Ethiodized poppyseed oil-based contrast medium is superior to water-based contrast medium during hysterosalpingography regarding image quality improvement and fertility enhancement: A multicentric, randomized and controlled trial

Zhang, Jing; Lan, Weishun; Wang, Yitang; Chen, Kunshan; Zhang, Guofu; Yang, Wei; Chen, Hui‐Chun; Xu, Wenjian; Ma, Jing; Qin, Wenhua; Zhang, Yao; Wang, Wuquan; Wang, Huichun; Dong, Zijun; Wang, Yanli; Chen, Yi; Ning, Gang; Tang, Yichuan

doi:10.1016/j.eclinm.2022.101363

Cited by 11 publications

(15 citation statements)

References 18 publications

(39 reference statements)

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“…25 With acknowledgement of the small sample size, the observed prevalence signifies intravasation as a relevant risk to consider, particularly given the rising use of OSCMs. [5][6][7][8][9][20][21][22][23][24][25][26] Additionally, intravasation was found to be underreported by 55% (n = 12). Within reported intravasations (n = 10), 70% (n = 7) were graded despite the absence of a standardised system for stratifying severity.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, there has been a notable shift towards utilising OSCMs due to increasing research demonstrating their fertility-enhancing benefits in both spontaneous and artificially induced pregnancies. [5][6][7][8][9][20][21][22][23][24][25][26] In 2017, a multi-centre randomised controlled trial comparing OSCM against WSCM 20 found significant benefit in ongoing pregnancy rates with OSCM, later supported by similar studies. 23,24 (Ongoing pregnancy is defined as a positive foetal heartbeat on ultrasound after 12 weeks of gestation.…”

Section: Therapeutic Benefit Of Oscmmentioning

confidence: 99%

“…[5][6][7][8][9][20][21][22][23][24][25][26] In 2017, a multi-centre randomised controlled trial comparing OSCM against WSCM 20 found significant benefit in ongoing pregnancy rates with OSCM, later supported by similar studies. 23,24 (Ongoing pregnancy is defined as a positive foetal heartbeat on ultrasound after 12 weeks of gestation. 20,24,25 ) In 2023, a meta-analysis found additional benefits of live births (defined as after 24 weeks of gestation) with OSCM use in HSG.…”

Section: Therapeutic Benefit Of Oscmmentioning

confidence: 99%

“…23,24 (Ongoing pregnancy is defined as a positive foetal heartbeat on ultrasound after 12 weeks of gestation. 20,24,25 ) In 2023, a meta-analysis found additional benefits of live births (defined as after 24 weeks of gestation) with OSCM use in HSG. 25 The cumulative data gathered in these studies [5][6][7][8][9][20][21][22][23][24][25][26] revealed consistent therapeutic benefit of OSCM for sub-fertility, thereby influencing a swift adoption of OSCM use in hysterosalpingography services globally.…”

Section: Therapeutic Benefit Of Oscmmentioning

confidence: 99%

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Assessment of contrast intravasation in patients investigated by fluoroscopic hysterosalpingograms: A two‐year retrospective audit in Western Australia

Chia,

Lee

2024

J Med Imag Rad Onc

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IntroductionIntravasation on hysterosalpingogram (HSG) is defined by the flow of injected contrast from the uterine cavity into adjacent myometrial vessels. Evidence suggests intravasation can result in consequences such as pulmonary and cerebral embolisms. However, adverse events are poorly reported across published studies. Reported intravasation ranges from 0.0% to 13%, with higher rates attributed to oil‐soluble contrast medium (OSCM) use. Recent reviews of OSCM's fertility‐enhancing benefits have prompted rapid clinical uptake by fertility specialists worldwide. This instigates increased concern for intravasation and its associated sequelae. We aim to assess the prevalence of intravasation in fluoroscopic HSGs and its reporting in Western Australia (WA).MethodsA two‐year retrospective analysis of all fluoroscopic HSGs in one public teaching hospital within WA was conducted. All HSGs were retrieved from the public radiology information system and a blinded method was utilised to verify the presence and grading of intravasation in captured HSG images. Grading of intravasation was attributed by anatomical spread: 1 to myometrium, 2 to parametrium and 3 to para‐iliac vessels. Results were subsequently compared with reported intravasation to assess for discrepancies.ResultsOf 308 successful HSGs, an intravasation rate of 7.1% was identified. Of these cases, 45% were reported and 32% were graded. Majority (73%) of intravasation events were classified as grade 1, with 9.0% and 18% of cases classified as grade 2 and 3, respectively.ConclusionUnder‐reporting of intravasation emphasises a need for increased vigilance of radiologists. Standardised classification can provide interpretational consistency and should be considered to improve safety in future practice.

