Transplantation of UC-MSCs in ovary improves ovarian function and intermediate outcomes in IVF/ICSI cycles of POI patients: a clinical cohort study.

BACKGROUND

This study aimed to evaluate the clinical outcomes of umbilical cord mesenchymal stem cell (UC-MSC) transplantation on ovarian function in women with premature ovarian insufficiency (POI), and its potential to improve in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) outcomes.

METHODS

A clinical cohort study was conducted at the Reproductive Medicine Center of Nanjing Drum Tower Hospital from 2019 to 2023. The study included POI patients who underwent either UC-MSC ovarian tissue injection or traditional IVF/ICSI-FET treatment. UC-MSCs were isolated from Wharton's jelly of the umbilical cord, cultured, and transplanted into the ovaries of patients via transvaginal ultrasound-guided injection. The embryo freezing rate, number of oocytes retrieved, and ovarian function indicators (e.g., serum FSH levels, antral follicle count (AFC)) were compared between the UC-MSC-treated group and the traditional IVF/ICSI-FET group.

RESULTS

A total of 71 POI patients were included, with 43 in the UC-MSC group and 28 in the IVF/ICSI-FET control group. After treatment, the AFC in the UC-MSC group was significantly higher compared to the control group (3.86 ± 2.93 vs. 2.39 ± 1.66, p = 0.019). Furthermore, the number of oocytes retrieved in the initial controlled ovarian hyperstimulation (COS) cycle following treatment was significantly greater in the UC-MSC group (1.88 ± 1.00 vs. 1.39 ± 1.13, p = 0.034). Patients undergoing UC-MSC treatment exhibited a substantial increase in the number of oocytes retrieved in their first COS cycle compared to their pre-treatment cycle (1.88 ± 1.00 vs. 1.28 ± 1.01, p = 0.007). Additionally, the number of frozen embryos significantly increased (0.74 ± 0.82 vs. 0.14 ± 0.41, p < 0.001), and the proportion of cycles resulting in frozen embryos was notably higher (55.81% vs. 11.63%, p < 0.001). Further Gene Set Enrichment Analysis (GSEA) revealed that genes expression in ovarian hormones and estrogen related signaling pathways were up-regulated following UC-MSCs therapy.

CONCLUSION

UC-MSC ovarian tissue injection is a promising therapeutic strategy for improving clinical outcomes in IVF/ICSI cycles for women with POI. The use of UC-MSCs may offer a novel and effective alternative to conventional infertility treatments for POI patients, especially those seeking genetic offspring. Further studies are required to explore the long-term safety and efficacy of this treatment in larger, multi-center trials.