Tubal flushing for subfertility

Wang, Rui; Watson, Andrew; Johnson, Neil; Cheung, Karen C.; Fitzgerald, Cheryl; Mol, Ben W.; Mohiyiddeen, Lamiya

doi:10.1002/14651858.cd003718.pub5

Cited by 25 publications

(39 citation statements)

References 65 publications

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“… 17 (4) Ethiodized poppyseed oil was able to ameliorate the endometrial receptivity and promote the dislodgement of debris in the proximal part of the tubes. 8 , 9 Generally, the efficacy of the ethiodized poppyseed oil-based contrast medium in fertility was superior to that of the water-based contrast medium. In addition, another finding of this study is worth noting: we observed that the VAS score in our study was numerically lower than that in a previous study (H2Oil trial: 4.8 (3.0–6.4) in the oil group vs. 5.0 (3.0–6.7) in the water group).…”

Section: Discussionmentioning

confidence: 99%

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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

Zhang

Lan²,

Wang³

et al. 2022

eClinicalMedicine

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Section: Discussionmentioning

confidence: 99%

“… 4 , 6 More importantly, HSG has therapeutic effects on infertility to some extent, including the treatment of proximal obstruction via tubal flushing. 6 , 7 , 8 , 9 …”

Section: Introductionmentioning

confidence: 99%

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

Lan²,

Wang³

et al. 2022

eClinicalMedicine

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“…Most randomized clinical trials regarding the fertility enhancing effect of oil-based contrast during HSG have been previously performed in couples with unexplained infertility and/or mild male factor. While several trials have also included women with other types of infertility [ 31 – 34 ], none were able to show a significant positive effect of tubal flushing with oil-based contrast mostly due to a low sample size, and the results of previous trials among women with unexplained infertility cannot simply be extrapolated to all women facing infertility [ 14 ]. Another strength of this study is its multinational character.…”

Section: Discussionmentioning

confidence: 99%

“…Hysterosalpingography (HSG) is traditionally used as first choice tubal patency test to rule out tubal pathology [ 3 , 4 ]. Although HSG was initially introduced as a diagnostic test, therapeutic effects of tubal flushing, especially with oil-based contrast, have been studied extensively [ 11 – 14 ]. The most recent review [ 14 ] included six studies comparing HSG with oil-based contrast and water-based contrast.…”

Section: Introductionmentioning

confidence: 99%

“…Although HSG was initially introduced as a diagnostic test, therapeutic effects of tubal flushing, especially with oil-based contrast, have been studied extensively [ 11 – 14 ]. The most recent review [ 14 ] included six studies comparing HSG with oil-based contrast and water-based contrast. Three of these studies reported on live birth but meta-analysis could not be performed due to heterogeneity of the population.…”

Section: Introductionmentioning

confidence: 99%

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Oil-based versus water-based contrast media for hysterosalpingography in infertile women of advanced age, with ovulation disorders or a high risk for tubal pathology: study protocol of a randomized controlled trial (H2Oil2 study)

et al. 2022

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Background In women with unexplained infertility, tubal flushing with oil-based contrast during hysterosalpingography (HSG) increases ongoing pregnancy and subsequent live birth rates when compared to tubal flushing with water-based contrast. It is currently unclear whether an HSG with oil-based contrast also results in more ongoing pregnancies and live births in women of advanced age, women with ovulation disorders, and women with potential tubal pathology when compared to an HSG with water-based contrast. Methods We plan an international, multicentre, open-label, randomized controlled trial (RCT) studying three groups of infertile women who have an indication for tubal patency testing according to their treating physician and additionally; (1) are 39 years of age or older, (2) have an ovulation disorder or (3) have a high risk for tubal pathology based on their medical history. Women with an allergy for iodinated contrast medium are excluded, as are women with diabetes, hyperprolactinemia or untreated hyper- or hypothyroidism, and women with a partner with severe male infertility. After informed consent, women will be randomly allocated to the intervention, tubal flushing with the use of oil-based contrast during HSG or the control group, tubal flushing with the use of water-based contrast during HSG in a 1:1 ratio by the web-based system Castor. The primary endpoint will be ongoing pregnancy leading to live birth with conception within six months after randomization. Secondary outcomes are other pregnancy outcomes, used fertility treatments, adverse events and cost-effectiveness. Based on the expected ongoing pregnancy rate of 17% in the control group and 27% in the intervention group, the sample size will be 930 women (465 per group). Study inclusion is expected to be complete in four years. Discussion This multicentre RCT will establish whether, for women of advanced age, women with ovulatory disease, and women who have a high risk for tubal pathology, there is a fertility enhancing effect of tubal flushing with oil-based contrast during HSG and whether the use of this contrast medium is cost-effective. Trial Registration The study was prospectively registered in the Netherlands Trial Register on August 1st 2019 as ‘H2Oil2’ (reference number NL7925, https://www.trialregister.nl/trial/7925).

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