Flushing Fallopian Tubes Moderates Infertility

A new study suggests that hysterosalpingography (HSG), a century-old fluoroscopic imaging technique, can dramatically reduce infertility rates.

Researchers at the University of Adelaide, VU University Medical Centre, and other institutions conducted a multicenter, randomized trial in 27 hospitals in the Netherlands in which 1,119 infertile women undergoing HSG were randomly assigned to either an oil-based or water-based contrast agent. The couples then underwent expectant management, or the women underwent intrauterine insemination. The primary outcome was ongoing pregnancy within six months of randomization.

In all, 557 women were assigned to HSG using oil contrast, and 562 women were assigned to water contrast. After six months, 39.7% of the women in the oil group and 29.1% women in the water group had an ongoing pregnancy. At the termination of the study, 38.8% of women in the oil group and 28.1% of women in the water group had live births. Rates of adverse events were low and similar in the two groups. The study was presented at the 13th World Congress on Endometriosis, held during May 2017 in Vancouver (Canada).

“Over the past century, pregnancy rates among infertile women reportedly increased after their tubes had been flushed with either water or oil during this X-ray procedure. Until now, it has been unclear whether the type of solution used in the procedure was influencing the change in fertility,” said senior author Professor Ben Mol, MD, PhD, who was conceived after his mother underwent HSG. “Our results have been even more exciting than we could have predicted, helping to confirm that an age-old medical technique still has an important place in modern medicine.”

HSG is an x-ray fluoroscopy technique to examine the uterus and fallopian tubes of a woman who is having difficulty becoming pregnant. First carried out in 1917, the procedure is also used to investigate miscarriages and to determine presence and severity of tumor masses, adhesions, and uterine fibroids. The underlying mechanisms by which HSG might enhance fertility are unclear; some studies suggest that it flushes debris and dislodge mucus plugs from undamaged tubes. The oil contrast might also have an effect on peritoneal macrophage activity and on endometrial receptivity, thereby enhancing fertility by an implantation-mediated mechanism.