Treating infertility caused by endometriosis

Treating infertility caused by endometriosis

Infertility is common. According to the U.S. Department of Health & Human Services, 12 or 13 couples out of 100 will have trouble becoming pregnant.  Infertility is usually caused by one of six major categories of disease, four of which are female specific:

  1. Endometriosis
  2. Ovulation disorders, overwhelmingly the most common is polycystic ovary syndrome (PCOS)
  3. Uterine tumors such as polyps and fibroids
  4. Scarred, swollen, damaged, oftentimes blocked fallopian tubes

The two most common of the four listed are presumably endometriosis and PCOS.

A woman’s menstrual history, though a low-tech observation, is still a very powerful tool in providing a strong clue as to what might be causing her infertility.  A woman who has infertility and erratic menstrual cycles very likely has PCOS of some degree of severity.  A woman who has infertility and regular consistent menstrual cycles most likely has some degree of endometriosis, which is what we will be focusing on today.

Endometriosis and infertility

It is probably fair to say that endometriosis is the most controversial and debated disease in all of women’s reproductive health with a very wide spectrum of medical opinions.  In recent decades, the role of endometriosis in infertility has been questioned. Many doctors trained in the last two to three decades were taught to think that a woman who has just infertility and does not have crippling pelvic pain does not have endometriosis, thus not offering treatment specific for it to the patient.  This is unfortunate; this mindset ignores work of nearly four decades ago that found that some 50-80% of women with infertility, normal tubes and normal menstrual cycles will be found to have endometriosis.1  Making it doubly unfortunate is that simple, relatively specific, generally-covered-by-insurance (unlike in vitro fertilization (IVF)) therapy for endometriosis is available.  A study done in 2003-20042 showed substantial infertility cure rates with a simple hysterosalpingogram done with a certain specific technique for patients with infertility due to endometriosis.

What is a hysterosalpingogram?

The hysterosalpingogram is the standard, basic test that is done to check an infertile woman’s tubes to find out if the tubes are damaged and/or blocked.  It is generally covered by most insurance policies.  What the 2004 study by Johnson showed was that this simple, outpatient, non-surgical, takes-only-a-few minutes diagnostic procedure has the wonderful additional benefit of providing effective treatment for endometriosis if a specific type of x-ray dye is used.  Only the x-ray dye, ethiodized poppy seed oil, carries the big therapeutic benefit for patients with endometriosis; no other type of x-ray dye is nearly as effective.

Treating infertility caused by endometriosis

The benefit of a hysterosalpingogram done with ethiodized poppy seed oil for curing infertility has now been shown in three prospective studies.3 The most recent confirmatory study was published only a couple years ago. Despite this, many American doctors and hospitals do not seem to be aware of the technique. (This reason could be because all three studies were done outside the United States – in New Zealand or Europe.) Our experience is that most patients who have hysterosalpingography in this region outside of the two Huntington hospitals do not receive the more powerful technique.  Thus, if you have female infertility due to endometriosis, or infertility that your doctor has passed off as being “unexplained,”then you might be very well served by looking into the possibility of having hysterosalpingography with poppy seed oil.

If you would like to learn more about this test or schedule an appointment, please call Marshall Obstetrics & Gynecology at 304-691-1400. We treat both male and female fertility issues and offer the latest techniques in vitro fertilization.

1T. S. Drake and G. M. Grunert, “The unsuspected pelvic factor in the infertility investigation,” Fertility and Sterility volume 34, page 27, 1980.

2N. P. Johnson and others, “The FLUSH trial—flushing with lipiodol for unexplained (and endometriosis-related) subfertility by hysterosalpingography: a randomized trial,” Human Reproduction volume 19, page 2043, 2004.

3Prospective studies, when patients are studied and analyzed going forward in “real time,” are generally thought to be more powerful and more reliable than retrospective studies, when patients are only analyzed from their old records.

4K. Dreyer and others, “Oil-based or water-based contrast for hysterosalpingraphy in infertile women,” New England Journal of Medicine volume 376, page 2043, 2017.


William Burns, MD

Dr. Burns is a board-certified OB/GYN and associate professor in the department of obstetrics & gynecology at the Marshall University Joan C. Edwards School of Medicine.