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Lipiodol Flushing Procedure

What is Lipiodol?

Lipiodol is a liquid contrast agent made from poppy seed oil. It was originally found to be useful because it contains iodine which makes it radio-opaque. However these days we don’t need to use x-rays, we use ultrasound to follow its flow. To make it visible with ultrasound we aerate it before its instillation.

Download Lipiodol Product Info.

How is the procedure done?

We use ultrasound guidance to avoid radiation exposure. A sterile speculum is inserted into the vagina and the cervix is washed with antiseptic. A soft narrow plastic tube is inserted into the uterus so that the Lipiodol can be introduced into the uterus and Fallopian tubes. With a simultaneous trans-vaginal ultrasound examination the Lipiodol can be visualised 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 it improve the chances of pregnancy?

In recent papers, the Lipiodol flush procedure was shown to improve the chances of pregnancy. The exact mechanism has not yet been confirmed. The Lipiodol may

• help embryos implant into the endometrium
• clear out the Fallopian tubes
• alter the balance of macrophage and other immunological cell activity around the tubes and ovaries.

Who is not suitable?

Women who are already pregnant or could be conceiving this cycle.

This is because we do not want to disturb the pregnancy.

Lipiodol tubal flushing should not be performed at any time when there is a chance of pregnancy. To ensure that you are not pregnant on the day of the procedure, we usually book it on or before day 12 of your cycle, but after bleeding has ceased.

Women with blocked tubes

Lipiodol flushing is only appropriate for women who have functioning Fallopian tubes as we do not want to intentionally inject the Lipiodol and have it collecting in blocked tubes. This increases the chances of complications. Therefore it is recommended that tubal patency be confirmed before we book in the procedure. Please bring a copy of your previous hystero-salpingogram (HSG), hystero-contrast-sonography (HyCoSy) or laparoscopy and dye report.

If tubal patency has not been assessed previously, it can be done at the time of the Lipiodol flushing, with air aerated saline.  The disadvantages of this approach about the whole procedure takes longer and maybe harder to tolerate. Also there is no good evidence about whether flushing with saline before the Lipiodol affects the results or the pregnancy outcomes. 

Women with a risk of pelvic infection

Neither HyCoSy nor Lipiodol tubal flushing should be performed in women with suspected pelvic infection. If you have a concern about a past history of pelvic infection, please discuss the option of prophylactic antibiotics with your doctor before hand.

 

Patients with an Iodine allergy

As Lipiodol contains Iodine it is not suitable for women who have a history of Iodine allergy.

What are the risks and complications?

This procedure is minimally invasive, well tolerated and is associated with a very low risk of side effects. The known risks of the Lipiodol flushing are as follows:

1. Allergic reaction to Iodine
   This is more common if there are blocked tubes and high pressures are used during the procedure which could result in Lipiodol entering blood vessels of the uterus directly.
2. Lipiodol can persist in the pelvic cavity for several weeks. There do not appear to be any harmful effects arising from this. It is eventually absorbed.
3. Rarely the procedure may activate pelvic inflammation.
4. Granuloma formation
   This is a chronic inflammatory response to Lipiodol and, in extremely rare circumstances, could lead to the need for surgery, for example to remove an inflamed Fallopian tube affected by a granuloma.

Lipiodol tubal flushing has been performed in different ways for decades. The techniques have been perfected, and it has now become a very well tolerated, minimally invasive procedure.

A recent meta-analysis of multiple trials has shown higher pregnancy rates in the 6 months post-procedure for those couples who had the Lipiodol flush procedure.

The articles show that not all patients conceived after the procedure. It does not guarantee a pregnancy for everyone as there are so many other factors which are important.

You should discuss the risks and benefits of the Lipiodol flush procedure with your fertility specialist to understand if the procedure is suitable for you.

Download Lipiodol Research Metaanalysis.