100-year-old technique offers fertility hope

Infertile couples have a major opportunity to achieve a successful pregnancy without the need for IVF, thanks to new research into a 100-year-old medical technique.

The now lesser known technique, which involves flushing the woman's fallopian tubes with an iodised poppy seed oil, has been proven to have significant benefits for fertility, according to the largest study undertaken by a team involving researchers in the Netherlands and Australia.

Known as the H2Oil study, the project compared the benefits of flushing the fallopian tubes with either an oil-based or water-based solution in 1119 women. With Professor Mol, this work was conducted by Dr Kim Dreyer and Dr Velja Mijatovic from the Department of Reproductive Medicine, VU University Medical Centre, Amsterdam, and a research team from 27 medical centres in the Netherlands.

The procedure, known as hysterosalpingography (HSG), is a dye test of the fallopian tubes conducted under X-ray. The procedure was first carried out in 1917, and since the 1950s both water-based and oil-based solutions have been used.

"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. Until now, it has been unclear whether the type of solution used in the procedure was influencing the change in fertility," said Mol, who himself was conceived after his mother underwent such a procedure.

"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," he said.

Almost 40% of infertile women in the oil group and 29% of infertile women in the water group achieved successful pregnancies within six months of the technique being performed.

The oil-based product used in the study was Lipiodol® Ultra-Fluid, an iodised solution of fatty acids from poppy seeds. This product is currently available in 47 countries around the world.

"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," Professor Mol says.

"It was long believed that testing a woman's fallopian tubes could have fertility benefits through 'flushing out' the kind of debris that hinders fertility. The reality is, we still don't really understand why there is a benefit, only that there is a benefit from this technique, in particular for women who don't present with any other treatable fertility symptoms," Mol noted.

Further research would need to be conducted into the mechanisms behind what we're seeing. For now, and considering the technique has been used for 100 years without any known side-effects, we believe it is a viable treatment for infertility prior to couples seeking IVF.

The study is published in The New England Journal of Medicine.