Oil-Based or Water-Based Contrast for Hysterosalpingography in Infertile Women

Kim Dreyer; Joukje van Rijswijk; Velja Mijatovic; Mariëtte Goddijn; Harold R Verhoeve; Ilse A J van Rooij; Annemieke Hoek; Petra Bourdrez; Annemiek W Nap; Henrike G M Rijnsaardt-Lukassen; Catharina C M Timmerman; Mesrure Kaplan; Angelo B Hooker; Anna P Gijsen; Ron van Golde; Cathelijne F van Heteren; Alexander V Sluijmer; Jan-Peter de Bruin; Jesper M J Smeenk; Jacoba A M de Boer; Eduard Scheenjes; Annette E J Duijn; Alexander Mozes; Marie J Pelinck; Maaike A F Traas; Machiel H A van Hooff; Gijsbertus A van Unnik; Cornelia H de Koning; Nan van Geloven; Jos W R Twisk; Peter G A Hompes; Ben W J Mol

doi:10.1056/NEJMoa1612337

Oil-Based or Water-Based Contrast for Hysterosalpingography in Infertile Women

Dreyer K, van Rijswijk J, Mijatovic V, Goddijn M, Verhoeve HR, van Rooij IAJ, Hoek A, Bourdrez P, Nap AW, Rijnsaardt-Lukassen HGM, Timmerman CCM, Kaplan M, Hooker AB, Gijsen AP, van Golde R, van Heteren CF, Sluijmer AV, de Bruin JP, Smeenk JMJ, de Boer JAM, Scheenjes E, Duijn AEJ, Mozes A, Pelinck MJ, Traas MAF, van Hooff MHA, van Unnik GA, de Koning CH, van Geloven N, Twisk JWR, Hompes PGA, Mol BWJ

Published May 25, 2017 The New England Journal of Medicine, 376(21), 2043-2052

DOI 10.1056/NEJMoa1612337 PMID 28520519

RRM Academy Synopsis

Hysterosalpingography with oil contrast led to more live births

Hysterosalpingography with oil contrast led to more live births than water contrast. A Dutch randomized trial in 27 hospitals followed 1,108 infertile women aged 18 to 39 at low risk of tubal disease. About 4 out of 10 women in the oil group had a live birth, against about 3 out of 10 in the water group.

Key Findings

Ongoing pregnancy within 6 months: 220 of 554 women with oil (39.7%) and 161 of 554 with water (29.1%); rate ratio 1.37, 95% CI 1.16 to 1.61.
Live birth at 24 weeks or later: 214 of 552 women with oil (38.8%) and 155 of 552 with water (28.1%); rate ratio 1.38, 95% CI 1.17 to 1.64.
Clinical pregnancy: 251 of 554 (45.3%) with oil and 194 of 554 (35.0%) with water; rate ratio 1.29, 95% CI 1.12 to 1.50. Miscarriage: 29 (5.2%) and 31 (5.6%).
Adverse events occurred in 3 of 554 women with oil (0.5%) and 4 of 554 with water (0.7%).
Congenital abnormalities were recorded in 3 infants from the oil arm and none from the water arm; the authors consider this probably due to chance.

Interpretation

Hysterosalpingography is an X-ray of the uterus and fallopian tubes, used to check whether the tubes are open. Women were randomly assigned to oil or water contrast, so the difference between groups can be read as an effect of the contrast in this population. The women were 18 to 39, at low risk of tubal disease, with no known endocrine disorders. Similar shares of women in each group later had insemination (39.7% and 41.0%). The authors note the findings should not be generalized beyond women like them. The findings support larger studies of oil contrast across a wider range of fertility profiles.

RRM Context

Most women in the trial (87.7% with oil, 88.4% with water) had a workup that found unexplained or mild male infertility. RRM regards unexplained infertility as undiagnosed. Couples entered only if the male partner met a minimum sperm count. RRM holds that evaluation comes before treatment and includes both partners. In this low-risk group, a tubal test with oil contrast was followed by more live births than the same test with water contrast.

