REGENERATIVE THERAPY IN SEVERE ENDOMETRIOSIS. A CASE REPORT

Endometriosis affects 10% of reproductive woman age, some studies show that 25% to 50% of infertile women has endometriosis, and 30 a 50% of this group are infertile. There are many treatments to control endometriosis, nowadays the use of mesenchymal stem cells can be used as a treatment, even if it’s an intravenous or intraovarian use.

We report a 28-year-old woman, with a history of left salpingo-oophorectomy because of endometrioma and laparotomy because of endometriosis. We performed a transvaginal ultrasound, we found an endometrioma in the right ovary 4.5x4.8 cm, and the presence of 3 antral follicles. An antimüllerian hormone was reported 1.04 ng/ml. The patient was undergoing laparoscopic surgery for resection of the endometrioma capsule, right salpingectomy because of hydrosalpinx, and endometriotic implants, in addition, 7 million mesenchymal stem cells obtained from endometrial tissue were placed in the ovary cortex. Leuprolide acetate 3.75mg was used as a complementary treatment for 2 months. Three months later we performed a transvaginal ultrasound, 7 antral follicles, and a 3x3 cm endometrioma were found. Antimüllerian hormone reported 2.91 mg/ml. We performed a controlled ovarian stimulation, with follitropin alfa (corneumon), use of antagonist and trigger with human chorionic gonadotropin (Choriomon), after this we got 8 oocytes Metafase II, those were vitrified.

Discussion

The mesenchymal stem cells were used in this patient because of the antimüllerian hormone result and the diagnosis of severe endometrioma, with the premise that mesenchymal stem cells would improve ovarian response and increase hormone levels. Mesenchymal stem cells have several interesting features including their ability to grow rapidly, secrete cytokinin that has a positive effect on proliferation, survival, and repair of damaged tissues, are able to differentiate into other cell types, and participated directly in ovarian follicle formation. There are some studies where the use of mesenchymal stem cells induced the expression of granulosa cells in the follicles, improved the ovarian and hormonal function, and increased the AMH level.

Conclusions

The use of mesenchymal stem cells has been demonstrated to be a safe alternative in endometriosis patients, where there is a high inflammatory process in the pelvic cavity, can be functional.