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Fertil Steril. 2018 Aug;110(3):496-505.e1. doi: 10.1016/j.fertnstert.2018.04.025. Epub 2018 Jun 28.

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

Author information

1
Fundación IVI, La Fe University Hospital, Valencia, Spain; IVI-RMA Valencia, La Fe University Hospital, Valencia, Spain; Reproductive Medicine Research Group, IIS La Fe, La Fe University Hospital, Valencia, Spain. Electronic address: Sonia.Herraiz@ivi.es.
2
Reproductive Medicine Research Group, IIS La Fe, La Fe University Hospital, Valencia, Spain; Women's Health Area, La Fe University Hospital, Valencia, Spain.
3
Fundación IVI, La Fe University Hospital, Valencia, Spain; Reproductive Medicine Research Group, IIS La Fe, La Fe University Hospital, Valencia, Spain; Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain.
4
Women's Health Area, La Fe University Hospital, Valencia, Spain.
5
IVI-RMA London, London, UK.
6
Hematology Department, La Fe University Hospital, Valencia, Spain.
7
Radiology Department, La Fe University Hospital, Valencia, Spain.
8
Fundación IVI, La Fe University Hospital, Valencia, Spain; Reproductive Medicine Research Group, IIS La Fe, La Fe University Hospital, Valencia, Spain; IVI-RMA Rome, Rome, Italy.

Abstract

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.

CLINICAL TRIAL REGISTRATION NUMBER:

NCT02240342.

KEYWORDS:

AMH; Poor responder; antral follicular count; bone marrow-derived stem cell transplant; ovarian reserve

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