Preovulatory uterine flushing for Unexplained infertility?

Emobileclinic Researchers’corner

A recent study is proposing preovulatory uterine flushing for unexplained infertility. According to the author ‘preovulatory uterine flushing could reduce intrauterine debris and inflammatory factors preventing pregnancy and constitute an alternative to IVF’ .She explained that In vitro fertilisation (IVF) is the treatment of choice for unexplained infertility. The study’s objective is to assess the efficacy of preovulatory uterine flushing with physiological saline for the treatment of unexplained infertility.

Infertility affects approximately one in six couples. In over a quarter of cases, the infertility remains unexplained. Unfortunately, effective treatment options are also limited. The researchers are of the opinion that ‘ovarian stimulation with clomiphene citrate and intrauterine insemination have not been shown to be effective treatments’.


To back the last assertion up, they said ‘ the National Institute for Health and Care Excellence (NICE) and the American Society for Reproductive Medicine (ASRM) no longer recommend their use in unexplained infertility’.

IVF has always been mostly used for unexplained infertility and the researchers felt even Gonadotropins with its high rates of multiple pregnancy has limited its use to in vitro fertilization (IVF) protocols, leaving IVF as the only current reasonable treatment for unexplained infertility.

This necessitated their research for further alternative. Their recommendations for uterine flushing are born out of the benefits and results of the procedure. According to the author, ‘ UF is usually well tolerated and could represent a less expensive and better tolerated option than IVF’. They advocate for the use of ‘physiological saline ‘ because’ is the most affordable and the least invasive contrast avoiding any risk of allergy. In order to obtain an appropriate visualization of the tubes, an average of 9 mL and up to 22 mL of contrast are injected into the uterus. The amount of fluid may have an important role to play in the ability to dislodge plugs or other debris from within the fallopian tubes.

The researchers did a randomised control trial based on consecutive women aged between 18 and 37 years consulting for unexplained infertility for at least 1 year. On the day of their luteinising hormone surge, 192 participants was randomised in two equal groups to either receive 20 mL of physiological saline by an intrauterine catheter or 10 mL of saline intravaginally.’The result was assessed based on ‘risk of live birth (primary outcome), as well as pregnancy (secondary outcome) over one cycle of treatment. ‘

The results in the following months show tubal patency and increase in pregnancies and live births.’ A growing body of evidence suggests that uterine flushing could promote fertilization by removing debris from otherwise undamaged tubes and altering interleukin and prostaglandin production by macrophages’.

Research Source

BMJ

‘Preovulatory uterine flushing with saline as a treatment for unexplained infertility: a randomised controlled trial protocol’ by Sarah Maheux-Lacroix