Oil or Water-Based Contrast for Hysterosalpingography?
BACKGROUND AND PURPOSE:
Following hysterosalpingography (HSG), infertile women often see increased rates of pregnancy
Oil-based HSG has been associated with increased pregnancy rates
Tubal ‘flushing’ has been hypothesized as the mechanism for this beneficial effect and/or peritoneal macrophage activity
Because the literature has been inconsistent with limited high quality studies, Dreyer et al. (NEJM, 2017) sought to determine if the type of contrast does impact pregnancy rates following diagnostic HSG
Randomized Controlled Trial (RCT)
The trial could not be blinded due to procedural differences
1,119 infertile women undergoing HSG were included
557 women were randomized to receive oil contrast
562 women were randomized to receive water contrast
Following the procedure women either received expectant management or underwent intrauterine insemination based on clinical indications such as male infertility
Primary outcome for this study was a positive fetal heartbeat > 12 weeks within 6 months after randomization
There was no statistical difference between the two groups with regard to bilateral tubal patency, nor the percent of women undergoing IVF
39.7% (220/554) of women in the oil group had an ongoing pregnancy compared to 29.1% (161/554) in the water group (rate ratio, 1.37; 95% CI 1.16 to 1.61; P<0.001)
Women in the oil group 38.8% (214/552) also had higher rates of live births compared to 28.1% (155/552) in the water group (rate ratio, 1.38; 95% CI 1.17 to 1.64; P<0.001)
The 10% increase in clinical pregnancy rate with oil corresponds with a number needed to treat of 10.
Hysterosalpingography with oil contrast leads to an increased chance of ongoing pregnancy at 12 weeks and a higher rate of live births
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