A new study demonstrates that an old medical imaging procedure might significantly increase an infertile couple's chance of conceiving. The findings are likely to spark big changes in the way that infertility is approached.
Infertility tends to be a taboo topic - it is rarely discussed, even among family members and friends.
However, infertility affects a substantial cross-section of the public. For instance, in the United States, 1 million married women (aged between 15 and 44) are unable to get pregnant after 12 months of trying to conceive.
An estimated 6.9 million women in the U.S. in the same age bracket have used infertility services.
Infertility is a complex problem; there are a range of reasons why it can occur in both men and women. Although lifestyle factors and medical conditions can play a role, the causal factors are not always so clear cut. Often, doctors cannot find a reason behind the infertility.
Assisted reproductive technology (ART) has revolutionized fertility treatment. The most common type of ART is in vitro fertilization (IVF), in which a woman's eggs are removed and fertilized in a laboratory, and the resulting embryos are then transferred back into the woman. ART can be very effective, and an estimated 1.6 percent of all children born each year in the U.S. are conceived as a result of this treatment.
However, IVF is a relatively long procedure, it can be costly to carry out, and success rates vary substantially.
A recent study, testing a procedure that dates back 100 years, offers hope of a solution that is significantly cheaper and quicker.
Flushing the fallopian tubes
A study conducted by Prof. Ben Mol, from the University of Adelaide's Robinson Research Institute in Australia, investigated an infertility treatment first used 100 years ago: flushing the fallopian tubes with an iodized poppy seed oil.
The procedure is called hysterosalpingography (HSG) and was first carried out in 1917. The procedure is a dye test conducted under X-ray and is used to examine the uterus and fallopian tubes of women having trouble becoming pregnant. Either water-based or oil-based solutions are used to flush the tubes.
HSG was designed as an imaging procedure, rather than a treatment. "Over the past century, pregnancy rates among infertile women reportedly increased after their tubes had been flushed with either water or oil during this X-ray procedure," says Prof. Mol. "Until now, it has been unclear whether the type of solution used in the procedure was influencing the change in fertility."
To investigate whether this old procedure might help infertile couples to reproduce, Prof. Mol set up a study named H2Oil in conjunction with Dr. Kim Dreyer and Dr. Velja Mijatovic, from the Department of Reproductive Medicine at the VU University Medical Centre in Amsterdam, the Netherlands. His results were recently presented at the 13th World Congress on Endometriosis in Vancouver, Canada.
The study involved 1,119 women, all classed as infertile and who were actively trying for a child. Half of the participants received an HSG using oil (specifically, the product is Lipiodol Ultra-Fluid, an iodized solution of fatty acids made from poppy seeds). The other half of the participants had an HSG using water.
Nearly 40 percent of the women in the oil group and 29 percent in the water group conceived within 6 months of having the procedure.
According to Prof. Mol, the results were "more exciting than we could have predicted." The results are published this week in the New England Journal of Medicine. Finding such a significant effect using a one-off intervention is unusual.
"The rates of successful pregnancy were significantly higher in the oil-based group, and after only one treatment. This is an important outcome for women who would have had no other course of action other than to seek IVF treatment. It offers new hope to infertile couples."
Prof. Ben Mol
Keep it in the family
In an interesting twist, Prof. Mol himself has revealed that he was conceived as a result of HSG. After several years of infertility, his mother underwent the procedure (also using Lipiodol). When he began investigating HSG, he was unaware of this fact. He says, "It was only after I started researching this technique that my family told me what had happened [...] I also have a younger brother. So, it's entirely possible - in fact, based on our team's research, it's highly likely - that my brother and I are both the result of this technique helping my mother to achieve fertility."
How does HSG increase fertility? The short answer to that question is that nobody is sure. The theory is that certain types of debris that interfere with fertility are flushed out of the system during HSG. To date, nothing more is known.
Because the findings from the current study are so intriguing, there is likely to be further research in the coming years. As mentioned earlier, IVF can be effective, but it is expensive, involves multiple hospital visits, and comes with a range of risks.
HSG, on the other hand, is quick, relatively cheap and, across its 100 years of use, no side effects have ever been reported.