[LUM#10] Fertility regained

[LUM Magazine] - Published on December 2, 2019 in Science-Society

To help women who have difficulty conceiving due to poor uterine healing, chemists atIBMM have designed a unique and innovative device. This is a real breakthrough for patients with intrauterine adhesions.

Cesarean sections, curettage, fibroid removal, uterine revision... there are many surgical procedures performed on the uterus. These are common procedures, but they are far from harmless. They can cause intrauterine adhesions. "These highly invasive surgical procedures sometimes cause healing problems: the walls of the uterus stick together via a band of connective tissue, which is known as intrauterine adhesions, or synechiae, " explains Xavier Garric, Professor the Max Mousseron Biomolecules Institute (IBMM).

Repeated miscarriages

Problem: these adhesions have significant repercussions on health and fertility. " They can cause problems with menstrual flow and intense pain, " says the researcher, "but above all, they are the leading mechanical cause of infertility." Synechiae can prevent implantation, the stage following fertilization during which the embryo implants itself in the uterine wall. "And when implantation does occur, they also prevent the normal development of the fetus in the uterine cavity." As a result, women with intrauterine adhesions have repeated miscarriages and are unable to carry a pregnancy to term. "Synechiae are responsible for one in five miscarriages, " says the researcher.

To remove these synechiae, patients must undergo hysteroscopy, a procedure in which the surgeon inserts a camera through the cervix to cut away the adhesions. However, this solution is not always permanent: "In 40% to 50% of cases, the adhesions reform after the procedure, " laments Xavier Garric.

In discussions with Stéphanie Huberlant and Vincent Letouzey, practitioners in the gynecology and obstetrics department at Nîmes University Hospital, Xavier Garric's team noted the significant gaps in the therapeutic arsenal available to gynecological surgeons. This is where chemists come in. Their idea? "To create an anti-adhesion barrier to be inserted into the uterus after any procedure likely to cause synechiae." This device would also be used after operative hysteroscopy to cut adhesions, in order to prevent recurrence.

There is already a hyaluronic acid gel used for this purpose, which is injected into the uterus after surgery to prevent adhesions. Unfortunately, this product liquefies quickly and is eliminated within 24 to 48 hours, whereas the uterine lining takes between four and six days to reform after surgery, so the product does not remain in place long enough to fully perform its role," explains the chemist.

New polymer

Synthesizing a new polymer, biodegradable in 15 days, which would prevent adhesions by spreading in the uterus to prevent the walls from coming into contact, is the challenge taken up by Xavier Garric and his collaborator Salomé Leprince.

"We tested 15 polymers before finding the ideal candidate," explains the researcher.

The researchers designed a device consisting of a thin sheet of this new polymer. Inserted like an IUD, it unfolds in the uterus and acts as a barrier to prevent the walls from sticking together during healing. It then turns into a gel that is naturally expelled through the vagina.

To support the development of this new product, Xavier Garric founded Womed with Gonzague Issenmann, Dr. Stéphanie Huberlant, and SATT AxLR. In 2018, the company won the grand prize in the i-Lab innovative business creation competition, organized each year by the French Ministry of Higher Education, Research, and Innovation. The anti-adhesion device won over the jury. "We are very proud to be recognized for the solution we are going to provide to tens of thousands of women who want to conceive a child but are unable to do so because of poor healing of their uterus, " says Gonzague Issenmann, CEO of Womed.

Clinical trials

This success also crowns a collaboration between doctors and chemists specializing in the development of new materials. "By better analyzing clinical needs, we were able to design and develop a solution that is easy for doctors to use and meets the needs of patients."

The next step for Womed is to launch clinical trials. "In total, this could eventually affect nearly 150,000 patients per year in France," says Xavier Garric. "It would be a real revolution for these women." And for the children who will undoubtedly be born thanks to this innovative device...

Keywords: Innovation, LUM#10, LUM Magazine, Medicine, Research, Health