Implementation of ethiodized oil for treatment of endometriosis-associated infertility.
pdf

Keywords

endometriosis
hysterosalpingography
immunotherapy
infertility
lipiodol

How to Cite

Maksym, R. B. (2021). Implementation of ethiodized oil for treatment of endometriosis-associated infertility. Quarterly Journal Fides Et Ratio, 47(3), 84-94. https://doi.org/10.34766/fetr.v47i3.897
Keywords

Abstract

One of the leading health conditions associated with female infertility is endometriosis, which is the presence of endometrial-like tissue outside the uterine cavity. It is estimated that endometriosis can be demonstrated in up to half of infertile patients, but this does not mean that in all cases, it is the only cause that reduces fertility. Apart from the relatively rare case of endometriosis-induced anatomical changes that mechanically impede fertilization, the main effect is to modify the immune system by the secretion of soluble signaling factors by ectopic endometriotic lesions. The primary treatment of endometriosis in patients trying to become pregnant is radical excision of foci outside the uterus, which is associated with the normalization of immune system disorders and often leads to pregnancy. However, the significant technical complexity and the possibility of complications make the surgery a good solution, mainly for patients who, apart from infertility, pain is also an important factor. An important medical problem remains the development of methods that could eliminate disorders caused by endometriosis and, at the same time, could be used in patients with minor or moderate ailments and in patients with contraindications to surgery. At present, despite many approaches, there are no specific immunotherapy methods. It is interesting that for several decades, it has been reported that the examination of the patency of the Fallopian tubes has a beneficial effect on the possibility of pregnancy. Detailed analyzes have shown that this is not a common effect, but it mainly concerns patients with endometriosis and the use of etiodized oil contrast. In this group, there is a significant, five-fold increase in infertility. Therefore, every second previously infertile patient becomes pregnant within six months. A smaller but also distinct effect is observed in the case of idiopathic infertility. The impact is so significant that it can be used both for the practical treatment of patients as well as to understand the mechanisms underlying fertility disorders occurring in endometriosis. The data so far show that the immunotherapeutic effect of etiodized oil contrast is overwhelming. However, it is not entirely clear why the improvement is not achieved using other currently more popular water contrasts. The dissemination of perfusion of the uterine cavity and Fallopian tubes with the use of oil contrast seems to be a simple, safe and effective strategy that allows patients to offer patients alternative treatment methods and improve the final effectiveness and increase the pharmacoeconomics of treatment of endometriosis-related infertility.

https://doi.org/10.34766/fetr.v47i3.897
pdf

References

Adamson, G. D. & Pasta, D. J. (2010). Endometriosis fertility index: the new, validated endometriosis staging system, Fertility Sterility, 94, 1609-15, https://doi.org/10.1016/j.fertnstert.2009.09.035.

Court, K. A., Dare, A. J., Weston-Webb, M., Hadden, W. E., Sim, R. G. & Johnson, N. P. (2014). Establishment of lipiodol as a fertility treatment–prospective study of the complete innovative treatment data set, Australian and New Zeland Journal of Obstetrics and Gynaecology, 54, 13-9, https://doi.org/10.1111/ajo.12124.

Daniilidis, A. & Pados, G. (2018). Comments on the ESHRE recommendations for the treatment of minimal endometriosis in infertile women, Reproductive Biomedicine Online, 36, 84-87, https://doi.org/10.1016/j.rbmo.2017.10.103.

Dreyer, K., Van Rijswijk, J., Mijatovic, V., Goddijn, M., Verhoeve, H. R., Van Rooij, I. a. J., Hoek, A., Bourdrez, P., Nap, A. W., Rijnsaardt-Lukassen, H. G. M., Timmerman, C. C. M., Kaplan, M., Hooker, A. B., Gijsen, A. P., Van Golde, R., Van Heteren, C. F., Sluijmer, A. V., De Bruin, J. P., Smeenk, J. M. J., De Boer, J. a. M., Scheenjes, E., Duijn, A. E. J., Mozes, A., Pelinck, M. J., Traas, M. a. F., Van Hooff, M. H. A., Van Unnik, G. A., De Koning, C. H., Van Geloven, N., Twisk, J. W. R., Hompes, P. G. A. & Mol, B. W. J. (2017). Oil-Based or Water-Based Contrast for Hysterosalpingography in Infertile Women, New England Journal of Medicine, 376, 2043-2052, https://doi.org/10.1056/NEJMoa1612337.

Dunselman, G. A., Vermeulen, N., Becker, C., Calhaz-Jorge, C., D’hooghe, T., De Bie, B., Heikinheimo, O., Horne, A. W., Kiesel, L., Nap, A., Prentice, A., Saridogan, E., Soriano, D. & Nelen, W. (2014). ESHRE guideline: management of women with endometriosis, Human Reproduction, 29, 400-12, https://doi.org/10.1093/humrep/det457.

