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

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?