Could ‘flushing’ fallopian tubes displace IVF?

If a couple is having trouble conceiving after a year, or even as little as six months, they often head off to an IVF clinic.

However, as advocates of natural family planning have been saying for decades, the costly, emotionally draining and ethically contentious process of IVF many not be necessary.

And now the fertility industry could have another strong competitor. A cheap, simple, time-tested fertility remedy has been proved to be even more effective than IVF.

For a hundred years, doctors have checked whether a woman’s fallopian tubes are blocked by flushing them with iodised poppy seed oil. Although the test is purely diagnostic, many women claimed that it helped them to become pregnant.

And now a team of Dutch and Australian researchers has shown that it really does help.

A study published in the New England Journal of Medicine compared the benefits of flushing the fallopian tubes with either an oil-based or water-based solution in 1119 women.

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," says Professor Ben Mol, a Dutch doctor at the University of Adelaide, in South Australia. He 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 says. Almost 40 percent of infertile women in the oil group and 29 percent of infertile women in the water group achieved successful pregnancies within six months of the technique being performed. 

"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. Writing in The Conversation, he noted that the technique has some big advantages over IVF:

Tubal flushing has several advantages over IVF, including that the benefit persists over time, while IVF only helps for the current cycle. Tubal flushing also helps achieve an otherwise natural conception, and its costs are around A$600, a fraction of the cost of a A$10,000 IVF cycle. IVF also has a heavy impact on emotional wellbeing and sometimes causes medical complications.

In our study, 40 percent of women undergoing HSG with an oil-based contrast achieved a successful pregnancy within six months. That’s 40 percent of couples with unexplained infertility who could avoid the huge financial and emotional costs associated with undergoing IVF treatment.

Until he embarked on this study, Professor Mol had no idea that he himself was the result of a successful pregnancy following such a procedure. In the 1960s, after being considered infertile for nine years, his mother underwent an HSG which, coincidentally, also used the poppy-seed oil. "It was only after I started researching this technique that my family told me what had happened," Professor Mol says.

"My mother went from being infertile for many years to becoming pregnant, and I was born in 1965. 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."

A leading Australian IVF practitioner, Dr David Molloy, dismissed the news, saying that IVF patients have more complex fertility issues. "They are totally different populations of patients," he told the ABC. "One is a low-risk group starting out at the very start of their infertility journey that have got virtually nothing wrong with them, and our IVF patients are a higher risk group."

Scepticism about procedures which threaten the status (and profitability) of IVF is to be expected. But a big dollop of scepticism about IVF is needed, too.

IVF was adopted after the birth of Louise Brown in 1978 without the randomized control trials that doctors expect of nearly every other treatment. And ever since, according to research published earlier this year in a leading academic journal, Human Reproduction, “IVF patients are routinely offered and charged for a selection of adjunct treatments and tests or ‘add-ons’ that they are told may improve their chance of a live birth, despite there being no clinical evidence supporting the efficacy of the add-on.”

Fertility experts often exploit women’s longing for children by offering “new, improved” IVF techniques with little or no proof. One hundred years of proof backed up by formal research published in the world’s leading medical journal is worth investigating.

Michael Cook is editor of MercatorNet.

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