Filipecka-Tyczka, D., Kajdy, A., Siekierski, B.P., Stańczyk, M., Rogowski, A., Rabijewski, M., Maksym, R.B. (2020). Deep infiltrating endometriosis as a cause of severe urogynecological complications despite invasive treatment–report of two cases from the center of endometriosis surgery, Clinical and Experimental Obstetrics & Gynecology, 47, 955-960, https://doi.org/10.31083/j.ceog.2020.06.2092.

Hirata, J., Kikuchi, Y., Imaizumi, E., Tode, T. & Nagata, I. (1994). Endometriotic tissues produce immunosuppressive factors, Gynecology and Obstetrics Investigation, 37, 43-7, https://doi.org/10.1159/000292519.

Johnson, N.P. (2014). Review of lipiodol treatment for infertility–an innovative treatment for endometriosis-related infertility? Australian and New Zeland Journal of Obstetrics and Gynaecology, 54, 9-12, https://doi.org/10.1111/ajo.12141.

Johnson, N.P., Farquhar, C.M., Hadden, W.E., Suckling, J., Yu, Y. & Sadler, L. (2004). The FLUSH trial—flushing with lipiodol for unexplained (and endometriosis-related) subfertility by hysterosalpingography: a randomized trial, Human Reproduction, 19, 2043-51, https://doi.org/10.1093/humrep/deh418.

Johnson, N. P. & Hummelshoj, L. (2013). Consensus on current management of endometriosis, Human Reproduction, 28, 1552-1568, https://doi.org/10.1093/humrep/det050.

Johnson, N.P., Kwok, R., Stewart, A.W., Saththianathan, M., Hadden, W.E. & Chamley, L.W. (2007). Lipiodol fertility enhancement: two-year follow-up of a randomized trial suggests a transient benefit in endometriosis, but a sustained benefit in unexplained infertility, Human Reproduction, 22, 2857-2862, https://doi.org/10.1093/humrep/dem275.

Jothilakshmi, P.K. & Watson, A.J. (2005). ‚Flushing with lipiodol for unexplained (and endometriosis-related) subfertility by hysterosalpingography’, Human Reproduction, 20, 843; author reply 843, https://doi.org/10.1093/humrep/deh641.

Mathews, D.M., Johnson, N.P., Sim, R.G., O’sullivan, S., Peart, J.M. & Hofman, P.L. (2021). Iodine and fertility: do we know enough? Human Reproduction, 36, 265-274, https://doi.org/10.1093/humrep/deaa312.

Pfeifer, S., Butts, S., Dumesic, D., Fossum, G., Gracia, C., La Barbera, A., Odem, R., Pisarska, M., Rebar, R., Reindollar, R., Rosen, M., Sandlow, J., Sokol, R., Vernon, M. & Widra, E. (2015). Diagnostic evaluation of the infertile female: a committee opinion, Fertility Sterility, 103, e44-50, https://doi.org/10.1016/j.fertnstert.2015.03.019.

Pfeifer, S., Fritz, M., Goldberg, J., Mcclure, R.D., Lobo, R., Thomas, M., Widra, E., Schattman, G., Licht, M., Collins, J., Cedars, M., Racowsky, K., Vernon, M., Davis, O., Barnhart, K., Gracia, C., Catherino, W., Rebar, R. & La Barbera, A. (2012). Endometriosis and infertility: a committee opinion, Fertility Sterility, 98, 591-598, https://doi.org/10.1016/j.fertnstert.2012.05.031.

Reilly, S.J., Glanville, E.J., Dhorepatil, B., Prentice, L.R., Mol, B.W. & Johnson, N.P. (2019). The IVF-LUBE trial–a randomized trial to assess Lipiodol(®) uterine bathing effect in women with endometriosis or repeat implantation failure undergoing IVF, Reproductive Biomedicine Online, 38, 380-386, https://doi.org/10.1016/j.rbmo.2018.11.015.

Sekhon, J., Lee, E., Lo, G., Woolcock, J., Ramkrishnan, J., Menezes, M., Tan, S., Meagher, S. & Murphy, A. (2020). Lipiodol flush under ultrasound guidance in Australia, Australian and New Zeland Journal of Obstetrics and Gynaecology, 60, 965-969, https://doi.org/10.1111/ajo.13244.

Shigesi, N., Kvaskoff, M., Kirtley, S., Feng, Q., Fang, H., Knight, J. C., Missmer, S. A., Rahmioglu, N., Zondervan, K. T. & Becker, C. M. (2019). The association between endometriosis and autoimmune diseases: a systematic review and meta-analysis, Human Reproduction Update, 25, 486-503, https://doi.org/10.1093/humupd/dmz014.

