Professor Neil Johnson
Fertility Specialist and President of the World Endometriosis Society
Women considering fertility treatment should be aware of a simple procedure that may increase their chances of becoming pregnant without the need for expensive and involved IVF.
Women experiencing infertility problems may feel under pressure to start IVF (in vitro fertilisation) treatment immediately.
But there is a quick, minimally-invasive intervention they could explore first, potentially increasing their chance of becoming pregnant without the need for IVF. The procedure involves using iodised poppy seed oil, which probably flushes fertility-hindering debris from the fallopian tubes and appears to have a positive immuno-biological impact on fertility.
However, many patients are unaware this treatment exists — and that’s wrong, says Professor Neil Johnson, a fertility specialist based in Auckland, New Zealand, and President of the World Endometriosis Society.
“IVF is involved, expensive and carries the possibility of complications,” he notes. “This intervention, however, is low-invasive, cost-effective, carries a very low chance of complications and is very effective.”
What to expect during the procedure
The iodised poppy seed oil can be administered in a hysterosalpingogram (HSG). “The patient lies on an x-ray bed,” Professor Johnson explains. “A speculum is then inserted into the vagina and tubing is sent through the canal of the cervix. The solution is then gently instilled into the uterus, through the fallopian tubes and bathes the pelvic cavity.
Iodised poppy seed oil (instead of dye) doubled fertility within a trial group.
“Very occasionally, there may be some discomfort, but it is not usually painful, and the vast majority of patients tolerate it extremely well. Appointments take around half an hour, but the main part of the procedure usually takes just 10 minutes.”
Particular success for woman with endometriosis
An HSG was once a purely diagnostic intervention, where dye is injected into the cervical canal in order to investigate the shape of the womb and fallopian tubes.
However, between 1999 and 2004, Professor Johnson and his team recognised its remarkable therapeutic effects when iodised poppy seed oil doubled fertility within a trial group with unexplained infertility.
The procedure was particularly beneficial to women with a history of endometriosis, an inflammatory disease where tissue that normally lines the inside of the uterus is also found outside of the uterus.
“Endometriosis is a benign condition that can cause abdominal pain, pelvic pain and infertility,” he says.
“In New Zealand, we’ve discovered that this procedure has increased the fertility of women with endometriosis, which can have a substantial negative fertility impact even when the disease itself is not extensive.
“Indeed, we found that those with a history of endometriosis in our trial group experienced around a four-fold improvement in fertility. We thought it was amazing and have been offering it as a routine treatment for infertility since 2004.”
Patients who are unsuitable for treatment
Nevertheless, there are women who are unsuitable for the intervention. “For example, if a patient’s fallopian tubes are blocked or damaged, then the treatment is not going to work, and they should proceed to IVF,” says Professor Johnson.
“Other patients who won’t find it beneficial include women who don’t release an egg — they will need ovulation induction instead — and those whose partners have a low sperm count.
“However, it is absolutely appropriate for the majority of women who have relatively mild endometriosis-related infertility that hasn’t damaged their fallopian tubes. In fact, it’s probably their best first-line treatment because it’s so effective.”
There’s now growing interest in the procedure around the world. “That’s very exciting,” says Professor Johnson. “I think every woman visiting a fertility service should have the opportunity to explore this treatment as a first option, instead of moving straight to IVF.”