Born Slippy: A Tribological Discourse on Hysterosalpingography as a Therapeutic Treatment for Infertile Women

Lead Research Organisation: University of Birmingham
Department Name: Mechanical Engineering

Abstract

Blocked fallopian tubes are a common cause of female infertility. When seeking treatment for this, the first stage of any intervention will be a search for tube blockages. This procedure involves inserting a dye into the uterus that can then be used to screen how well the tubes are open using x-ray. This medical technique is called hysterosalpingography. The dye or contrast used is either a poppy seed oil based emulsion or water. A recent study led by Prof. Ben Mol at the University of Adelaide has shown a 10% increase in the rates of pregnancy and births for women who received the oil-based contrast. This is a remarkable result given that more common fertility treatment such as Intrauterine insemination raises pregnancy rates by 1 or 2 %. The underlying mechanisms, however, that explain how fertility is enhanced are not clear. It has been suggested that tubal patency testing with an oil contrast flushes debris and dislodges mucus when the fallopian tubes are undamaged. This does not explain why water does not exhibit similarly impressive effects.

The transport of the ovum (or oocyte) from the ovary to the womb is essentially a tribological process. Poppy seed oil is composed, amongst other things of fatty acids and esters both of which are very good at improving the frictional response, or lubricity, of a given system. Good lubricity may help the oocyte to move more easily through the tube, may the prevent the formation of debris in the tubes, prevent the fallopian tubes from closing and/ or aid sperm mobility. All of these effects can be explained by understanding tribology of the system.

This research sets out an ambitious goal of measuring the tribological properties of this Mol's observed phenomenon. At its centre is the use of a novel method to nondestructively measure the frictional properties of an oocyte in transit through a simulated fallopian tube using direct observation, mechanical modelling and a machine-learning algorithm.

Infertility is a big problem. 186 million women in the developed world are affected by it, equivalent to one in four adults. By understanding the underlining tribology of HSG therapy and the interaction between specific components within the contrast, the surfaces within the reproductive and the physiological reproductive process, a new tailored and extremely effective approach to the treatment of female infertility could be developed.

Planned Impact

186 million women in the developed world are affected by infertility, equivalent to one in four adults. BORN SLIPPY will offer a tribological profile of therapeutic hysterosalpingography (HSG) that can be used to develop a tailored approach to the treatment of infertility and will serve as a basis for improved infertility treatments with global impact.
There will be societal beneficiaries not least the one in four or 186 million married women in the developed world who are affected by infertility. The development of new more effective treatment for infertility will improve outcomes for those who have trouble getting pregnant. The potential impact here is huge. Already the use of hysterosalpingography (HSG) is documented as being extremely beneficial and has been predicted to cause a disruptive change to medical practice. This means that there is a potential to reduce the 50,000 (approx.) UK women who undergo in-vitro fertilisation (IVF) each year. It has been estimated that using HSG today as a treatment could allow 20,000 to avoid IVF, this number could be increased if the contrast was tailored for the patients 'tribological' profile, further reducing the financial, personal and social burden of the fertility treatment. More widely, addressing a falling birth rate in the developed world may help to address the demographic-economic paradox, and redress the potential social problems associated with an ageing population.
There are many potential economic beneficiaries. There will be the patients benefiting from improved fertility treatment, reducing or even eliminating the high costs associated with IVF. There are also indirect economic costs associated with infertility diagnosis and treatment that will be reduced, such as time lost from work, child care expenses or debt incurred to pay for treatment for patients. In the UK, IVF treatment is available under certain circumstance through the National Health Service. A tailored HSG therapy would represent a fraction of the cost of a single cycle of IVF. Other economic beneficiaries in a more general context will be societally focused. Increasing the birth rate will ensure in the long term that there is a young productive workforce able to generate income and provide appropriate social care for an again population. From a policy perspective, a tailored HSG treatment could be used by the Department of Health, with the government as part of the development of a promotion of natural conception.

Other application areas that will potentially benefit includes bio-tribologists, chemists and material scientists where the interaction between cells, fluids and internal organs is an important factor in understanding physiological processes or developing effective treatments. The routes to ensure that the outputs of this project receive maximum exposure are described in detail in the 'pathways to impact document.

Relating specifically to Engineering a Prosperous Nation: BORN SLIPPY addresses the HEALTHY NATION prosperity outcome H4, with the overall aim to contribute to the development of future therapeutic technologies to treat infertility, by understanding the tribology of the female reproductive system and the interaction with radiologic HSG. By studying the components of the radiologic contrasts, there is a potential for treatments for specific tubal patency to be optimized addressing the HEALTHY NATION prosperity outcome H3. An optimized infertility treatment provides a better solution to this acute health threat and addresses RESILIENT NATION prosperity outcome R3.

Publications

10 25 50
 
Description Amsterdam UMC - Endometriosis Centre 
Organisation Amsterdam Medical Center
Country Netherlands 
Sector Hospitals 
PI Contribution Technological and engineering expertise, research and development, funding applications and bids.
Collaborator Contribution Clinical expertise and advice relating to publications and grant applications, HSG images for analysis, project management and oversite.
Impact Publications and grants applications, small scale clinical trial.
Start Year 2020
 
Description Ben Mol et al. Monash University 
Organisation Monash University
Country Australia 
Sector Academic/University 
PI Contribution Engineering support for the development of novel theranostics treatments for infertility
Collaborator Contribution Gynaecological and cheimcal support for the development of novel theranostics treatments for infertility.
Impact Funding application to the Australian Medical Council
Start Year 2018
 
Title Pressure measure device during HSG 
Description Our pressure measuring device is used during HSG (Hysterosalpingography), to monitor the pressure within the uterus and fallopian tubes. The device consists of a small catheter, which is inserted through the cervix and into the uterus. The catheter is attached to a pressure transducer, which is a device that converts pressure into an electrical signal that can be displayed on a monitor. As the contrast medium is injected into the uterus, the pressure within the uterus and fallopian tubes will increase. The pressure measuring device detects and measures these changes in pressure, allowing the healthcare provider to assess the patency of the fallopian tubes and identify any blockages or abnormalities. The pressure measuring device is generally well-tolerated by patients, although some discomfort or cramping may occur during the procedure. It is important for patients to communicate any discomfort or pain to their healthcare provider during the HSG, so that appropriate measures can be taken to ensure their comfort and safety. 
Type Diagnostic Tool - Non-Imaging
Current Stage Of Development Initial development
Year Development Stage Completed 2023
Development Status Under active development/distribution
Impact Measuring pressure during HSG helps better assess fallopian tube patency, identify potential reproductive issues, and ensure patient safety and comfort. It helps diagnose and treat infertility and abnormalities within the uterus and understand the underlying physics of HSG. 
 
Description Conference 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Attendance and Presentation at Fertility 2020
Year(s) Of Engagement Activity 2020
 
Description STEM for Britian 2019 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Presented and discussed our ground-breaking research to Members of both Houses of Parliament at Westminster, and fostered greater dialogue and engagement between early-stage researchers and Members both in Westminster and in their Constituencies
Year(s) Of Engagement Activity 2019
URL http://www.setforbritain.org.uk/index.asp