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Century-old fertility method may eliminate need for in vitro fertilization

Flushing a woman's fallopian tubes with an iodized poppyseed oil showed significant benefits for fertility, according to research recently published in The New England Journal of Medicine.

Researchers suggested the 100-year old technique — hysterosalpingography, — provides a “major opportunity” for successful pregnancy.

According to the Office of Women’s Health, about 10% (6.1 million) women in the United States aged 15 to 44 have difficulty getting pregnant or staying pregnant, and researchers noted that one out of every six couples is infertile.)

“Many studies have shown a fertility-enhancing effect of hysterosalpingography with the use of oil contrast, but few randomized, controlled trials have assessed this effect,” Kim Dreyer, MD, PhD, department of reproductive medicine, VU University Medical Center, Amsterdam, and colleagues wrote. “In view of this uncertainty, we conducted a multicenter, randomized, controlled trial to compare ongoing pregnancy rates and other pregnancy outcomes among women who underwent hysterosalpingography with oil contrast with those among women who underwent this procedure with water contrast.”

In this study, infertile women undergoing hysterosalpingography were randomly assigned to have the procedure with the oil-based contrast Lipiodol (ethiodized oil, Guerbet LLC) or a water-based contrast. The primary outcome was ongoing pregnancy, which was assessed 6 months after randomization.

Dreyer and colleagues found that 220 of the 554 women in the oil group (39.7%) and 161 of 554 women in the water group (29.1%) had an ongoing pregnancy (rate ratio = 1.37; 95% CI, 1.16-1.61). In addition, 214 of 552 women in the oil group (38.8%) and 155 of 552 women in the water group (28.1%) had live births (rate ratio = 1.38; 95% CI, 1.17-1.64). Researchers also reported that rates of adverse events were low and similar in the two groups.

“Until now, it has been unclear whether the type of solution used in the procedure was influencing the change in fertility,” Ben Mol, MD PhD MSc, of the South Australian Health and Medical Research Institute’s Healthy Mothers, Babies and Children theme, said in a press release. “Our results have been even more exciting than we could have predicted, helping to confirm that an age-old medical technique still has an important place in modern medicine.”

Researchers added that the technique has financial benefits over IVF, but should be used with caution.

“Tubal flushing with hysterosalpingography during a fertility workup is minimally invasive and inexpensive, as compared with IVF,” Dreyer and colleagues wrote. “The safety of the use of oil contrast must be considered. There is a theoretical risk of intravasation of the oil contrast with a subsequent allergic reaction or fat embolism... However, this is a rare complication; no cases were observed in our trial nor in other trials involving hysterosalpingography with oil contrast.”

Researchers also wrote that the occurrence of congenital anomalies with oil contrast was not greater than rates reported in the general population, and that they were unaware of other data suggesting such an increase would occur. – by Janel Miller

References:

Office of Women's Health Infertility Fact Sheet (accessed 05-23-17)

Disclosure: Mol reports being a consultant for Guerbet. Healio Family Medicine was unable to determine the other researchers’ relevant financial disclosures prior to publication.