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Tubal flushing for subfertility.

Rui Wang¹, Andrew Watson², Neil Johnson³

¹Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia.

The Cochrane Database of Systematic Reviews

|October 14, 2020

Summary

Tubal flushing with oil-soluble contrast media (OSCM) may improve live birth and pregnancy rates compared to no treatment. However, water-soluble contrast media (WSCM) show uncertain benefits, and OSCM increases intravasation risk.

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Utero-tubal Embryo Transfer and Vasectomy in the Mouse Model

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Published on: February 28, 2014

Area of Science:

Reproductive Medicine
Gynecological Procedures
Infertility Treatment

Background:

Tubal flushing is a diagnostic procedure for subfertility, involving contrast medium injection to assess fallopian tube patency.
Observed conception rates post-procedure suggest potential therapeutic benefits for infertility.
Debate exists regarding the optimal contrast medium (oil-soluble vs. water-soluble) and its impact on pregnancy rates and safety.

Purpose of the Study:

To evaluate the effectiveness of tubal flushing using oil-soluble contrast media (OSCM) and water-soluble contrast media (WSCM) on subsequent fertility outcomes.
To assess the safety profile of tubal flushing with OSCM and WSCM in women with subfertility.
To compare the efficacy and safety of OSCM versus WSCM for tubal flushing.

Main Methods:

Systematic review and meta-analysis of randomized controlled trials (RCTs).
Searched multiple databases including Cochrane, MEDLINE, Embase, CENTRAL, and PsycINFO up to April 2020.
Included RCTs comparing tubal flushing with OSCM, WSCM, or no treatment in women with subfertility.

Main Results:

Tubal flushing with OSCM may increase live birth (low-quality evidence) and clinical pregnancy rates (low-quality evidence) compared to no treatment.
Uncertainty exists regarding the effect of WSCM on live birth and clinical pregnancy rates compared to no treatment (low-quality evidence).
OSCM may increase clinical pregnancy rates compared to WSCM (low-quality evidence), but is associated with a higher risk of asymptomatic intravasation (moderate-quality evidence).

Conclusions:

Tubal flushing with OSCM appears to enhance fertility outcomes (live birth, clinical pregnancy) compared to no treatment.
The benefits of WSCM for fertility outcomes remain uncertain.
OSCM use is linked to increased intravasation risk, and overall reporting of adverse events, particularly long-term ones, is inadequate across studies.