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Huang Q, Mo L, Wang J, Qin A. Oil-soluble contrast medium bathing attenuated endometrial inflammation and improved endometrial receptivity in women with recurrent implantation failure: a descriptive study. BMC Womens Health 2024; 24:326. [PMID: 38840118 PMCID: PMC11151508 DOI: 10.1186/s12905-024-03160-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/27/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND The oil-soluble contrast medium used in hysterosalpingography has been shown to have a fertility-enhancing effect, but the underlying mechanism is unclear, especially regarding the role of window of implantation (WOI). This study aimed to assess the endometrial immunological impact of the WOI before and after bathing with the oil-soluble contrast medium in women with recurrent implantation failure (RIF). METHODS This descriptive study involved two medical centers between December 18, 2019, and December 30, 2020. We included infertile women who underwent three or more transfer cycles, cumulative transplantation of at least four high-quality cleavage-stage embryos or three high-quality blastocysts without clinical pregnancy, and high-quality frozen embryos that were still available for implantation. Patients received 5 ml of ethiodized poppyseed oil bathing, endometrial biopsy around bathing, and frozen-thawed embryo transfer (FET) within four menstrual cycles after bathing. Patients were excluded if failure to complete anyone. Data on the baseline characteristics and clinical data of the FET cycles were collected, and endometrial biopsy specimens were collected in the luteal phase before and after bathing and subjected to immunohistochemistry. The number of CD56 and CD138 positive cells and H-score of expression of ανβ-3 and HOXA10 in endometrium were collected. RESULTS Thirty-four patients were initially enrolled in the study; ultimately, twelve patients with a median age of 32.5 years (range 27-40 years) completed the research. The median number of embryo transfer cycles was three (range 3-8). A total of 4 of 12 women (33.33%) were diagnosed with chronic endometritis before oil-soluble contrast bathing. After bathing, the median numbers of CD138-positive cells in endometrium decreased from 0.75 (range 0-13.5) to 0.65 (range 0-6), P = 0.035; additionally, the H-score of expression of ανβ-3 in endometrium increased from 148.50 ± 31.63 to 175.58 ± 31.83, P < 0.001. The thickness of the endometrium also significantly increased (8.90 ± 1.45 mm vs.10.11 ± 1.98 mm, P = 0.005). However, no consistent changes were found in the expression of CD56 and HOXA10 in the endometrium. Five patients experienced biochemical pregnancies (41.67%), four had clinical pregnancies (33.33%), and three achieved live births following oil-soluble contrast bathing (25%). CONCLUSIONS These results suggest that oil-soluble contrast medium bathing decreased CD138-positive cells and upregulated expression of ανβ-3 during WOI in patients with RIF. This histological impact of endometrium may result in enhanced fertility during FET cycles. Investigating the ability of intrauterine bathing with lower-dosage oil-soluble contrast to improve pregnancy in the RIF population is warranted.
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Affiliation(s)
- Qiuyan Huang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, 510632, Guangdong, China
- Key Laboratory of Metabolic Diseases of Baise, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, China
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530022, Guangxi, China
| | - LinIing Mo
- Maternal and Child Health Hospital of the Guangxi Zhuang Autonomous Region, Nanning, 530028, Guangxi, China
| | - Junli Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, 510632, Guangdong, China.
- Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, China.
| | - Aiping Qin
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530022, Guangxi, China.
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Au LS, Feng Q, Shingshetty L, Maheshwari A, Mol BW. Evaluating prognosis in unexplained infertility. Fertil Steril 2024; 121:717-729. [PMID: 38423380 DOI: 10.1016/j.fertnstert.2024.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
IMPORTANCE The diagnosis of unexplained infertility presents a dilemma as it signifies both uncertainty about the cause of infertility and the potential for natural conception. Immediate treatment of all would result in overtreatment. Prediction models estimating the likelihood of natural conception and subsequent live birth can guide treatment decisions. OBJECTIVE To evaluate if in couples with unexplained infertility, prediction models are effective in guiding treatment decisions. EVIDENCE REVIEW This review examines 25 studies that assess prediction models for natural conception in couples with unexplained infertility in terms of derivation, validation, and impact analysis. FINDINGS The largest prediction models have been integrated in the synthesis models of Hunault, which includes female age and infertility duration, having been pregnant before and motile sperm percentage. Despite its limited discriminative capacity, this model demonstrates excellent calibration. Importantly, the impact of the Hunault model has been evaluated in randomized clinical trials, and shows that in couples with unexplained infertility and 12-month natural conception chances exceeding 30%, immediate treatment with intrauterine insemination (IUI) and controlled ovarian hyperstimulation is not better than expectant management for 6 months. Below the threshold of 30%, treatment with IUI is superior over expectant management, but immediate in vitro fertilization was not better than IUI. CONCLUSION In couples with unexplained infertility and a good prognosis for natural conception, treatment can be delayed, whereas in couples with a poor prognosis, immediate treatment (with IUI-controlled ovarian hyperstimulation) is warranted. RELEVANCE These data indicate that in couples with unexplained infertility, integration of prediction models into clinical decision making can optimize treatment selection and maximize fertility outcomes while limiting unnecessary treatment.
