Oil-based versus water-based contrast for hysterosalpingography in infertile women: a systematic review and meta-analysis of randomized controlled trials

Hysterosalpingography is a commonly used diagnostic modality utilized in women with infertility and may be considered a possible therapy option for infertility. Our meta- analysis showed that women who previously underwent hysterosalpingography using oil contrast had higher rates of ongoing pregnancy compared to women who under- went this procedure using water contrast. This suggests that using oil-soluble contrast material may increase the chance of pregnancy after hysterosalpingography.


Volume 110, Issue 1, Pages 153–160.e3


Fang Fang, M.D., Yu Bai, M.D., Yu Zhang, M.D., Andrew Faramand, M.D.



To determine the effect of the using oil-soluble contrast material (OSCM) vs. water-soluble contrast material (WSCM) for hysterosalpingography on pregnancy rates in infertile women.


Systematic review and meta-analysis.


Not applicable.


Infertile women.


We included randomized controlled trials comparing pregnancy outcomes in women with infertility undergoing hysterosalpingography using OSCM and WSCM. Paired reviewers independently screened citations, assessed risk of bias of included studies, and extracted data. A random-effects model was used to report all outcomes. The Grading of Recommendations Assessment, Development, Evaluation(GRADE) system was used to quantify absolute effects and quality of evidence.

Main Outcome Measure(s)

The primary outcome was ongoing pregnancy per randomized women.


Six trials with a total of 2,562 patients were selected. Our meta-analysis showed OSCM was associated with significantly higher rates of ongoing pregnancy compared with WSCM (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.12–1.93; I2 = 44%, moderate-quality evidence). Three trials reported live birth, but they were not pooled owing to extreme statistical heterogeneity (I2 = 86%). There was no difference in incidence of miscarriage (OR 0.83, 95% CI 0.56–1.24) or ectopic pregnancy (OR 0.65, 95% CI 0.18–2.36) between OSCM and WSCM groups. Three trials were rated as low risk of bias, whereas three were considered unclear.


Women who previously underwent hysterosalpingography using oil contrast had higher rates of ongoing pregnancy compared with women who underwent this procedure using water contrast. There is not enough evidence to either support or oppose the difference between groups concerning miscarriage and ectopic pregnancy.

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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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