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

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.

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.