Oil-based or water-based contrast for hysterosalpingography in infertile women: a cost-effective analysis of a randomized controlled trial

Hysterosalpingography with oil-based contrast leads to higher ongoing pregnancy rate within 6 months compared to water-based contrast, for an additional cost of US$8,198 per ongoing pregnancy.

Volume 110, Issue 4, Pages 754–760


Joukje van Rijswijk, M.D., Clarabelle T. Pham, B.Sc., Kim Dreyer, M.D., Ph.D., Harold R. Verhoeve, M.D., Ph.D., Annemieke Hoek, M.D., Ph.D., Jan-Peter de Bruin, M.D., Ph.D., Annemiek W. Nap, M.D., Ph.D., Rui Wang, M.D., Cornelis B. Lambalk, M.D., Ph.D., Peter G.A. Hompes, M.D., Ph.D., Velja Mijatovic, M.D., Ph.D., Jonathan D. Karnon, M.Sc., Ph.D., Ben W. Mol, M.D., Ph.D.



To determine the cost effectiveness of the use of oil-based versus water-based contrast in infertile women undergoing hysterosalpingography (HSG).


Economic evaluation alongside a multicenter randomized trial.




Infertile women with an ovulatory cycle, 18–39 years of age, low risk of tubal pathology.


Use of oil-based versus water-based contrast during HSG.

Main Outcome Measure(s)

Costs per additional ongoing pregnancy and per live birth within 6 months of randomization, incremental cost-effective ratios (ICERs).


A total of 1,119 women were randomized to HSG (oil-based contrast, n = 557; water-based contrast, n = 562). After HSG, most women had no additional treatment; a minority had IUI or IVF. In the oil group, 39.7% women had an ongoing pregnancy within 6 months of randomization versus 29.1% women in the water group. There was a 10.7% increase in the live birth rate in the oil group. For ongoing pregnancy, the mean costs per couple were US$2,014 in the oil group and US$1,144 in the water group, with a corresponding ICER of US$8,198 per additional ongoing pregnancy. For live birth, the mean costs per couple were US$11,532 in the oil group and US$8,310 in the water group, with a corresponding ICER of US$30,112 per additional live birth.


Hysterosalpingography with oil-based contrast results in higher 6-month ongoing pregnancy and live birth rate. If society is willing to pay US$8,198 for an additional ongoing pregnancy, HSG with oil-based contrast is a cost-effective strategy compared with HSG with water-based contrast for infertile, ovulatory women at low risk for tubal pathology.

Clinical Trial Registration Number

Dutch Trial Register, NTR 6577 (www.trialregister.nl).

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