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Let’s Talk Fertility – July 2017

Lipiodol Hysterosalpingogram

What it means for your patients
Hysterosalpingogram (HSG) has been around for a long time so for doctors, the recent news suggesting HSG is a new miracle technology for infertile women had a few scratching their heads. Hysterosalpingogram has been a diagnostic tool used to diagnose blocked tubes and originally used an oil based contrast solution (poppy seed oil / Lipiodol). In recent decades it was discovered that water-based medium was a much better diagnostic tool as our radiologist colleagues could acquire clearer images.

For many years we have seen anecdotally that some women at fertility clinics were being sent for HSG tests to determine treatment continuums and would end up falling pregnant naturally. Fertility SA’s Dr Bruno Radesic authored a study in New Zealand regarding improvement in implantation rates in women with endometriosis and unexplained subfertility. The recent study in Australia and The Netherlands by Professor Ben Mol from Adelaide University showed that women with greater than 12 months unexplained infertility who underwent HSG with water-based contrast would have a 27% chance of natural conception following the HSG. Those who underwent HSG with Lipiodol had a pregnancy rate of 40%. Thus, the diagnostic tool has become a therapeutic tool.

Does this change how I manage patients?
• Patients should still be trying for 12months if they are under 35 years old before medical intervention
• Patients 35 and above or with a complicated gynaecological history should see medical opinion to achieve pregnancy after 6 months
• We would still encourage referrals be made to a fertility specialist to combine HSG with other preliminary tests
• Those doctors undertaking fertility investigations themselves should combine HSG tests with other fertility tests

Other things to know:
• The cost to perform a lipiodol HSG is no different to a standard HSG providing patients bring the Lipiodol with them. That is approximately $330 upfront with $190 reimbursed through Medicare.
• The cost of Lipiodol itself is approximately $450.00 and the script should be provided by the doctor to fill for the ampoule of Lipiodol.
• When referring to a radiology provider, please know where the provider can undertake lipiodol HSG. For example, Benson Radiology only perform Lipiodol HSG at their Melbourne Street facility.
• The patient should bring the ampoule on the day for their appointment.
• For patients with private health cover, it may be more cost effective for Lipiodol HSG to be undertaken as an inpatient with the hospital covering the expense of the Lipiodol*

*Please check individual hospitals and insurance conditions

Unfortunately, there may still be patients who require further intervention and a thorough investigation is part of this. Fertility SA are proud of our individualised approach to patients and will seek to find the best possible option using the most up to date science and most suitable treatment to enable your patient to achieve a healthy baby.

Thank you for placing your trust in us.

From The Fertility SA team

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