title: Autologous stem cell transplantation in refractory Asherman's syndrome: A novel cell based therapy.
abstract: BACKGROUND
  There is substantial evidence that adult stem cell populations exist in human endometrium, and hence it is suggested that either endogenous endometrial stem/progenitor cells can be activated or bone marrow derived stem cells can be transplanted in the uterine cavity for endometrial regeneration in Asherman's syndrome (AS).
  
  
  OBJECTIVE
  The objective was to evaluate the role of sub-endometrial autologous stem cell implantation in women with refractory AS in attaining menstruation and fertility.
  
  
  METHODS
  Tertiary care referral center.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  Six cases of refractory AS with failed standard treatment option of hysteroscopic adhesiolysis in the past were included. Mononuclear stem cells (MNCs) were implanted in sub-endometrial zone followed by exogenous oral estrogen therapy. Endometrial thickness (ET) was assessed at 3, 6, and 9 months.
  
  
  RESULTS
  Descriptive statistics and statistical analysis of study variables was carried out using STATA version 9.0. The mean MNC count was 103.3 × 106 (±20.45) with mean CD34+ count being 203,642 (±269,274). Mean of ET (mm) at 3 months (4.05 ± 1.40), 6 months (5.46 ± 1.36) and 9 months (5.48 ± 1.14) were significantly (P < 0.05) increased from pretreatment level (1.38 ± 0.39). Five out of six patients resumed menstruation.
  
  
  CONCLUSIONS
  The autologous stem cell implantation leads to endometrial regeneration reflected by restoration of menstruation in five out of six cases. Autologous stem cell implantation is a promising novel cell based therapy for refractory AS.
authors.affiliation: Department of Obstetrics and Gynaecology and Stem Cell Facility, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Neeta
authors.initials: N
authors.lastname: Singh
authors.affiliation: Department of Obstetrics and Gynaecology and Stem Cell Facility, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sujata
authors.initials: S
authors.lastname: Mohanty
authors.affiliation: Department of Obstetrics and Gynaecology and Stem Cell Facility, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Tulika
authors.initials: T
authors.lastname: Seth
authors.affiliation: Department of Obstetrics and Gynaecology and Stem Cell Facility, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Shankar
authors.affiliation: Department of Obstetrics and Gynaecology and Stem Cell Facility, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sruthi
authors.initials: S
authors.lastname: Bhaskaran
authors.affiliation: Department of Obstetrics and Gynaecology and Stem Cell Facility, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sona
authors.initials: S
authors.lastname: Dharmendra
keywords: Asherman's syndrome; autologous stem cells; bone marrow; endometrial regeneration