As an obstetrician and gynaecologist specialising in fertility, I see a vast range of patients with infertility concerns. The starting point with patients is to always try to determine the cause of their infertility and whether any early fertility interventions can be implemented to achieve pregnancy success.
One such method of early intervention that I have been utilising for nearly six years is what is commonly known as the “poppy seed flush” or hysterosalpingography with oil contrast method.
What is a hysterosalpingography?
The iodised poppy seed oil is inserted into the uterus and then an X-ray examination occurs of the woman’s uterus and fallopian tubes, using a special form of X-ray called fluoroscopy, to detect the contrast material (iodised poppy seed oil) and how easily it is moving through the fallopian tubes.
The process entails flushing the woman’s fallopian tubes with the oil-based product, which often results in helping clear potential debris causing blockages that have previously hindered fertility.
Who will require this treatment?
A hysterosalpingography is used primarily to examine women who have had difficulty becoming pregnant, by allowing the fertility specialist to evaluate the shape and structure of the uterus, the openness of the fallopian tubes, and any scarring within the uterine or peritoneal (abdominal) cavity.
When appropriate, the procedure can be used to investigate repeated miscarriages that result from congenital or acquired abnormalities of the uterus and to determine the presence and severity of these abnormalities, including tumour masses, adhesions, and uterine fibroids.
I have had several patients go on to have successful pregnancies after undergoing this procedure – always a pleasing outcome.
It must be noted, however, that while hysterosalpingography is useful in some cases, this is not an option for everybody and does not replace other forms of treatment. In fact, many women in a recent study involving this method had almost all the fertility interventions used on them, starting as early as two months after flushing, that a modern clinic would employ if required (e.g. intra-uterine insemination (IUI), in vitro fertilisation (IVF), intracytoplasmic sperm injection (ICSI) and laparoscopy.
Limitations of this method
This method was recently examined in a paper published in the New England Journal of Medicine, which reported a higher pregnancy rate in women treated with the oil-based medium. It is important to note that the study was limited to women who: were aged between 18 and 39; had spontaneous menstrual cycles; and had been trying to conceive for at least one year already.
This study received a lot of publicity but I feel some of the critical information was omitted in the news stories. For instance, the investigators excluded those with: known endocrine disorders (e.g. polycystic ovary syndrome, diabetes, hyperthyroidism, and hyperprolactinemia); fewer than eight menstrual cycles a year; a high risk of tubal disease (as indicated by a history of pelvic inflammatory disease, previous chlamydia infection, or known endometriosis); iodine allergy (since the contrast mediums under study both contained iodine); and a partner who had a low final total mobile sperm count.
In other words, if you have the same criteria as the group of women who were tested, then the poppy seed oil flushing may be beneficial to you, but if you or your partner have any of the conditions that precluded women from participating in this study, then another fertility treatment might be more appropriate.
In conclusion, we are always on the lookout for new evidence for old treatments or developing new treatments, but before you make a decision on what is appropriate for you, make sure you thoroughly investigate the options with the help of a fertility specialist.
I have had the “poppy seed flush” technique available at my clinic since 2011 and will continue to offer it to suitable patients. If you are interested in discussing whether it might be suitable for you, please contact the clinic on 08 8371 3466.
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