Skibińska, M. & Maksym, R. B. (2019). Diagnostyka niepłodności kobiecej w oparciu o międzynarodowe wytyczne, Kwartalnik Naukowy Fides et Ratio, 39, https://doi.org/10.34766/fetr.v3i39.118.

Skibińska, M. & Maksym, R.B. (2020). Podłoże autoimmunologiczne rozwoju endometriozy, Kwartalnik Naukowy Fides et Ratio, 43, https://doi.org/10.34766/fetr.v43i3.315.

Ścieżyńska, A., Komorowski, M., Soszyńska, M. & Malejczyk, J. (2019). NK Cells as Potential Targets for Immunotherapy in Endometriosis, Journal of Clinical Medicine, 8, https://doi.org/10.3390/jcm8091468.

Tan, Y., Zheng, S., Lei, W., Wang, F., Jiang, S., Zeng, T., Zhou, B. & Hong, F. (2019). Ethiodized poppyseed oil versus ioversol for image quality and adverse events in hysterosalpingography: a prospective cohort study, BMC Medical Imaging, 19, 50, https://doi.org/10.1186/s12880-019-0346-0.

Van Rijswijk, J., Pham, C. T., Dreyer, K., Verhoeve, H.R., Hoek, A., De Bruin, J.P., Nap, A.W., Wang, R., Lambalk, C.B., Hompes, P.G.A., Mijatovic, V., Karnon, J.D. & Mol, B.W. (2018). Oil-based or water-based contrast for hysterosalpingography in infertile women: a cost-effectiveness analysis of a randomized controlled trial, Fertility Sterility, 110, 754-760, https://doi.org/10.1016/j.fertnstert.2018.05.001.

Van Rijswijk, J., Van Welie, N., Dreyer, K., Pham, C.T., Verhoeve, H.R., Hoek, A., De Bruin, J. P., Nap, A.W., Van Hooff, M.H.A., Goddijn, M., Hooker, A.B., Bourdrez, P., Van Dongen, A., Van Rooij, I. a. J., Van Rijnsaardt-Lukassen, H.G.M., Van Golde, R.J.T., Van Heteren, C.F., Pelinck, M.J., Duijn, A.E.J., Kaplan, M., Lambalk, C.B., Mijatovic, V. & Mol, B.W.J. (2020). Tubal flushing with oil-based or water-based contrast at hysterosalpingography for infertility: long-term reproductive outcomes of a randomized trial, Fertility Sterility, 114, 155-162, https://doi.org/10.1016/j.fertnstert.2020.03.022.

Van Welie, N., Dreyer, K., Van Rijswijk, J., Verhoeve, H.R., Goddijn, M., Nap, A. W., Smeenk, J.M.J., Traas, M. a. F., Rijnsaardt-Lukassen, H.G.M., Van Dongen, A., Bourdrez, P., De Bruin, J.P., Sluijmer, A.V., Gijsen, A.P., Van De Ven, P.M., Lambalk, C.B., Mijatovic, V. & Mol, B.W.J. (2019). Treatment effect of oil-based contrast is related to experienced pain at HSG: a post-hoc analysis of the randomised H2Oil study, Human Reproduction, 34, 2391-2398, https://doi.org/10.1093/humrep/dez206.

Watson, A., Vandekerckhove, P., Lilford, R., Vail, A., Brosens, I. & Hughes, E. (1994). A meta- analysis of the therapeutic role of oil soluble contrast media at hysterosalpingography: a surprising result? Fertility Sterility, 61, 470-7, https://doi.org/10.1016/s0015-0282(16)56578-9.

Weir, W.C. & Weir, D.R. (1951). Therapeutic value of salpingograms in infertility Fertility Sterility, 2, 514-22, https://doi.org/10.1016/s0015-0282(16)30725-7.

Wyns, C., Bergh, C., Calhaz-Jorge, C., De Geyter, C., Kupka, M.S., Motrenko, T., Rugescu, I., Smeenk, J., Tandler-Schneider, A., Vidakovic, S. & Goossens, V. (2020). ART in Europe, 2016: results generated from European registries by ESHRE, Human Reproduction Open, 2020, hoaa032, https://doi.org/10.1093/hropen/hoaa032.

Zen, M., Kirby, A., Dowthwaite, S., Gibson, R. & Mizia, K. (2020). Lipiodol visibility under ultrasound, Australian and New Zeland Journal of Obstetrics Gynaecology, 60, 598-604, https://doi.org/10.1111/ajo.13150.

Downloads

Download data is not yet available.