Autologous stem cell ovarian transplantation to increase reproductive potential in patients who are poor responders

Sonia Herraiz, Mónica Romeu, Anna Buigues, Susana Martínez, César Díaz-García, Inés Gómez-Seguí, José Martínez, Nuria Pellicer, Antonio Pellicer
Fertility and Sterility 2018, 110 (3): 496-505.e1

OBJECTIVE: To evaluate effects of autologous stem cell ovarian transplant (ASCOT) on ovarian reserve and IVF outcomes of women who are poor responders with very poor prognosis.

DESIGN: Prospective observational pilot study.

SETTING: University hospital.

PATIENT(S): Seventeen women who are poor responders.

INTERVENTION(S): Ovarian infusion of bone marrow-derived stem cells.

MAIN OUTCOME MEASURE(S): Serum antimüllerian hormone levels and antral follicular count (AFC), punctured follicles, and oocytes retrieved after stimulation (controlled ovarian stimulation) were measred. Apheresis was analyzed for growth factor concentrations.

RESULT(S): The ASCOT resulted in a significant improvement in AFC 2 weeks after treatment. With an increase in AFC of three or more follicles and/or two consecutive increases in antimüllerian hormone levels as success criteria, ovarian function improved in 81.3% of women. These positive effects were associated with the presence of fibroblast growth factor-2 and thrombospondin. During controlled ovarian stimulation, ASCOT increased the number of stimulable antral follicles and oocytes, but the embryo euploidy rate was low (16.1%). Five pregnancies were achieved: two after ET, three by natural conception.

CONCLUSION(S): Our results suggest that ASCOT optimized the mobilization and growth of existing follicles, possibly related to fibroblast growth factor-2 and thrombospondin-1 within apheresis. The ASCOT improved follicle and oocyte quantity enabling pregnancy in women who are poor responders previously limited to oocyte donation.


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