Oil, Water, and Infertility: Which Contrast Fluid Is Better for Hysterosalpingography?

Summary and Comment |
May 18, 2017

Oil, Water, and Infertility: Which Contrast Fluid Is Better for Hysterosalpingography?

  1. Robert L. Barbieri, MD

In a large randomized trial, oil-based fluid resulted in more post-HSG pregnancies.

  1. Robert L. Barbieri, MD

Although hysterosalpingography (HSG) is commonly used in the diagnostic setting to assess tubal patency in infertile women, some studies have suggested that this procedure can enhance fertility, especially when oil-based as opposed to water-based contrast fluid is used. To evaluate post-HSG pregnancy rates using either form of fluid, Dutch investigators randomized 1119 infertile women to oil- or water-based HSG. Women were then followed for 6 months. Couples with predicted likelihood of >30% for pregnancy within 12 months received expectant management; others were offered intrauterine sperm insemination with or without mild ovarian stimulation. Overall, in vitro fertilization was recommended for about 1.5% of couples.

Among women receiving oil-based or water-based contrast fluid, clinical pregnancy rates were 40% versus 29%, respectively (rate ratio, 1.4; 95% confidence interval, 1.2–1.6) and live birth rates were 39% versus 28% (RR, 1.4; 95% CI, 1.2–1.6).

Comment

This study demonstrates that uterine infusion with oil-based contrast results in significantly more post-HSG pregnancies and live births than water-based contrast. The mechanisms underlying these differences are not well characterized, but mechanical (enhanced flushing of debris out of the fallopian tubes) and immunologic (inhibition of peritoneal macrophages) hypotheses have been proposed. Many fertility centers now use water-based contrast out of the belief that, if any fluid accidentally enters the circulation, oil-based material is more likely to lead to embolism (which did not occur in this — or any — trial of oil-based contrast). The authors note that, to test for tubal patency, many clinicians use water-based fluid with ultrasound, not fluoroscopy, to monitor the transit of the fluid from the uterus, through the fallopian tubes, and into the peritoneal cavity. Clinicians using this method might consider infusing oil-based contrast at the end of the ultrasound test, with an eye toward improving postprocedure fertility.

Editor Disclosures at Time of Publication

  • Disclosures for Robert L. Barbieri, MD at time of publication Editorial boards UpToDate; OBG Management

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