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Section: Discussionmentioning

confidence: 99%

Section: Therapeutic Benefit Of Oscmmentioning

confidence: 99%

Section: Therapeutic Benefit Of Oscmmentioning

confidence: 99%

Section: Therapeutic Benefit Of Oscmmentioning

confidence: 99%

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Assessment of contrast intravasation in patients investigated by fluoroscopic hysterosalpingograms: A two‐year retrospective audit in Western Australia

Chia,

Lee

2024

J Med Imag Rad Onc

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“…The oil‐based contrasts available today are lipiodol ultra fluid (Guerbet) and ethiodized poppyseed oil (EPO, Heng Rui Medicine) 13 . A recent randomized, controlled trial showed that EPO‐based oil contrast is superior to water‐based contrast during HSG in terms of image quality improvement and fertility enhancement 14 . At present, the effect of oil‐based contras bathing on CE is currently unknown due to a lack of related research, which prompted us to conduct this animal study with the aims of evaluating the effects of EPO bathing in a rat model of CE and identifying the potential mechanisms.…”

Section: Introductionmentioning

confidence: 99%

Oil‐based contrast for hysterosalpingography‐regulated Th1/Th2‐type cytokines and alleviated inflammation in rats with LPS‐induced chronic endometritis

Huang

Yang

Yuan

et al. 2022

J of Obstet and Gynaecol

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Aim: The chronic endometritis (CE) prevalence in people experiencing infertility is 2.8-56.8%, pregnancy rates in patients with infertility increase after hysterosalpingography with oil-based contrast, but the effect and mechanism are not clear. Here, we analyzed the effects of intrauterine ethiodized poppyseed oil (EPO) bathing on a rat model of CE and the possible underlying mechanism. Methods: CE rats were induced by lipopolysaccharide (LPS) exposure, and rats were subjected to intrauterine bathing with EPO or phosphate-buffered saline (PBS) after model verification. Serum and uterus levels of IFN-γ, IL-4, TNF-α, and IL-1β were detected by ELISA kit, and the number of CD138 + and CD68 + cells and uterine IFN-γ, IL-4, TNF-α, IL-1β, and NF-κB P65 expression were detected by immunohistochemistry after bathing. Results: LPS exposure induced the typical CE phenotype with CD138 + phagocyte infiltration of the endometrial stroma. Compared with PBS bathing, bathing with EPO in CE rats showed decreases in the CD138 + and CD68 + cells populations and significant decreases in serum and uterine IFN-γ levels, moreover, uterine IL-4 levels were slightly higher, and the IFN-γ/IL-4(Th1/Th2-type cytokine ratio) in the uterus was significantly lower. Local IFN-γ, TNF-α, and NF-κB P65 expression in the endometrium was significantly downregulated, while IL-4 expression was upregulated. Conclusion: Intrauterine oil-based contrast bathing significantly alleviated local inflammation in the rat CE model by downregulating NF-κB P65 expression, reducing IFN-γ (Th1), increasing IL-4 levels (Th2) in the endometrium, and regulating the Th1/Th2-type cytokine trends toward Th2.

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Contrast media for hysterosalpingography: systematic search and review providing new guidelines by the Contrast Media Safety Committee of the European Society of Urogenital Radiology

Geenen,

van der Molen,

Dekkers

et al. 2024

Eur Radiol

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Objectives Hysterosalpingography (HSG) is widely used for evaluating the fallopian tubes; however, controversies regarding the use of water- or oil-based iodine-based contrast media (CM) remain. The aim of this work was (1) to discuss reported pregnancy rates related to the CM type used, (2) to validate the used CM in published literature, (3) to discuss possible complications and side effects of CM in HSG, and (4) to develop guidelines on the use of oil-based CM in HSG. Methods A systematic literature search was conducted for original RCT studies or review/meta-analyses on using water-based and oil-based CM in HSG with fertility outcomes and complications. Nine randomized controlled trials (RCTs) and 10 reviews/meta-analyses were analyzed. Grading of the literature was performed based on the Oxford Centre for Evidence-Based Medicine (OCEBM) 2011 classification. Results An approximately 10% higher pregnancy rate is reported for oil-based CM. Side effects are rare, but oil-based CM have potentially more side effects on the maternal thyroid function and the peritoneum. Conclusions 1. HSG with oil-based CM gives approximately 10% higher pregnancy rates. 2. External validity is limited, as in five of nine RCTs, the CM used is no longer on the market. 3. Oil-based CM have potentially more side effects on the maternal thyroid function and on the peritoneum. 4. Guideline: Maternal thyroid function should be tested before HSG with oil-based CM and monitored for 6 months after. Clinical relevance statement Oil-based CM is associated with an approximately 10% higher chance of pregnancy compared to water-based CM after HSG. Although side effects are rare, higher iodine concentration and slower clearance of oil-based CM may induce maternal thyroid function disturbance and peritoneal inflammation and granuloma formation. Key Points • It is unknown which type of contrast medium, oil-based or water-based, is the optimal for HSG. • Oil-based contrast media give a 10% higher chance of pregnancy after HSG, compared to water-based contrast media. • From the safety perspective, oil-based CM can cause thyroid dysfunction and an intra-abdominal inflammatory response in the patient.

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Ethiodized poppyseed oil-based contrast medium is superior to water-based contrast medium during hysterosalpingography regarding image quality improvement and fertility enhancement: A multicentric, randomized and controlled trial

Cited by 11 publications

References 18 publications

Assessment of contrast intravasation in patients investigated by fluoroscopic hysterosalpingograms: A two‐year retrospective audit in Western Australia

Assessment of contrast intravasation in patients investigated by fluoroscopic hysterosalpingograms: A two‐year retrospective audit in Western Australia

Oil‐based contrast for hysterosalpingography‐regulated Th1/Th2‐type cytokines and alleviated inflammation in rats with LPS‐induced chronic endometritis

Contrast media for hysterosalpingography: systematic search and review providing new guidelines by the Contrast Media Safety Committee of the European Society of Urogenital Radiology

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