From the Guidelines
Stem cell therapy is not currently recommended as a standard treatment for patients with Premature Ovarian Insufficiency (POI). The current standard of care for POI typically involves hormone replacement therapy (HRT) until the natural age of menopause (around 50 years), usually with estradiol 1-2mg daily and progesterone 100-200mg for 12-14 days monthly if the uterus is present, as recommended by the ESHRE guideline 1. This helps manage symptoms and prevent long-term health consequences like osteoporosis and cardiovascular disease. For patients seeking fertility, options include egg donation, embryo adoption, or in some cases, fertility preservation before ovarian function declines completely. Some POI patients may have intermittent ovarian function, so spontaneous pregnancy remains possible in about 5-10% of cases.
While stem cell approaches (including ovarian tissue transplantation, bone marrow-derived stem cells, and mesenchymal stem cells) show promise in restoring ovarian function in preliminary studies, these should be considered experimental and accessed only through properly designed clinical trials with appropriate ethical oversight and informed consent, as discussed in the context of first-in-human stem cell clinical trials 1. The management of POI should be tailored to the individual patient's needs, taking into account their demographic, clinical, and psychological profile, and should involve a multidisciplinary team including gynecologists, pediatricians, endocrinologists, dietitians, and psychologists, as outlined in the practical recommendations for hormonal replacement therapy in adolescents and young women with chemo- or radio-induced POI 1.
Key considerations in the management of POI include:
- Hormone replacement therapy to reduce the risk of osteoporosis, cardiovascular diseases, and urogenital atrophy, and to improve quality of life
- Induction of puberty in prepubertal girls with POI
- Fertility preservation and options for patients seeking fertility
- Multidisciplinary care involving a team of healthcare professionals
- Patient education and informed consent for experimental therapies, including stem cell approaches.
From the Research
Stem Cell Therapy for POI
- Stem cell therapy, including mesenchymal stem cell (MSC) therapy, has been introduced as a novel strategy for the treatment of Premature Ovarian Insufficiency (POI) 2.
- MSC therapy has shown promise in improving ovarian function in some animal studies, but its effectiveness and safety in women with POI are still limited and require further research 2.
- The use of stem cell therapy for POI is still in the experimental stage and requires precise design components to accelerate its conversion into clinical treatments 3.
Limitations and Challenges of Stem Cell Therapy
- MSC therapy can have side effects such as high cost, time-consuming processes, limited lifespan and cell sources, loss of original characteristics during in vitro proliferation, dependence on specific culture environments, and potential immune reactions 2.
- The therapeutic mechanisms of MSC therapy are still unknown, and more research is needed to determine its effectiveness and safety for women with POI 2.
Alternative Therapies
- Exosome therapy, a newer therapy, has shown some promise in animal studies, but its effectiveness and safety in women with POI are still limited and require further research 2.
- Hormone replacement therapy (HRT) is still the recommended treatment for women with POI, as it alleviates symptoms, prevents bone loss and cardiovascular disease, and may improve quality of life and life expectancy 4, 5, 6.