Tubal flushing with oil-based or water-based contrast at hysterosalpingography for infertility: long-term reproductive outcomes of a randomized trial

In women with unexplained or mild male factor infertility undergoing hysterosalpingography, the use of oil-based contrast results in more ongoing pregnancies, live births, and reduces time to pregnancy in a 5-year time frame.

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Volume 114, Issue 1, Pages 155–162

Authors:

Joukje van Rijswijk, M.D., Nienke van Welie, M.D., Kim Dreyer, M.D., Ph.D., Clarabelle T. Pham, B.Sc., 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., Machiel H.A. van Hooff, M.D., Ph.D., Mariëtte Goddijn, M.D., Ph.D., Angelo B. Hooker, M.D., Petra Bourdrez, M.D., Angelique J.C.M. van Dongen, M.D., Ph.D., Ilse A.J. van Rooij, M.D., Ph.D., Henrike G.M. van Rijnsaardt-Lukassen, M.D., Ph.D., Ron J.T. van Golde, M.D., Ph.D., Cathelijne F. van Heteren, M.D., Ph.D., Marie J. Pelinck, M.D., Ph.D., Annette E.J. Duijn, M.D., Mesrure Kaplan, M.D., Cornelis B. Lambalk, M.D., Ph.D., Velja Mijatovic, M.D., Ph.D., Ben W.J. Mol, M.D., Ph.D.

Abstract:

Objective

To determine the impact of oil-based versus water-based contrast on pregnancy and live birth rates ≤5 years after hysterosalpingography (HSG) in infertile women.

Design

A 5-year follow-up study of a multicenter randomized trial.

Setting

Hospitals.

Patient(s)

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

Intervention(s)

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

Main Outcome Measure(s)

Ongoing pregnancy, live births, time to ongoing pregnancy, second ongoing pregnancy.

Result(s)

A total of 1,119 women were randomly assigned to HSG with oil-based contrast (n = 557) or water-based contrast (n = 562). After 5 years, 444 of 555 women in the oil group (80.0%) and 419 of 559 women in the water group (75.0%) had an ongoing pregnancy (relative risk [RR] 1.07; 95% confidence interval [CI] 1.00–1.14), and 415 of 555 women in the oil group (74.8%) and 376 of 559 women in the water group (67.3%) had live births (RR 1.11; 95% CI 1.03–1.20). In the oil group, 228 pregnancies (41.1%) were conceived naturally versus 194 (34.7%) pregnancies in the water group (RR 1.18; 95% CI 1.02–1.38). The time to ongoing pregnancy was significantly shorter in the oil group versus the water group (10.0 vs. 13.7 months; hazard ratio, 1.25; 95% CI 1.09–1.43). No difference was found in the occurrence of a second ongoing pregnancy.

Conclusion(s)

During a 5-year time frame, ongoing pregnancy and live birth rates are higher after tubal flushing with oil-based contrast during HSG compared with water-based contrast. More pregnancies are naturally conceived and time to ongoing pregnancy is shorter after HSG with oil-based contrast.

Clinical Trial Registration Number

Netherlands Trial Register (NTR) 3270 and NTR6577(www.trialregister.nl).

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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