologous bone marrow-derived nucleated cell (aBMNC) transplantation improves endometrial function in patients with refractory Asherman’s syndrome or with thin and dysfunctional endometrium. J Assist Reprod Genet 40, 1163–1171 (2023). https://doi.org/10.1007/s10815-023-02727-w

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