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Affiliation(s)
- Ling Shan Au
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Qian Feng
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Laxmi Shingshetty
- Aberdeen Centre of Reproductive Medicine, NHS Grampian, Aberdeen, United Kingdom
| | - Abha Maheshwari
- Aberdeen Centre of Reproductive Medicine, NHS Grampian, Aberdeen, United Kingdom
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria, Australia; Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, United Kingdom.
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Geenen RWF, van der Molen AJ, Dekkers IA, Bellin MF, Bertolotto M, Correas JM, Heinz-Peer G, Mahnken AH, Quattrocchi CC, Radbruch A, Reimer P, Roditi G, Sebastià C, Stacul F, Romanini L, Clément O, Brismar TB. Contrast media for hysterosalpingography: systematic search and review providing new guidelines by the Contrast Media Safety Committee of the European Society of Urogenital Radiology. Eur Radiol 2024:10.1007/s00330-024-10707-6. [PMID: 38573340 DOI: 10.1007/s00330-024-10707-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/29/2024] [Accepted: 03/04/2024] [Indexed: 04/05/2024]
Abstract
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.
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Affiliation(s)
- Remy W F Geenen
- Department of Radiology, Northwest Clinics, Alkmaar, The Netherlands
| | - Aart J van der Molen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marie-France Bellin
- AP-HP, University Hospital Bicêtre, Department of Radiology, BioMaps, University Paris Saclay, Le Kremlin-Bicêtre, France
| | | | - Jean-Michel Correas
- AP-HP, Groupe Hospitalier Necker, DMU Imagina, Service de Radiologie, Université de Paris, Paris, France
| | | | - Andreas H Mahnken
- Department of Diagnostic and Interventional Radiology, Marburg University Hospital, Marburg, Germany
| | | | - Alexander Radbruch
- Clinic for Diagnostic and Interventional Neuroradiology, University Clinic Bonn, and German Center for Neurodegenerative Diseases, DZNE, Bonn, Germany
| | - Peter Reimer
- Department of Radiology, Institute for Diagnostic and Interventional Radiology, Klinikum Karlsruhe, Karlsruhe, Germany
| | - Giles Roditi
- Department of Radiology, Glasgow Royal Infirmary, Glasgow, UK
| | - Carmen Sebastià
- Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Fulvio Stacul
- Department of Radiology, Ospedale Maggiore, Trieste, Italy
| | | | - Olivier Clément
- AP-HP, Hôpital Européen Georges Pompidou, DMU Imagina, Service de Radiologie, Université de Paris, Paris, France
| | - Torkel B Brismar
- Unit of Radiology, CLINTEC, Karolinska Institutet, Alfred Nobels alle 8, 141 52, Huddinge, Sweden.
- Department of Radiology, Karolinska University Hospital in Huddinge, Stockholm, Sweden.
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Feng Q, Li W, Callander EJ, Wang R, Mol BW. Applying a simplified economic evaluation approach to evaluate infertility treatments in clinical practice. Hum Reprod 2024; 39:448-453. [PMID: 38148026 PMCID: PMC10905501 DOI: 10.1093/humrep/dead265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/20/2023] [Indexed: 12/28/2023] Open
Abstract
IVF is the backbone of infertility treatment, but due to its costs, it is not affordable for everyone. The cost of IVF is further escalated by interventions added to the routine treatment, which are claimed to boost pregnancy rates, so-called add-ons. Consequently, it is critical to offset the increased costs of an intervention against a potentially higher benefit. Here, we propose using a simplified framework considering the cost of a standard IVF procedure to create one live-born baby as a benchmark for the cost-effectiveness of other fertility treatments, add-ons inclusive. This framework is a simplified approach to a formal economic evaluation, enabling a rapid assessment of cost effectiveness in clinical settings. For a 30-year-old woman, assuming a 44.6% cumulative live birth rate and a cost of $12 000 per complete cycle, the cost to create one live-born baby would be ∼$27 000 (i.e. willingness to pay). Under this concept, the decision whether to accept or reject a new treatment depends from an economic perspective on the incremental cost per additional live birth from the new treatment/add-on, with the $27 000 per live-born baby as a reference threshold. This threshold can vary with women's age, and other factors such as the economic perspective and risk of side effects can play a role. If a new add-on or treatment costs >$27 000 per live birth, it might be more rational to invest in a new IVF cycle rather than spending on the add-on. With the increasing number of novel technologies in IVF and the lack of a rapid approach to evaluate their cost-effectiveness, this simplified framework will help with a more objective assessment of the cost-effectiveness of infertility treatments, including add-ons.
