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

Radosław Maksym
In: Kwartalnik Naukowy Fides et Ratio · 2021 · vol. 47(3) , pp. 84–94 · doi:10.34766/fetr.v47i3.897 · W3203751050
article OA: diamond CC0
🔓 Open OA copy Full text JSON View on OpenAlex View at publisher
⚙ AI-generated summary by claude@2026-06, 2026-06-10 ⓘ

Ethiodized oil instillation in infertile patients with endometriosis significantly increases pregnancy rates, suggesting an immunotherapeutic mechanism potentially related to tubal patency evaluation.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 · read from full text ⓘ

The paper examines the use and implementation of ethiodized oil during hysterosalpingography as an “oil contrast” approach to treat endometriosis-associated infertility, focusing on how tubal patency testing with lipiodol/ethiodized oil may produce fertility benefits. Drawing on prior evidence and randomized trial data, it reports that in women with endometriosis this approach is associated with a marked increase in pregnancy rates—about a five-fold rise in infertility-to-pregnancy outcomes within six months—while noting a smaller benefit in idiopathic infertility, with the proposed mechanism involving immune modulation rather than purely mechanical tubal effects. The paper highlights an explicit limitation that it is not fully understood why oil contrast works more effectively than other water-based contrasts and frames the evidence as showing a strong immunotherapeutic effect without complete mechanistic clarity. This paper is centrally about endometriosis — it focuses on implementing ethiodized oil as a treatment targeting immune/disorder mechanisms in endometriosis-associated infertility.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works

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.
Full text 11,633 characters · extracted from oa-doi-fallback · 2 sections · click to expand

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.

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.

Text is read by the "Ask this paper" AI Q&A widget below. Extraction quality varies by source — PMC NXML preserves structure cleanly, OA-HTML may include some navigation residue, and OA-PDF can have broken hyphenation. The publisher copy (via DOI) is the canonical version.

My notes (saved in your browser only)

⚙ Ask this paper AI returns verbatim quotes from the full text · source: oa-doi-fallback ⓘ

Answers must be backed by verbatim quotes from this paper's full text. Hallucinated quotes are dropped automatically; if no verbatim passage answers the question, we say so. How this works

Condition tags

endometriosisinfertility

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (26)

Source provenance

openalex
last seen: 2026-06-10T17:14:06.276822+00:00
License: CC0 · commercial use OK