Advances in improving fertility in women through stem cell-based clinical platforms

ABSTRACT

Introduction: Due to their regenerative ability, stem cells are looked at as a promising tool for improving infertility treatments in women. As the main limiting factor in female fertility is represented by the decrease of ovarian reserve, the main goals of stem cell-based clinical platforms would be to obtain in vitro or in vivo neo-oogenesis. Refractory endometrial factor infertility also represents an obstacle for female reproduction for which stem cells might provide novel treatment strategies.

Areas covered: A systematic search of the literature was performed on MEDLINE/PubMed database to identify relevant articles using stem-cell based clinical or research platforms in the field of female infertility.

Expert opinion: In vitro oogenesis has not so far developed beyond the stage of oocyte-like cells whose normal progression to mature oocytes and ability to be fertilized was not proved. Extensive epigenetic programming of gamete precursors and the complex interactions between somatic and germ cells required for human oogenesis likely represent the main obstacles in stem-cell-based neo-oogenesis. Also resuming oogenesis in vivo in adulthood still appears a distant hypothesis, as there is still a lack of consensus about the existence and functionality of adult ovarian stem cells.

KEYWORDS:

• Female infertility
• germ stem cells
• stem cells

Article highlights

• Decrease in ovarian reserve and endometrial factor infertility are the main causes of failure in obtaining a pregnancy by autologous gametes.

• The main goals of stem cell-based clinical platform would be to obtain neo-oogenesis and improve endometrial function/receptivity.

• In vitro oogenesis has not so far developed beyond the stage of oocyte-like cells whose normal progression to mature oocytes and ability to be fertilized was not proved.

• Adult stem cells within the ovary might be targeted for resuming in vivo of neo-oogenesis in adult life but many controversies still exist about their existence.

• Safety and long-term effects of stem cell-based clinical platforms on gametes are still lacking.

• Encouraging results are coming from stem cell-based pilot studies in endometrial factor infertility but data confirmation from randomized clinical trials is needed.

• The tissue-repairing capacity of stem cells also holds a potential in fertility preservation techniques. Animal models in this field show promising results but no human studies are currently available.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This manuscript has not been funded.