Our editorial summary of this paper, not the article's abstract.

Abstract

Background

Pregnancy rates among infertile women have been reported to increase after hysterosalpingography, but it is unclear whether the type of contrast medium used (oil-based or water-soluble contrast) influences this potential therapeutic effect.

Methods

We performed a multicenter, randomized trial in 27 hospitals in the Netherlands in which infertile women who were undergoing hysterosalpingography were randomly assigned to undergo this procedure with the use of oil-based or water-based contrast. Subsequently, couples received expectant management or the women underwent intrauterine insemination. The primary outcome was ongoing pregnancy within 6 months after randomization. Outcomes were analyzed according to the intention-to-treat principle.

Results

A total of 1119 women were randomly assigned to hysterosalpingography with oil contrast (557 women) or water contrast (562 women). A total of 220 of 554 women in the oil group (39.7%) and 161 of 554 women in the water group (29.1%) had an ongoing pregnancy (rate ratio, 1.37; 95% confidence interval [CI], 1.16 to 1.61; P<0.001), and 214 of 552 women in the oil group (38.8%) and 155 of 552 women in the water group (28.1%) had live births (rate ratio, 1.38; 95% CI, 1.17 to 1.64; P<0.001). Rates of adverse events were low and similar in the two groups.

Conclusions

Rates of ongoing pregnancy and live births were higher among women who underwent hysterosalpingography with oil contrast than among women who underwent this procedure with water contrast. (Netherlands Trial Register number, NTR3270 .).

Topics

Diagnostics › Tubal and Uterine Imaging › Hysterosalpingography · Infertility › Tubal Factor › Selective Salpingography

Kim Dreyer, Joukje van Rijswijk, Velja Mijatovic, Mariëtte Goddijn, Harold R Verhoeve, Ilse A J van Rooij, Annemieke Hoek, Petra Bourdrez, Annemiek W Nap, Henrike G M Rijnsaardt-Lukassen, Catharina C M Timmerman, Mesrure Kaplan, Angelo B Hooker, Anna P Gijsen, Ron van Golde, Cathelijne F van Heteren, Alexander V Sluijmer, Jan-Peter de Bruin, Jesper M J Smeenk, Jacoba A M de Boer, Eduard Scheenjes, Annette E J Duijn, Alexander Mozes, Marie J Pelinck, Maaike A F Traas, Machiel H A van Hooff, Gijsbertus A van Unnik, Cornelia H de Koning, Nan van Geloven, Jos W R Twisk, Peter G A Hompes, Ben W J Mol

K Dreyer, J Rijswijk, V Mijatovic, M Goddijn, H Verhoeve, I Rooij, A Hoek, P Bourdrez, A Nap, H Rijnsaardt-Lukassen, C Timmerman, M Kaplan, A Hooker, A Gijsen, Ronald Golde, R Golde, C Heteren, Alex Sluijmer, A Sluijmer, J Bruin, J Smeenk, J Boer, E Scheenjes, A Duijn, Alex Mozes, A Mozes, M Pelinck, M Traas, M Hooff, G Unnik, C Koning, N Geloven, J Twisk, Pete Hompes, P Hompes, Benjamin Mol, B Mol

PMID 28520519 28520519 DOI 10.1056/NEJMoa1612337 10.1056/NEJMoa1612337 Dreyer et al. 2017, Dreyer 2017

Keywords

Adult, Contrast Media, Female, Humans, Hysterosalpingography/methods, Infertility, Female/diagnostic Imaging, Live Birth, Oils, Pregnancy, Pregnancy Rate, Water, Young Adult, Contrast Media, Oils, Water

Oil-Based or Water-Based Contrast for Hysterosalpingography in Infertile Women

Hysterosalpingography with oil contrast led to more live births

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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Keywords