Stem Cell Treatment
Medicine of Reproduction
Stem Cell Treatments
Reproductive Medicine and Stem Cell Therapies
While assisted reproductive techniques are applied, the idea of benefiting from stem cells and similar treatments has been on the agenda for 20 years and research continues. The results of the evidence-based data are not certain about these applications. The associations (ESHRE, ASRM, SART) that give their opinions on the rejuvenation, activation and current application of egg cells follow and support the researches, but they are distant to the issue of evidence-based applicability. It causes discussions on the subject and in some cases on ethical issues. In reproductive medicine, the patient group with decreased egg reserve and age factor are the leading areas that are thought to benefit from stem cell therapy. Ethical problems related to the subject cause debates.
In reproductive medicine, the patient group with decreased egg reserve and age factor comes at the beginning of the fields that are thought to benefit from stem cell therapy.
Conditions That Decrease Egg Reserve;
- Surgical operations applied to the ovaries (cyst etc.)
- Abscesses and infections
- Chemotherapy and cancer treatments
- Excessive smoking and caffeine consumption
Practices to Increase Egg Reserve and Quality
Mitochondria transfer (autologous or heterologous)
Mitochondria are the organelles that provide energy to the egg, egg aging is a process that goes parallel with the aging of the mitochondria. The transfer of cytoplasm rich in mitochondria from the patient's own cells (autologous) is experimental. Successful results have been reported with the method in which mitochondria-rich ooplasm obtained from the egg of a young woman is injected into the egg. However, since there will be genetic transfer to the embryo to be formed by the transfer of DNAs in the mitochondria, a situation that causes ethical debates arises due to the formation of a three-parent embryo. It is a method that cannot be done according to Turkish laws.
It is based on the principle of activating dormant, non-activated eggs in the ovary in younger women, whose egg reserve is reduced due to premature egg aging (POI). By laparoscopy, parts taken from the cortex (shell) parts of the ovaries are activated with various drugs applied in the laboratory environment, and dormant cells are stimulated. Re-transplantation of the patient with laparoscopy, spontaneous and assisted reproductive techniques are applied to achieve pregnancy. 63% pregnancy results were reported with the method applied for the first time in Japan. It is discussed that the application requires two surgical procedures and put it into practice because of its cost. In our country, planned research continues.
Stem cell Treatments
After bone marrow transplantation, after an increase in ovarian response was noticed, it was used to increase ovarian response, and live births have been reported. A 45-year-old patient who had a live birth by injecting bone marrow aspiration directly into the ovarian tissue was published in a prestigious journal called Human Reproduction in 2018.
PRP (Platelet-rich plasma) application is based on the principle that the patient's own blood is centrifuged, enriched with growth factor, calcium and vitamins, and then injected into the ovarian tissue with the help of ultrasonography or laparoscopy. Although this method, which is used primarily in plastic surgery, orthopedics and CVC due to its regenerative feature of damaged tissue, is preferred because of its simplicity, the results on the subject are still controversial. There are studies claiming that positive results are obtained by injecting into the uterus or under the endometrium layer in cases where the inner layer of the uterus remains thin.
Stem cells and similar treatments are controversial in clinical practice, since they have not been reported to be applicable with definitive evidence by associations that play a guiding role in IVF treatment such as ASRM and ESHRE. The publications of various researchers from all over the world stating that they have obtained positive results are considered cautiously, and it is accepted among the adjuvant treatment methods that need further studies on its effectiveness.