Interventional Radiology in New York City

What is Lipiodol?

Lipiodol is an iodized poppy-seed oil which has been used safely for many years to visualize fallopian tubes in x-ray images. It was initially found to be useful because it contains iodine which makes it radio-opaque. Although HSG is not a new procedure, recent research has shown significant benefits for fertility linked with the use of lipiodol, compared to water-based dye solutions.

What to expect during Lipiodol HSG

This examination is very similar to a conventional HSG. The difference is that Lipiodol HSG uses a poppy seed oil-based contrast, rather than a water-soluble contrast, to flush the fallopian tubes.

All the major elements of the examination remain the same as the traditional HSG. A Lipiodol HSG is performed between days 6 and 12 of your menstrual cycle. Please call on the first day of your period to arrange your HSG appointment.

Patients may experience pelvic cramping during the procedure. A mild analgesic, such as ibuprofen, can be taken before your procedure. A speculum is inserted into the vagina. A soft narrow plastic tube is inserted into the uterus so that the Lipiodol can be introduced into the uterus and fallopian tubes.

The Lipiodol can be visualized passing into the uterus, out both fallopian tubes and spilling into the pelvis. This tubal flushing appears to improve the chances of pregnancy in the next 6 months after the procedure.

How does Lipiodol improve chances of pregnancy?

Although HSG is not a new procedure, recent research has shown significant benefits for fertility linked with the use of Lipiodol, compared to water-based dye solutions. There have been a small number of studies that suggest that flushing the media through the tubes gives a short-term rise in fecundity in patients with unexplained infertility.

A systematic medical literature review has identified a significant increase in fertility, especially in those women who have endometriosis when using Lipiodol flushing. The exact mechanism has not yet been confirmed. Whether Lipiodol® Ultra-Fluid is working through improving the environment where eggs mature, the endometrial environment where the embryo is implanting, or through flushing of non-occlusive but pregnancy-hindering debris from the fallopian tubes, Lipiodol is a cost-effective intervention that significantly improves a woman’s fertility.

When is Lipiodol HSG not suitable?

• Iodine or poppy seed allergies
• Abnormal fallopian tubes
• History of pelvic inflammatory disease
• Cervical erosion or endocervicitis
• Intrauterine bleeding
• In the immediate postmenstrual phase
• After day 12 of the menstrual cycle
• Within 30 days of curettage or conization

After your procedure

• You may experience spotting for 24 hours after your procedure (avoid using tampons).
• You may experience lower abdominal cramping. A mild analgesic, such as ibuprofen, can be taken prior to and several hours after your procedure.

Risks

This procedure is minimally invasive and is associated with a very low risk of side effects. The recognized hazards of the procedure are as follows:

• Lipiodol can persist in the pelvic cavity for several months after treatment. There do not appear to be any harmful effects recognized from this.
• Rarely the procedure may activate pelvic inflammation, especially if you are carrying one of the organisms known to cause this.
• Intravasation (escape of Lipiodol into the blood vessel close to the uterus), can sometimes result in adverse reactions. Such reactions can be quite severe in rare circumstances.
• Granuloma formation. This is a chronic inflammation response to Lipiodol and, in extremely rare circumstances, could lead to the need for surgery.

References

• Dreyer K, et al. Oil versus water-based contrast medium for hysterosalpingography in infertile women (H2Oil study); a randomised trial. N Eng J Med 2017 [ePub]
• Johnson NP, Farquhar CM, Hadden WE, Suckling J, Yu Y, Sadler L. The FLUSH Trial – Flushing with Lipiodol for Unexplained (and endometriosis-related) Subfertility by Hysterosalpingography: a randomised trial. Hum Reprod 2004;19:2043-51.
• Mohiyiddeen L, Hardiman A, Fitzgerald C, et al. Tubal flushing for subfertility. Cochrane Database Syst Rev 2015;5:CD003718.