OPTIMIZATION OF PREOPERATIVE PREPARATION IN WOMEN WITH THIN ENDOMETRIUM BASED ON DECIDUALIZED STROMAL CELLS

Abstract

Thin endometrium remains a clinically significant problem in reproductive medicine because it is associated with impaired endometrial receptivity, implantation failure, recurrent reproductive loss, and reduced effectiveness of assisted reproductive technologies. Conventional treatment strategies, including estrogen administration, vasoactive therapy, and adjuvant pharmacologic support, may improve endometrial thickness in some patients, yet their efficacy remains inconsistent, especially in refractory cases. In recent years, growing attention has been directed toward regenerative and cell-based approaches aimed not only at increasing endometrial thickness but also at restoring morphofunctional competence. Among these, menstrual blood-derived mesenchymal stem cells and their decidualized stromal derivatives have emerged as especially promising because of their accessibility, low invasiveness of procurement, angiogenic activity, immunomodulatory properties, and ability to enhance the secretory profile of the endometrial microenvironment. Decidualization appears to potentiate stromal cell functionality by increasing the expression of implantation-related and proangiogenic mediators, thereby improving tissue remodeling, vascularization, and endometrial receptivity. Current evidence suggests that such approaches may be particularly relevant for women with recurrent implantation failure, chronic endometrial insufficiency, and poor response to standard hormonal regimens. At the same time, many aspects remain unresolved, including protocol standardization, patient selection, long-term safety, and the translation of promising preclinical findings into routine clinical practice. Thus, optimization of preoperative preparation in women with thin endometrium based on decidualized stromal cells represents a promising and biologically grounded direction that warrants further controlled investigation.