アッシャーマン症候群・子宮内膜萎縮の方に、幹細胞の自家移植 （実験的治療として） Autologous cell therapy with CD133＋bone marrow-derived stem cells for refractory Asherman’s syndrome and endometrial atrophy: a pilot cohort study Human Reproduction, Vol.31,No.5,pp.1087-1096,2016
Prof. Carlos Simon, who initiated ERA-RCT research with us, visited our clinic on Sunday 2. October. Whilst we discussed about fertility treatment topics, he mentioned about Prof. Yamanaka’ iPS cells, and Prof.Siomn’s utilization of stem cells for fertility treatment. So I would like to introduce this paper.
This was a prospective experimental study. There were 16 patients aged 30-45 years with refractory AS ( Asherman’s syndrome; N=11) and/or EA (endometrial atrophy; N=6) diagnosed by small menstrual bleeding and hysteroscopy.
BMDSC (bone marrow-derived stem cells) mobilization was performed by granulocyte-CSF (colony stimulating factor) injection, then CD133+cells were isolated through peripheral blood aphaeresis, and immediately delivered into the spiral arterioles by catheterization. Subsequently, 3 and 6 months later the endometrium was assessed.
All 11 AS patients and 4 out of 5 EA patients experienced an improved endometrial thickness two months after stem cell therapy. The beneficial effects of 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. Surprisingly 10 pregnancies were obtained by embryo transfers or natural intercourse.
At our clinic, there is a patient who underwent laser operation for Asherman’s syndrome and afterword became pregnant naturally. With an operation there is a risk of re-adhesion, but I believe that Dr. Tada is highly skilled in performing uterus operations.
This is the paper published in March 2016 which showed the proportion of clinicians across Australia, New Zealand and the UK that are currently offering or recommending endometrial scratching for subfertility from August to October of 2015. The result was 83% of clinicians responding to this survey are recommending endometrial scratching for women undergoing IVF, mainly for repeated implantation failure.
In our clinic, we have a technique with intrauterine fiberscope and curettage of the endometrium, also known as IFCE. We have implemented this procedure since 2010, which is 6years ago. If there is an endometrial polyp, we will remove it at a later stage. If there is chronic endometriosis, we will prescribe suitable antibiotics. Even though the endometrium is histopathologically normal, scratching itself works effectively for the next pregnancy. And the important point is the site of scratch and embryo transfer should be close. That’s why in this paper scratching and transfer are done in the same facilities. http://www.oakclinic-group.com/english/funin_eg/ss_ifce_eg.html
By the way, these three countries are the members of Commonwealth of Nations, which includes Canada, Australia etc. They have their own Olympic games every 4 years. I understand why Queen Elizabeth’s face is carved on the Australian coins.