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Hysteroscopy pp 725-741 | Cite as

Hysteroscopy and Stem Cell Therapy to Approach Refractory Asherman’s Syndrome

Chapter

Abstract

The endometrium is the tissue that lines the inside of the uterine cavity and whose function is to enable implantation of the embryo at the right moment. In the case that implantation of the embryo does not occur, the endometrium is partially destroyed and menstruation takes place, producing a new generation of tissue (upper 2/3), in the next menstrual cycle. It is therefore a tissue with a high capacity for renewal (“self-renewal”) regulated by hormones [1] that undergoes almost complete changes of growth, differentiation and shedding every 28 days during 400–500 cycles during a woman’s reproductive lifetime and also postmenopause with proper hormone replacement therapy. This level of tissue regeneration is only comparable to other tissues with high cellular turnover, such as epidermis, gut epithelium and bone marrow. An increasing number of studies which constitute the current knowledge about endometrium-derived stem cells (EDSCs) have been published in the last decade [2]. Histologically, the endometrium is divided into two functional layers: the basal and functional layers. The functional layer responds to progesterone and oestradiol, and this layer is completely shed during menstruation. The basal layer does not respond to hormones and also does not suffer desquamation, from which it regenerates the mucosa. The human endometrium is composed primarily of two main cell types, epithelial cells (luminal and glandular) and supporting mesenchymal cells (stromal cells), as well as endothelial cells and leukocytes. Additionally, endometrial–myometrial junction is irregular with no submucosal tissue to separate endometrial glandular tissue from the underlying smooth muscle of the myometrium [3].

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Asheman’s Project Director, IgenomixPaternaSpain
  2. 2.Ob/Gyn IVI BarcelonaBarcelonaSpain
  3. 3.Minimally Invasive Gynecologic Surgery and Infertility, Obstetrics and Gynecology, Newton Wellesley HospitalHarvard Medical SchoolBostonUSA

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