Role of autologous bone marrow-derived stem cell therapy for follicular recruitment in premature ovarian insufficiency: Review of literature and a case report of world's first baby with ovarian autologous stem cell therapy in a perimenopausal woman of age 45 year

Abstract

Stem cell (SC) therapy has come up enormously, particularly for indications where not much can be done medically or surgically to improve the condition. SCs are the foundation cells for every organ, tissue, and cell in the body, and it can either reproduce into a SC or differentiate into specialized types of cells. Premature ovarian insufficiency (POI) is a clinical syndrome defined by loss of ovarian activity before the age of 40 years. POI is characterized by menstrual disturbance (amenorrhea or oligomenorrhea) with raised gonadotropins, low anti-Mullerian hormone (AMH), and estradiol level. Autologous SCs were tried in POI to increase the follicular recruitment and avoiding the need for oocyte donation program. This review analyzes the causes, etiopathogenesis, and role of autologous bone marrow-derived SC therapy (ABMDSCT) in POI. It also highlights the recent studies and summarizes the current understanding and future directions for SCs in POI. Here, we also report the first successful birth of a baby from India, where autologous SC therapy in a 45-year-old perimenopausal single woman helped in procuring a pregnancy and delivery of a healthy 2.7 kg female baby through assisted reproduction. In the absence of SC therapy, accepting oocyte donor program or adoption would have been the only viable options for this patient for which she was not ready. This may be the world's first successful case of application of ABMDSCT in a 45-year-old female to give successful birth to a healthy baby.

Novel Approaches in Addressing Ovarian Insufficiency in 2019: Are We There Yet?

“…A live birth was finally achieved and the patient delivered via cesarean section at 38 weeks. No complications were observed in the pediatric follow up 33 .…”

Evaluation of safety, feasibility and efficacy of intra-ovarian transplantation of autologous adipose derived mesenchymal stromal cells in idiopathic premature ovarian failure patients: non-randomized clinical trial, phase I, first in human

“…After 8 weeks, her AMH level increased from 0.4 ng/mL to 0.9 ng/mL. An ultrasound imaging identified two follicles in each ovary and the patient became pregnant after a frozen embryo transfer cycle, which resulted in a live birth [ 25 ].…”

Live Birth After an Autologous Platelet-Rich Plasma Ovarian In Vitro Activation and Bone Marrow Stem Cells Transplantation in a Premature Ovarian Failure Case Report

“…Folliculogenesis during this period can be modulated by intraovarian growth factors through autocrine/paracrine mechanisms [17]. In addition, there are several reports that indicate a potential change in folliculogenesis conditions by using physical methods, autologous PRP growth factor treatments, and stem cell infusions [7,8,[14][15][16][17][18][19][20][21][22][23][24].…”

“…Injections of isolated BMSCs directly into the ovarian tissue or via an artery have been used extensively in the successful restoration of ovarian function in animal models of ovarian failure; however, there are currently very few studies on humans [20,21]. To the best of our knowledge, there have been only three case reports of autologous BMSCs applied in the clinical treatment of patients with ovarian failure, which resulted in successful pregnancies [22][23][24]. Both stem cell infusion and PRP treatment allow a partial reversion of aging of the ovary, by providing a better environment for follicle development, while ovarian cortex fragmentation induces folliculogenesis and in vitro activation enables the primary follicles to activate and mature, which would otherwise remain dormant in the ovary [7,23].…”

“…To the best of our knowledge, there have been only three case reports of autologous BMSCs applied in the clinical treatment of patients with ovarian failure, which resulted in successful pregnancies [22][23][24]. Both stem cell infusion and PRP treatment allow a partial reversion of aging of the ovary, by providing a better environment for follicle development, while ovarian cortex fragmentation induces folliculogenesis and in vitro activation enables the primary follicles to activate and mature, which would otherwise remain dormant in the ovary [7,23]. These are emerging treatment options for women with ovarian failure desiring pregnancy.…”