Tubal Flushing Treatment for Unexplained Infertility

Welie, Nienke van; Ludwin, Artur; Martins, W.P.; Mijatovic, Velja; Dreyer, Kim

doi:10.1055/s-0040-1721720

Cited by 5 publications

(1 citation statement)

References 121 publications

(136 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nowadays, the 4D-HyCoSy investigation is considered safe, well tolerated, rapid, easy to perform, inexpensive, and more accurate with respect to the 2D exam [ 11 , 12 ]. Therefore, several studies demonstrate an increase in the spontaneous pregnancy rate after HyCoSy, probably due to a positive effect defined as “tubal flushing,” in which several hypothesized mechanisms are involved, but, until now, this aspect is still controversial and debated [ 13 ]. A recent Cochrane analysis suggests that tubal flushing as oil-soluble contrast media, in specific foam instillation, may increase the chance of pregnancy and live birth compared to no intervention, and on the contrary, data regarding other contrast media, as an air-water solution, were inconclusive due to inconsistency and lack of statistical power [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Pregnancy after 4D‐Hysterosalpingo‐Sonography (HyCoSy) in the Same Menstrual Cycle: A Case Report and an Updating Review of the Current Literature regarding the Positive Impact of Tubal Flushing Effect on Fertility

Bisogni,

Galanti,

Riccio

et al. 2024

Case Reports in Obstetrics and Gynecology

View full text Add to dashboard Cite

Infertility is increasing worldwide, as well as in Italy, and fallopian tube pathology represents one of the most impacting causes of infertility for multiple women. Indeed, tubal patency assessment is a crucial step in medical evaluation for women attending an in vitro fertilization (IVF) center. Currently, different methods for tubal investigation are available, such as chromosalpingoscopy, hysterosalpingography (HSG), and hysterosalpingo‐contrast sonography (HyCoSy). This diagnostic exam is performed by ultrasonography and an air‐water‐based contrast agent represented by air‐water, or foam solution (HyFoSy). An additional side benefit of these assessment tests is a fertility‐enhancing effect, thanks to a positive effect defined as “tubal flushing,” which in current literature is more strongly associated with HyFoSy with respect to HyCoSy. In this report, we present a case of a 34‐year‐old woman presented to our attention at the Reproductive and Physiopathology Unit of Sandro Pertini Hospital, Rome, in 2023, with unexplained infertility for 3.1 years of free sexual intercourse with a partner who did not report sperm abnormalities. Subsequently, in this exam, the woman spontaneously conceived in the same menstrual cycle that the 4D‐HyCoSy was performed, without any additional fertility enhancement interventions. In this case report, we also include an updating review of the current literature regarding the insurgence of spontaneous pregnancy after this technique in order to explore the physiopathological and etiopathogenetic mechanisms underlying the achievement of spontaneous pregnancy and to confront our case with other recent works published. According to our clinical experience and the current literature, 4D‐HyCoSy is the easiest, safest, and cheapest diagnostic exam for investigating tubal patency, which can lead to medical success in some cases of “unexplained infertility” as the achievement of a spontaneous pregnancy.

show abstract

Section: Introductionmentioning

confidence: 99%

Spontaneous Pregnancy after 4D‐Hysterosalpingo‐Sonography (HyCoSy) in the Same Menstrual Cycle: A Case Report and an Updating Review of the Current Literature regarding the Positive Impact of Tubal Flushing Effect on Fertility

Bisogni,

Galanti,

Riccio

et al. 2024

Case Reports in Obstetrics and Gynecology

View full text Add to dashboard Cite

show abstract

Visual tubal patency tests for tubal occlusion and hydrosalpinx

Tros

Rosielle

Koks

et al. 2022

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

Contrast media for hysterosalpingography: systematic search and review providing new guidelines by the Contrast Media Safety Committee of the European Society of Urogenital Radiology

Geenen,

van der Molen,

Dekkers

et al. 2024

Eur Radiol

View full text Add to dashboard Cite

Objectives Hysterosalpingography (HSG) is widely used for evaluating the fallopian tubes; however, controversies regarding the use of water- or oil-based iodine-based contrast media (CM) remain. The aim of this work was (1) to discuss reported pregnancy rates related to the CM type used, (2) to validate the used CM in published literature, (3) to discuss possible complications and side effects of CM in HSG, and (4) to develop guidelines on the use of oil-based CM in HSG. Methods A systematic literature search was conducted for original RCT studies or review/meta-analyses on using water-based and oil-based CM in HSG with fertility outcomes and complications. Nine randomized controlled trials (RCTs) and 10 reviews/meta-analyses were analyzed. Grading of the literature was performed based on the Oxford Centre for Evidence-Based Medicine (OCEBM) 2011 classification. Results An approximately 10% higher pregnancy rate is reported for oil-based CM. Side effects are rare, but oil-based CM have potentially more side effects on the maternal thyroid function and the peritoneum. Conclusions 1. HSG with oil-based CM gives approximately 10% higher pregnancy rates. 2. External validity is limited, as in five of nine RCTs, the CM used is no longer on the market. 3. Oil-based CM have potentially more side effects on the maternal thyroid function and on the peritoneum. 4. Guideline: Maternal thyroid function should be tested before HSG with oil-based CM and monitored for 6 months after. Clinical relevance statement Oil-based CM is associated with an approximately 10% higher chance of pregnancy compared to water-based CM after HSG. Although side effects are rare, higher iodine concentration and slower clearance of oil-based CM may induce maternal thyroid function disturbance and peritoneal inflammation and granuloma formation. Key Points • It is unknown which type of contrast medium, oil-based or water-based, is the optimal for HSG. • Oil-based contrast media give a 10% higher chance of pregnancy after HSG, compared to water-based contrast media. • From the safety perspective, oil-based CM can cause thyroid dysfunction and an intra-abdominal inflammatory response in the patient.

show abstract

Tubal Flushing Treatment for Unexplained Infertility

Cited by 5 publications

References 121 publications

Spontaneous Pregnancy after 4D‐Hysterosalpingo‐Sonography (HyCoSy) in the Same Menstrual Cycle: A Case Report and an Updating Review of the Current Literature regarding the Positive Impact of Tubal Flushing Effect on Fertility

Spontaneous Pregnancy after 4D‐Hysterosalpingo‐Sonography (HyCoSy) in the Same Menstrual Cycle: A Case Report and an Updating Review of the Current Literature regarding the Positive Impact of Tubal Flushing Effect on Fertility

Visual tubal patency tests for tubal occlusion and hydrosalpinx

Contrast media for hysterosalpingography: systematic search and review providing new guidelines by the Contrast Media Safety Committee of the European Society of Urogenital Radiology

Contact Info

Product

Resources

About