Stem cell therapy for intrauterine adhesions: a systematic review and meta-analysis of clinical outcomes.

OBJECTIVE: Intrauterine Adhesions (IUA), including Asherman's Syndrome, are a significant cause of female infertility, while stem cell interventions emerge as a promising therapeutic strategy. This meta-analysis aims to systematically evaluate the effectiveness of stem cell interventions for IUA by analyzing various pregnancy outcomes. METHODS: This meta-analysis systematically searched five databases (PubMed, Web of Science, EMBASE, Scopus, and ProQuest) to identify clinical studies on stem cell interventions for IUA and endometrial repair. Data on cumulative live birth, biochemical pregnancy, clinical pregnancy, implantation rate, early spontaneous abortions, and ectopic pregnancy were extracted and analyzed. Subgroup analyses were conducted based on disease type and stem cell intervention method. RESULTS: Out of 211 identified records, 10 studies were included. The overall pooled proportion of cumulative live birth was 0.40 (95% confidence interval (CI): 0.22 to 0.60), with significant heterogeneity (I2 = 46.2%). Subgroup analysis showed the highest live birth rates in "General IUA" (0.57) and with "Autologous Cells with Scaffold/Matrix" (0.5632). Controlled trials demonstrated a significant benefit of stem cell therapy for live birth (odds ratio (OR) = 2.2535, 95% CI: 1.1750 to 4.3221). The pooled proportion for cumulative biochemical pregnancy was 0.6053 (95% CI: 0.4445 to 0.7461) with no significant heterogeneity. For cumulative clinical pregnancy, the pooled proportion was 0.4605 (95% CI: 0.3425 to 0.5831), also with significant heterogeneity (I2 = 36.9%). "General Intrauterine Adhesion" (0.6250) and "Autologous Cells with Scaffold/Matrix" (0.6207) showed the highest clinical pregnancy rates. Stem cell interventions significantly improved clinical pregnancy rates compared to controls (OR = 3.1277, 95% CI: 1.3802 to 7.0877). The overall implantation rate was 0.1200 (95% CI: 0.0549 to 0.2424). Early spontaneous abortions occurred at a pooled proportion of 0.1705 (95% CI: 0.1055 to 0.2637), and ectopic pregnancies at 0.0568 (95% CI: 0.0238 to 0.1293), with no significant heterogeneity in either. CONCLUSION: Stem cell therapy appears to be a promising intervention for IUA and endometrial repair, particularly with autologous cells combined with a scaffold, though more high-quality, controlled trials are needed to confirm these findings and optimize treatment protocols.