Low-Tech Treatment May Offer Alternative To IVF
July 7, 2008 - 7:11 PM
Pacific Rim Bureau (CNSNews.com) - Researchers in New Zealand investigating cases of unexplained human infertility may have found a simple, inexpensive and ethical alternative to in-vitro fertilization (IVF) treatment.
The trial is still underway, and the researchers stress the results are preliminary, but so far one of out three women who have had their reproductive organs flushed with a special liquid have conceived, usually within a couple of months.
Dr. Neil Johnson of the National Women's Hospital in Auckland said 80 couples with "unexplained infertility" or suffering from mild cases of endometriosis (a problem involving the womb lining tissue) had taken part in the study thus far.
Of those, half were randomly selected for the treatment, the remainder making up a control group.
As of now, one women in three of those whose fallopian tubes and uteruses were flushed with lipiodol, an oil-based medium used in x-rays, have subsequently conceived - usually within a couple of months.
The control group - women who received no treatment but have continued to try for a baby - has by contrast seen just two conceptions, one of which ended in miscarriage.
"To give it scientific validity, we need bigger numbers," Johnson said in an interview.
The researchers' original aim was to sign up 150 couples, but they now say they will continue recruitment for three years and no more.
"Then we'll close the trial and analyze the results. We hope they will bear out the degree of guarded optimism we feel now."
In 10 to 20 percent of cases of infertility the cause is not known, according to experts in the field.
Meredith and Jonathan Thorpe, both in their 20s, struggled to conceive for two years.
They underwent various tests, but "there was nothing obviously wrong with either or us," Meredith said Tuesday.
"It was horrible, I've been looking back in my diaries, and the best way to describe it is like a roller-coaster - one day up and feeling great, the next right down. Every month you think, this might be it. Even though it was 'only' for two years, it was really hard."
Eventually they entered the study, were pleased to be chosen as part of the test group, and she underwent the quick and "straightforward" procedure.
"I didn't think much would come of it, but went home and promptly forgot about it afterwards. At that stage, you don't want to get your hopes up."
But several months later, she learned she was pregnant, and daughter Amarah was born 10 months ago.
Meredith said IVF had crossed their minds, and if they had been older - perhaps in their late-30s - they may have tried it.
The results of the lipiodol flush were amazing, she said.
"It's so non-invasive, takes so little time and has no side-effects. It's great to be able to go somewhere for half a day, and two months later be pregnant ... to have an intermediate point between 'we can't find anything wrong with you' and IVF."
Megan MacDonald, 28 and her 30-year-old husband Jason had been trying for two-and-a-half years to have a child, with no success.
"Each month that passed made us feel discouraged," she recalled Tuesday.
They sought expert help. Megan had a laproscopy (an inspection of the reproductive organs with a small, telescope-like instrument inserted through the navel) and Jason's sperm count was tested and found to be normal.
The couple also thought about IVF, "but we only wanted to do that as a last option."
In New Zealand, couples have to wait four or five years before the government will fund the treatment, and even then only one round of IVF is paid for. After that, couples have to pay up to $3,400 for each attempt.
When they heard about the trial, the couple decided to give it a go. "It might work, and we also liked the idea of helping out the research."
The procedure was a little uncomfortable, but otherwise easy - "like a pap smear, only longer."
Megan's tubes were flushed in April, and she conceived in early June. When she learned she was pregnant in July, she was "in a state of shock for about an hour, crying tears of joy."
Little Madison was born three months ago. "She's a great baby. We feel very privileged to have her."
The MacDonalds would like to have more children, and are encouraged by statistics suggesting that a second conception is often easier.
"It has to be a lot less stressful than going through IVF," she said. "It might not work for people with more extreme fertility problems. But if it helps some, it's got to be worth it."
According to team leader Johnson, the researchers have revived an old idea.
"For decades gynecologists have been trying to flush women's fallopian tubes with all manner of things, to try increase the likelihood of conceiving in the context of infertility.
"Unexplained fertility can be a doubly frustrating phenomenon, because of our inability to unearth the cause."
In the last 10-15 years the concept lost popularity, however, in the absence of data showing it to be effective.
"But meta-analysis - pooling the results from various trials -alerted us to the fact that there may be something in this after all."
Lipiodol was formerly used in x-ray dye tests to establish whether fallopian tubes were blocked, but has been replaced by newer, water-soluble liquids.
The couples involved in the trial have all already been cleared of possible known causes of infertility, such as the male factor.
Women with mild endometriosis, which has not affected the fallopian tubes, are also participating.
A small amount of the liquid is inserted through the vagina and moves through the uterus and the fallopian tubes.
The preliminary results, he said, "staggered us," although the study will continue for some time yet.
"Some people have billed lipiodol flushing as being the low-cost, non-invasive alternative to IVF treatment in selected couples. I'd hasten to add that's not the way I'd like to view it at the moment. It's basically a research technique under evaluation as things stand at the present.
"But if the effectiveness stacks up and the safety factor stacks up in our trial, we'll be more confident to hopefully widen the availability."
As far as Johnson is aware, the procedure is not being used in a widespread way anywhere.
As for the reason why it may enhance the chances of pregnancy, Johnson said the mechanism remains unclear.
Initially the researchers thought it may be effective simply by clearing debris from the fallopian tubes.
"But I'm tending to favor more the hypothesis that it exerts some type of reaction from the body's immune cells that could enhance the likelihood of either fertilization or implantation of an embryo."
Apart from the financial and psychological cost of IVF, for many pro-lifers the treatment is controversial because invariably more embryos are created than are needed. "Spare" embryos are either stored for possible future use or destroyed.
E-mail a news tip to Patrick Goodenough.
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