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 .).

Objectives To compare, in women with infertility, the effectiveness and safety of tubal flushing using oil-based contrast medium, water-based contrast medium or their combination, and no tubal flushing, and to evaluate the effectiveness of tubal flushing on fertility outcome over time. MethodsWe performed a systematic review and network meta-analysis, searching the electronic databases MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials, and trial registries, up to 25 September 2018. We included randomized controlled trials (RCTs) comparing the following interventions with each other or with no intervention in women with infertility: tubal flushing using water-based contrast medium, tubal flushing using oil-based contrast medium or additional tubal flushing with oil-based medium following diagnostic tubal flushing with water-based medium. The outcomes included clinical pregnancy, live birth, ongoing pregnancy, miscarriage, ectopic pregnancy and adverse events. ResultsOf the 283 studies identified through the search, 14 RCTs reporting on 3852 women with infertility were included. Network meta-analysis showed that tubal flushing using oil-based contrast medium was associated with higher odds of clinical pregnancy within 6 months after randomization and more subsequent live births compared with tubal flushing using water-based medium (odds ratio (OR), 1.67 (95% CI, 1.38-2.03), moderate certainty of evidence ; and OR, 2.18 (95% CI,, ConclusionsIn women with infertility undergoing fertility workup, tubal flushing using oil-based contrast medium probably increases clinical pregnancy rates within 6 months after randomization and may increase subsequent live-birth rates, compared with tubal flushing using water-based contrast medium and compared with no intervention. Evidence on fertility outcomes beyond 6 months is inadequate to draw firm conclusions.

Sedentary behaviour (SB) is increasing in Western societies and some studies suggest a deleterious effect of SB on bone. The aim of this systematic review was to examine the association between SB and bone health in children, adolescents and young adults. Electronic databases (PubMed, MEDLINE, PsycINFO and Science Citation Index) were searched for relevant articles up to January 9, 2017. Studies were included when results on bone health (e.g. strength, mass and structure) and either subjectively (questionnaires) or objectively (accelerometry) measured SB were reported in healthy participants ≤24 years. Two reviewers independently screened titles and abstracts for eligibility, rated methodological quality and extracted data. Seventeen observational studies were included. Several studies that used DXA or quantitative ultrasound suggested that objectively measured SB was negatively associated with lower extremity bone outcomes, such as femoral neck bone mineral density. The magnitude of this negative association was small and independent of moderate-to-vigorous physical activity. In contrast to the lower extremities, there was insufficient evidence for an association of lumbar spine bone outcomes with objectively measured SB. In high-quality studies that used DXA, no association was observed between objectively measured SB and total body bone outcomes. In studies using questionnaires, none of these relationships were observed. Well-designed longitudinal studies, objectively measuring SB, are needed to further unravel the effect of SB, physical activity and their interaction on bone health.Electronic supplementary materialThe online version of this article (doi:10.1007/s00198-017-4076-2) contains supplementary material, which is available to authorized users.

ClinicalTrials.gov: NCT01671644.