Mesenchymal Stem Cell Secretome as a Therapeutic Strategy for Thin Endometrium: A Narrative Review

Background & Objective: Thin endometrium (<7 mm) impairs receptivity and reduces pregnancy rates in Assisted Reproductive Technology (ART). Conventional therapies such as estrogen, vasodilators, Granulocyte Colony-Stimulating Factor (G-CSF), and platelet-rich plasma (PRP) showed inconsistent efficacy. Mesenchymal Stem Cell (MSC) secretome has emerged as a promising regenerative strategy. The narrative review was conducted with aim to synthesize evidence on the therapeutic potential of MSCs secretome for the treatment of thin endometrium.Materials & Methods: This narrative review was conducted through search in databases of PubMed, Scopus, and Google Scholar for studies up to 2025 using the keywords of “thin endometrium,” “mesenchymal stem cells,” “secretome,” and “exosomes.” Preclinical and clinical studies were included, with emphasis on human trials reporting endometrial thickness, receptivity, and pregnancy outcomes.Results: Preclinical studies demonstrate that the MSCs secretome enhances angiogenesis, modulates immune tolerance, reduces fibrosis, and promotes endometrial repair. Early clinical studies using bone marrow–, umbilical cord–, adipose tissue–, and menstrual blood–derived MSCs or their secretome report increased endometrial thickness and improved implantation, with some pregnancies and live births achieved. Safety data are favorable, particularly for secretome-derived extracellular vesicles, which avoid risks linked to cell transplantation.Conclusion: MSC secretome, based therapy offers a promising cell-free approach to manage thin endometrium through multimodal regenerative effects. While preliminary clinical findings are encouraging, larger controlled trials are needed to confirm the efficacy, optimize delivery, and establish long-term safety.