Intra-ovarian Injection of MSC-EVs in Idiopathic Premature Ovarian Failure

Premature ovarian failure (POF) is a clinical syndrome defined by loss of ovarian activity before the age of 40 years. POF is characterized by menstrual disturbance (amenorrhea or oligomenorrhea) with raised gonadotrophins and low estradiol. The prevalence of POF is 1-2%. Extracellular vesicles (EVs) are membrane-packed vesicles that are secreted by a variety of cell types, including T cells, B cells, dendritic cells, platelets, mast cells, epithelial cells, endothelial cells, neuronal cells, cancerous cells, oligodendrocytes, Schwann cells, embryonic cells, and mesenchymal stromal cells-derived (MSCs). MSCs-EV more stable and induce stronger signaling and are produced in higher concentrations than stem cells. They demonstrate no inherent toxicity, are not associated with any long-term maldifferentiation of engrafted cells or tumor generation, and carry no apparent risk of aneuploidy or immune rejection following in vivo allogenic administration.Several studies have evaluated the safety and possible efficacy of injection MSCs-EV for the treatment of premature ovarian failure in animal models. Based on the available evidence, the study was designed with the aim of investigating the safety and effectiveness of intraovarian injection of MSCs-EV in patients with POF diagnosis.

Inclusion Criteria: * Women between 20-38 years old * Baseline serum level of follicle stimulating hormone (FSH) higher or equal to 25 IU/l at least twice with an interval of 4 months * At least one year has passed since secondary amenorrhea and premature ovarian failure (POF) diagnosis * Normal karyotype and fragile X messenger ribonucleoprotein 1 (FMR1) gene Exclusion Criteria: * Primary amenorrhea * Congenital anomaly of the ovary * Thyroid disease Immune system diseases such as lupus, etc. * Previous and/or family history of ovarian tumor * Previous and/or family history of suffering from major diseases in the past and present such as cancer * Positive serological evidence regarding previous or current hepatitis B and C, Human T-lymphotropic virus 1, Human immunodeficiency virus (HIV), Syphilis Disturbance in the normal range of laboratory tests as levels of Hemoglobin Subunit Alpha 1 (HbA1), Alanine transaminase (ALT), The aspartate aminotransferase (AST), the number of white blood cells (WBCs), The creatinine (Cr), International normalised ratio (INR) , Platelets (Plt), Hematocrit (Hct) tests. * History of specific systemic disease (rheumatology, endocrine, cardiovascular, etc.) * Severe endometriosis (stage III and IV) * Small and non-injectable ovaries Lack of patient satisfaction * The patient's unwillingness to continue participating in the study