Regenerative capacity of mesenchymal stem cells in the management of Asherman syndrome – a systematic review and meta-analysis of clinical outcomes

Introduction
Asherman Syndrome is a refractory gynecological disorder resulting from injury to the endometrium due to various causes. The treatment of choice is hysteroscopic adhesiolysis; however, recurrence rates remain high. Stem cell therapy has emerged as a promising approach for regenerating damaged endometrium in refractory cases. So, this study aims to assess the efficacy of mesenchymal stem cell therapy in refractory Asherman syndrome unresponsive to conventional treatment.

Material and methods
The study involved the literature searched in PubMed, Embase and Google Scholar databases from inception to June 2024. We included pre- and postintervention studies. We excluded case reports, conference abstracts, articles without full texts and studies with animal trials. Women with primary or secondary infertility of the reproductive age group (aged 20–50 years) with AS (Grade I–IV) not responding to standard treatment (hysteroscopic adhesiolysis and hormonal therapy) were included. Primary outcome included pregnancy outcome and change in the endometrial thickness whereas secondary outcome included improvement in menstrual pattern.

Results
We identified 382 studies from our constructive search strategy. Finally, 12 studies with 137 women met the inclusion criteria. Stem cell therapy has been associated with an increase in endometrial thickness; the standardised mean difference was 2.09 (95% CI: 1.4–2.7). It has also been shown to improve pregnancy rate with risk ratio (RR) of 9.35 (95% CI: 4.2–24.9) and live birth rate (RR – 5.870, 95% CI: 2.071–16.633). All the patients reported improvement in menstrual function.

Conclusions
Stem cell therapy is safe and effective in improving endometrial thickness, menstrual function and pregnancy rate in women with refractory AS. However, given the limitations of our study, further studies with a large sample size are needed to validate the findings.