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#Grand Rounds

Tubal Flushing with Oil: Is There Really a Positive Impact on Fertility Outcomes?

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BACKGROUND AND PURPOSE:

  • Various procedures that make use of tubal flushing to determine tubal patency include
    • Hysterosalpingography (HSG)
    • Hysterosalpingo-contrast sonography (HyCoSy)
    • Hysterosalpingo-foam sonography (HyFoSy)
    • Laparoscopy with dye testing
  • Both water-based contrast media and oil-based contrast can be used for tubal flushing, with oil more typically employed for HSG
  • Wang et al. (Ultrasound in Obstetrics and Gynecology, 2019) looked at women with infertility and compared the effectiveness and safety of tubal flushing using oil-based contrast medium vs water-based contrast medium

METHODS:

  • Systematic review and network meta-analysis
  • Search parameters
    • MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials, and trial registries, through September 2018
  • Inclusion criteria
    • RCTs
    • Studies that compared the following interventions with each other or no treatment
      • Tubal flushing using water-based contrast medium
      • Tubal flushing using oil-based contrast medium
      • Additional tubal flushing with oil-based medium following diagnostic tubal flushing with water-based medium
  • Participants
    • Women wishing to conceive
    • Undergoing any test for patency technique
  • Primary outcomes
    • Clinical pregnancy and ongoing pregnancy
    • Live birth
    • Miscarriage | Ectopic pregnancy | Adverse events

RESULTS:

  • 14 RCTs | Total of 3,852 women
  • Tubal flushing using oil-based contrast medium was associated with
    • Higher odds of clinical pregnancy within 6 months
      • vs water-based media: Odds ratio (OR) 1.67 (95% CI, 1.38 to 2.03; moderate certainty of evidence)
      • vs no flushing: OR 2.28 (95% CI, 1.50 to 3.47; moderate certainty of evidence)
    • Higher odds of subsequent live births
      • vs water-based media: OR 2.18 (95% CI, 1.30 to 3.65; low certainty of evidence)
      • vs no flushing: OR 2.85 (95% CI, 1.41 to 5.74; low certainty of evidence)
  • Clinical pregnancy within 6 months: Insufficient evidence when comparing water-based contrast medium vs no intervention
    • OR, 1.36 (95% CI, 0.91 to 2.04), low certainty of evidence
  • Fertility outcomes >6 months: Insufficient evidence for any comparisons
  • Miscarriage or ectopic pregnancy: Inconclusive evidence for any comparisons
  • Intravasation (venous) of contrast media
    • Oil-based contrast medium was associated with higher odds of asymptomatic intravasation vs water-based
    • OR 5.06 (95% CI, 2.29 to 11.18; moderate certainty of evidence)

CONCLUSION:

  • Tubal flushing with oil-based contrast medium for women undergoing fertility work-up
    • “Probably” increases pregnancy rates
    • “May” increase live birth rates
  • Results are based on outcomes within 6 months
    • Inconclusive evidence >6 months
  • Theories suggested to explain findings
    • ‘Unplug’ mucus plugs in the Fallopian tubes
    • Improve tubal ciliary activity
    • Immunobiological effects

Learn More – Primary Sources:

Effectiveness on fertility outcome of tubal flushing with different contrast media: systematic review and network meta‐analysis

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Related ObG Topics:

Infertility Evaluation: Who, When and How
AHRQ Report: Comparative Effectiveness and Safety of Treatments for Common Causes of Infertility
Oil or Water-Based Contrast for Hysterosalpingography?

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