Lipiodol flush under ultrasound guidance in Australia

Sekhon, Jasmin; Lee, Emmeline; Lo, Glen; Woolcock, Jane; Ramkrishnan, Jayshree; Menezes, Melody; Tan, Shawn W.; Meagher, Simon; Murphy, Anthony

doi:10.1111/ajo.13244

Cited by 5 publications

(9 citation statements)

References 25 publications

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“…Our study adds to that of Sekhon et al 18 . in supporting Lipiodol flush under ultrasound guidance as a viable alternative to HSG, and is the first study to compare the sonographic visibility of Lipiodol to agitated saline in vivo .…”

Section: Discussionsupporting

confidence: 60%

“…16 It has been demonstrated ex vivo in model pelvises that agitated Lipiodol is visible with ultrasound imaging and can be sonographically visualised as well as, or even better than, WBCM. 17 Sekhon et al 18 have recently demonstrated that in patients with confirmed tubal patency with WBCM at HSG, ultrasound-guided Lipiodol flushing of the tubes is a safe and effective alternative to tubal flushing with OBCM at the time of HSG. This is a retrospective observational study to report the feasibility and tolerability of performing Lipiodol flushing at the time of tubal patency assessment with HyCoSy.…”

Section: Introductionmentioning

confidence: 99%

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Lipiodol flushing under ultrasound guidance at time of hystero‐salpingo contrast sonography (HyCoSy): A retrospective observational study

Kirby

Dowthwaite³

et al. 2022

Aust NZ J Obst Gynaeco

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Background: Up to 30% of female infertility can be attributed to tubal abnormalities. Assessment of fallopian tube patency forms a component of the basic assessment of infertility. Tubal patency can be checked through hysterosalpingogram (HSG) under radiologic guidance with oil-or water-based contrast medium (OBCM or WBCM), or hystero-salpingo contrast sonography (HyCoSy) under ultrasound guidance with WBCM. Tubal flushing with OBCM has been shown to improve fertility rates. Objectives: To study the feasibility and tolerability of performing Lipiodol (ethiodised oil) flush concurrently with HyCoSy. To examine the in vivo sonographic visibility of Lipiodol vs normal saline. Materials and Methods: Retrospective observational study of patients with subfertility referred for Lipiodol flushing under ultrasound guidance between August 2017-September 2020 at six private ultrasound practices in Sydney, Australia.Results: There were 412 patients who were referred for Lipiodol flushing. Of these, 86 patients did not have concurrent Lipiodol flush at HyCoSy performed due to strict exclusion criteria. Of the 326 patients who proceeded with Lipiodol flushing at HyCoSy, all cases were successful, with no cases of extravasation. There were no major complications. In vivo sonographic visualisation of Lipiodol was similar to that of the commonly used agitated 0.9% saline (n = 20; mean visibility score 4.3 ± 0.9 vs 4.0 ± 1.2). Conclusion:Our study has shown that Lipiodol flushing at time of HyCoSy as a single procedure is feasible and tolerable to patients. Flushing with Lipioidol during HyCoSy is likely as sonographically visible as 0.9% saline.

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Section: Discussionsupporting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Lipiodol flushing under ultrasound guidance at time of hystero‐salpingo contrast sonography (HyCoSy): A retrospective observational study

Kirby

Dowthwaite³

et al. 2022

Aust NZ J Obst Gynaeco

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“…Lipid-soluble contrast media may be preferred to increase the chances of pregnancy [17]. However, because of concerns that lipid-soluble agents remain in the ovarian tubes for a long time [18], water-soluble contrast agents have recently begun to be used in radiographic examination [36]. In the present study, the agent type was not investigated.…”

Section: Implications For Clinicians and Parentsmentioning

confidence: 98%

Mother’s iodine exposure and infants’ hypothyroidism: the Japan Environment and Children’s Study (JECS)

et al. 2022

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In this study, we aimed to determine the association of neonatal/post-neonatal hypothyroidism with mother's iodine exposure, especially povidone iodine disinfection, and hysterosalpingography. Participants were mother-child pairs in a Japanese birth cohort (n = 100,286). Risk factors of hypothyroidism were supplement intake, seaweed intake, other daily iodine intake, povidone iodine disinfection at delivery, and maternal history of hysterosalpingography, thyroid disease (Graves' disease and Hashimoto's thyroiditis), and medication (thiamazole and levothyroxine). Congenital hypothyroidism (CH) at age 1 year was assessed using a questionnaire. Transient hypothyroidism was defined as elevated thyroid stimulating hormone level at birth and absence of CH at age 1 year. The incidence of CH at age 1 year per 100 children was 1.1 for those born at 22-30 weeks' gestation, 0.17 following povidone iodine disinfection, and 0.07, 0.95, 0.81, 1.17, and 1.15 with a maternal history of hysterosalpingography, Graves' disease, Hashimoto's thyroiditis, thiamazole use, and levothyroxine use, respectively. Odds ratios (95% confidence intervals) of CH at age 1 year for povidone iodine disinfection, hysterosalpingography history, maternal Graves' disease, and maternal Hashimoto's thyroiditis were 1.13 (0.71-1.79), 0.47 (0.07-3.36), 7.06 (3.70-13.5), and 5.93 (2.90-12.1), respectively. For transient hypothyroidism for povidone iodine disinfection and hysterosalpingography history, these values were 1.99 (1.51-2.62) and 0.63 (0.20-1.96), respectively. Maternal thyroid disease greatly increased neonatal/post-neonatal hypothyroidism risk. Povidone iodine disinfection may increase transient hypothyroidism risk but not the risk at 1 year of age. Hysterosalpingography does not increase hypothyroidism risk from birth to age 1 year.

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“…In the study evaluating the effects of such treatment modification, it was shown that, similarly to the classic HSG, 51% of patients became pregnant after administering oil contrast under ultrasound control within six months. During the procedure, the patients experienced only moderate discomfort, and the procedure was characterized by a high safety profile (Sekhon et al, 2020). The oil contrast may be additionally shaken before administration or given to turbulent flow to create fine air bubbles that significantly improve visualization during ultrasound (Zen et al, 2020).…”

Section: The Therapeutic Effect Of Oil Contrastmentioning

confidence: 99%

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

Maksym

2021

FetR

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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.

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Lipiodol flush under ultrasound guidance in Australia

Cited by 5 publications

References 25 publications

Lipiodol flushing under ultrasound guidance at time of hystero‐salpingo contrast sonography (HyCoSy): A retrospective observational study

Lipiodol flushing under ultrasound guidance at time of hystero‐salpingo contrast sonography (HyCoSy): A retrospective observational study

Mother’s iodine exposure and infants’ hypothyroidism: the Japan Environment and Children’s Study (JECS)

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

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