Autologous Bone Marrow–Derived Stem Cell Therapy for Asherman's Syndrome and Endometrial Atrophy — 5‑Year Follow‑Up (Singh et al., 2020)

Neeta Singh, Bhawani Shekhar, Sujata Mohanty, Sunesh Kumar, Tulika Seth, Bhavana Girish J Hum Reprod Sci. 2020 Jan–Mar;13(1):31–37. PMID: 32577066 · PMCID: PMC7295252 · DOI: 10.4103/jhrs.jhrs6419

Keywords: Asherman’s syndrome, endometrial atrophy, bone marrow, stem cells

Conflict of interest: None declared.

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This study reports a small clinical trial where doctors used a patient's own bone marrow stem cells to help rebuild a thin or scarred uterine lining (endometrium). The idea is that bone marrow stem cells can help repair tissues that don't respond to conventional treatments. Over 5 years of follow‑up, many patients showed thicker endometrium, resumed menstrual bleeding, and a few achieved pregnancy. The results are promising for regenerative medicine and suggest potential value in having access to a patient’s own stem cells for future therapies — one reason people consider stem cell banking.

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• The endometrium (uterine lining) needs to be a certain thickness and healthy for normal menstruation and to support pregnancy.
• Some women develop severe scarring (Asherman’s syndrome) or very thin endometrium that does not respond to usual treatments. These conditions can cause infertility and loss of normal menstrual bleeding.
• Bone marrow (BM) contains stem/progenitor cells that can help repair tissues. Injecting a patient's own BM cells into the uterus has been proposed to regenerate the endometrium when other treatments fail.

This study tested that approach in a group of women with refractory (treatment‑resistant) Asherman’s syndrome or endometrial atrophy.

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• Type: Prospective, single‑arm, longitudinal study at a tertiary care center.
• Participants: 25 women with refractory Asherman’s syndrome (AS) or endometrial atrophy (EA).
• Intervention:
• Bone marrow was collected from each patient.
• Mononuclear cells (the fraction containing many stem and progenitor cells) were prepared and injected into the subendometrial zone (area just under the uterine lining).
• After the procedure, patients took oral estrogen for 3 months to support endometrial growth.
• Follow‑up assessments: Menstrual status and endometrial thickness (ET) by ultrasound were checked at 3, 6, 9 months and again at 5 years.

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• Number of patients: 25.
• Baseline (pre‑treatment) mean endometrial thickness (ET): 3.3 ± 1.0 mm.
• ET at 3 months: 5.1 ± 1.9 mm — statistically significant improvement (P = 0.001).
• ET at 6 months: 5.6 ± 1.5 mm — not statistically significant compared with baseline (P = 0.164).
• ET at 9 months: 6.1 ± 1.7 mm — not statistically significant compared with baseline (P = 0.135).
• ET at 5 years: no further significant change from earlier follow‑ups (mean stabilized).
• Menstruation: Of 7 patients who were amenorrheic (no periods) before treatment, 6 resumed menses after treatment.
• Fertility: 3 patients achieved a successful pregnancy during follow‑up.

Overall conclusion reported by the authors: intrauterine instillation of autologous bone marrow‑derived stem cells appears to be a promising approach for refractory AS and EA.

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• Figure 1: Change in mean endometrial thickness over the 5‑year follow‑up — shows biggest jump by 3 months and stabilization thereafter.
• Figure 2: Example ultrasound images from a single patient showing ET progression from ~3.3 mm before treatment to ~7.4 mm at 5 years.
• Figure 3: Hysteroscopic images from a patient who achieved pregnancy — shows marked reduction in intrauterine adhesions (from Grade III to Grade I) when compared pre‑ and 5 years post‑treatment.

(Images illustrate the practical tissue changes seen after the procedure.)

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Plainly put, this study demonstrates a real‑world application of autologous (self‑donor) stem cells to regenerate a specific tissue — the endometrium. Key implications:

• Autologous stem cells can be used safely to try to repair treatment‑resistant reproductive tissues. Using a patient's own cells reduces risks of rejection and some immune complications.
• For individuals considering stem cell banking, this is an example of why having access to one's own high‑quality stem cells later in life might be useful: autologous cells can enable regenerative treatments tailored to the person.
• Stem cell preservation could support future therapies not yet widely available. However, timing and type of cells matter (bone marrow vs cord blood vs adipose tissue vs other sources), and not all stored cell types are interchangeable.
• This study used freshly collected bone marrow cells. If cells are banked earlier (e.g., cord blood at birth), their characteristics may differ from adult bone marrow cells; research is ongoing about which sources are best for which therapies.

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• Bone marrow contains stem and progenitor cells that can help repair damaged tissues either by:
• Directly becoming (differentiating into) some local cell types, or
• Releasing growth factors and signaling molecules that encourage local repair (paracrine effects).
• In the damaged or scarred endometrium, these cells may help rebuild tissue architecture, reduce scarring, and improve blood supply — allowing the lining to thicken and function again.

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• Small study: only 25 patients and no randomized control group. That makes it harder to be certain that all improvements were due to the stem cells rather than other factors (e.g., estrogen therapy, surgical adhesiolysis performed earlier).
• Single‑arm design: stronger evidence requires randomized controlled trials comparing stem cell therapy to standard care or placebo.
• Long‑term safety: this 5‑year follow‑up is encouraging, but larger studies are needed to confirm safety and reproducibility.
• Procedure is specialized: requires bone marrow harvesting, cell processing, and intrauterine injection — all under experienced clinical teams and regulatory oversight.

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• This study supports the idea that autologous stem cell therapies can have meaningful regenerative effects for specific conditions (here, uterine lining problems that cause infertility).
• If you are considering stem cell banking because you want future access to autologous cells for regenerative therapies:
• Understand which cell types different banks store (cord blood, cord tissue, adult adipose, bone marrow options are different).
• Consider that many regenerative procedures in current trials use bone marrow–derived or mesenchymal stem cells; cord blood/tissue may be useful for some applications but are not identical to adult bone marrow cells.
• Banking does not guarantee a cure; it's an option to preserve biological material that might be useful as therapies evolve.
• Discuss with clinicians about the types of cells most likely to be useful for the conditions you are most concerned about.
• Regulatory and clinical standards vary by country and procedure — make sure treatments are performed in established clinical trials or accredited centers.

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Autologous bone marrow‑derived cell instillation showed promising results in this small cohort of treatment‑resistant Asherman’s syndrome and thin endometrium patients: early and sustained improvements in endometrial thickness for many patients, resumed menstruation for most amenorrheic women, and several pregnancies. The data support continued research into stem cell–based regeneration of the endometrium and highlight a potential benefit of having access to one’s own stem cells for future regenerative therapies. Larger, controlled trials are needed before this becomes a standard therapy.

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Singh N, Shekhar B, Mohanty S, Kumar S, Seth T, Girish B. Autologous Bone Marrow‑Derived Stem Cell Therapy for Asherman's Syndrome and Endometrial Atrophy: A 5‑Year Follow‑Up Study. J Hum Reprod Sci. 2020 Jan–Mar;13(1):31–37. PMID: 32577066. PMCID: PMC7295252. DOI: 10.4103/jhrs.jhrs6419

For further reading, related studies and reviews cited by the authors include pilot trials and reviews on mesenchymal stem cell therapy for endometrial regeneration (see references within the full article, PMC7295252).