Recent Comments

Mar 12, 2019

I would like to comment on this article by Herraiz and colleagues.

In this prospective observation pilot study of 17 women defined as PRs using the ESHRE criteria, bone marrow derived stem cells (BMDSC) were delivered directly to one ovary for each patient,  in an effort to optimize the recruitment of existing dormant follicles to improve IVF outcomes.

This was an interesting study design, because they had a built-in control. It was based on the hypothesis that infusing autologous stem cells into one ovary would selectively improve the ovarian response in that ovary, and this would presumably allow for the retrieval of more eggs from that when doing IVF, as compared to the contralateral ovary.  

This made a lot of intuitive sense, given all the hype surrounding stem cells in regenerative medicine, but sadly, this beautiful hypothesis was slayed by ugly facts. In fact, their own results showed that this infusion had no the number of punctured follicles in that ovary.  Sadly, they failed to share the number of eggs retrieved from the "treated" ovary versus the "control " ovary. However, their own results show that there was no difference in the AFC in the treated and control ovaries !

 It's interesting, but the dose of FSH required after ASCOT was more than the dose used prior to ASCOT , and the E2 level on Day of HCG administration was lower ( even though these results were not statistically significant, they are definitely not one would expect if their hypothesis was true).

The biggest tragedy is that instead of accepting that intraovarian autologous stem cell infusion does not affect ovarian response, they went ahead and massaged their data, to come up with a completely erroneous conclusion!

After subjecting patients to all that additional expense, they managed to achieve only 1 live birth in the post ASCOT IVF treatment cycle - hardly an impressive result, and one which could be purely because of chance !

They claim that this stem cell infusion improves pregnancy rates and ovarian response, but the reality is that most of the pregnancies which were achieved in the treatment group were natural pregnancies, and were treatment-independent  ! They conveniently confuse correlation with causation, and use the "post hoc, ergo propter hoc" illogic to justify this procedure.

The tragedy is that patients with poor PR are emotionally very vulnerable, and many doctors will now be tempted to use "advanced" techniques , which seem scientifically respectable, but have not been proven.

(1) Herraiz, S., Romeu, M., Buigues, A., Martínez, S., Díaz-García, C., Gómez-Sequí, I. et al. Autologous stem cell ovarian transplantation to increase reproductive potential in poor responder patients. Fertil Steril. 2018; 110: 173–182.e1