As children, many people assume that when they get older they will settle down and have children. Sadly, the route to parenthood is not always easy. One in seven heterosexual couples will experience infertility and may need medical treatment to conceive, such as IVF.

We still don’t fully understand all the causes of infertility, but we do know that scar tissue in the womb (uterus) can play a part. This is called intrauterine scarring. It can also cause recurrent miscarriage and other symptoms.

There are very limited treatment options available for this type of scar tissue. Currently, women are most likely to have a hysteroscopy. This is a surgical procedure that involves the scar tissue being manually removed by a doctor.

Now, researchers funded by Wellbeing of Women, have developed a new type of treatment that has the potential to help women avoid the need for such invasive and painful surgery.

The multidisciplinary team at Imperial College London have created a type of gel using molecules and minerals typically found in the body. This has been shown to prevent intrauterine scarring and help the tissue lining the womb (endometrium) to heal normally. It has important implications for protecting women's fertility.

The team included Professor Molly Stevens, Professor of Biomedical Materials and Regenerative Medicine, Mr Richard Smith, Consultant Gynaecological Surgeon and Honorary Senior Lecturer, and Dr Maxine Chan, Obstetrician and Gynaecologist and PhD Fellow.

What is intrauterine scarring?

Intrauterine scarring is when scar tissue develops on the lining of the womb. It is sometimes referred to as Asherman Syndrome.

This scarring can be caused by:

• gynaecological conditions, such as fibroids and adenomyosis
• pregnancy
• an infection
• any surgical procedure that involves the uterus, including a caesarean section.

This scarring stops the lining of the womb from healing properly, making it difficult for a woman to conceive. It can also cause pelvic pain, periods that are lighter than usual or non-existent, and an increased risk of recurrent miscarriage.

A new treatment to prevent intrauterine scarring

Prof Stevens and Mr Smith set out to develop a new targeted treatment using ‘extracellular matrix’ (ECM) - a network of molecules and minerals naturally found in the body.

Their team were able to design a hydrogel made from endometrial ECM. Researchers studied this in detail to ensure it would support the process of tissue healing. They found this hydrogel could support the growth of endometrial cells and alter the behaviour of immune cells to promote tissue repair.

Further studies in the laboratory highlighted that the gel, which is designed to be injected into the uterus or sprayed directly onto endometrial tissue, appeared to protect the endometrium from damage and prevent scarring.

Prof Stevens says:

“Scar tissue in the womb is a major cause of infertility – it is reported to be responsible for up to 22% of cases. Treatment options are few and far between with varying low levels of effectiveness. The only real option is surgery.

“A new, targeted treatment for intrauterine scarring is long overdue, but we are now one step closer towards this goal thanks to Wellbeing of Women.”

Mr Smith says:

“The ultimate aim of this research is to spare women the pain of being unable to conceive or repeatedly losing their unborn babies.

“Although this hydrogel is a long way from being licensed, our findings suggest it is effective at promoting tissue repair in the womb and has the potential to be an important treatment option for women diagnosed with intrauterine scarring.”

Next steps

The hydrogel developed by Prof Stevens and Mr Smith is currently designed to be used after surgery on the uterus, to prevent tissue damage and scarring. The next step is to explore if such a gel can treat pre-existing endometrial scarring. If successful, this may negate the need for invasive surgery.

Further studies are also required to assess the hydrogel’s ability to improve fertility and pregnancy outcomes.

Before it can be licensed as a treatment for intrauterine scarring, this hydrogel will need to be investigated in a clinical setting through regulated clinical trials.

Learn more from the research team

Wellbeing of Women is funding several research projects to understand more about gynaecological conditions and causes of infertility. These include:

• A clinical trial, funded in partnership with the Scottish Government, to develop the first ever non-hormonal, non-surgical treatment for endometriosis
• Dr Nicola Tempest exploring the role of stem cells in endometrial repair.
• Jane Cleal’s study to understand why some women struggle to become pregnant or experience miscarriage