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Affiliation(s)
- Qian Feng
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Wentao Li
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Emily J Callander
- Discipline for Health Services Management, School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Rui Wang
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- Aberdeen Centre for Women's Health Research, School of Medicine, University of Aberdeen, Aberdeen, UK
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Xie B, Huang Y, Hang F, Yu J, Hu Q, Li J, Qin A. Impact of oil-based contrast agents in hysterosalpingography on fertility outcomes in endometriosis: a retrospective cohort study. Reprod Biol Endocrinol 2024; 22:19. [PMID: 38308329 PMCID: PMC10837917 DOI: 10.1186/s12958-024-01190-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/25/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Previous studies have suggested that oil-based contrast agents used during hysterosalpingography (HSG) in infertile patients can enhance fertility. However, limited research has investigated the effect of oil-based contrast medium specifically in individuals with endometriosis-related infertility. OBJECTIVE This study aims to explore the impact of oil-based contrast medium on fertility outcomes in women with endometriosis-related infertility. METHODS Conducted at the First Affiliated Hospital of Guangxi Medical University (January 2020 to June 2022), the study included 512 patients undergoing HSG. Patients were categorized into oil-based and non-oil-based groups, and after propensity score matching, demographic characteristics were compared. Main outcomes included clinical pregnancy rates, live birth rates, early miscarriage rates, and ectopic pregnancy rates. RESULTS In our analysis, the Oil-based group showed significantly better outcomes compared to the Non-oil-based group. Specifically, the Oil-based group had higher clinical pregnancy rates (51.39% vs. 27.36%) and increased live birth rates (31.48% vs. 19.93%). This trend held true for expectant treatment, IUI, and IVF/ICSI, except for surgical treatment where no significant difference was observed. After adjusting for various factors using propensity score matching, the Non-oil-based group consistently exhibited lower clinical pregnancy rates compared to the Oil-based group. The Odds Ratio (OR) was 0.38 (95%CI: 0.27-0.55) without adjustment, 0.34 (0.22-0.51) in multivariable analysis, 0.39 (0.27-0.57) using inverse probability of treatment weighting (IPTW), and 0.22 (0.14-0.35) in propensity score matching. CONCLUSION Oil-based contrast medium used in HSG for women with endometriosis-related infertility is associated with higher clinical pregnancy rates and live birth rates compared to Non-oil-based contrast medium.
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Affiliation(s)
- Baoli Xie
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Yingqin Huang
- Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi, 530021, China
| | - Fu Hang
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Jiaxin Yu
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Qianwen Hu
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Jiaxu Li
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Aiping Qin
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China.
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6
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van Welie N, van Eekelen R, Dreyer K, Mijatovic V, Mol BW. Commentary: Fertility-enhancing effect of oil-based contrast agents during hysterosalpingography and the variation of this effect within a 3-year follow-up period in infertile patients. Front Med (Lausanne) 2024; 10:1287896. [PMID: 38298512 PMCID: PMC10828012 DOI: 10.3389/fmed.2023.1287896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 12/26/2023] [Indexed: 02/02/2024] Open
Affiliation(s)
- Nienke van Welie
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Rik van Eekelen
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
- Centre for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Kim Dreyer
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Velja Mijatovic
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Ben Willem Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- Aberdeen Centre for Women's Health Research, University of Aberdeen, King's College, Aberdeen, United Kingdom
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Chia CY, Lee E. Assessment of contrast intravasation in patients investigated by fluoroscopic hysterosalpingograms: A two-year retrospective audit in Western Australia. J Med Imaging Radiat Oncol 2024. [PMID: 38204210 DOI: 10.1111/1754-9485.13619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Intravasation on hysterosalpingogram (HSG) is defined by the flow of injected contrast from the uterine cavity into adjacent myometrial vessels. Evidence suggests intravasation can result in consequences such as pulmonary and cerebral embolisms. However, adverse events are poorly reported across published studies. Reported intravasation ranges from 0.0% to 13%, with higher rates attributed to oil-soluble contrast medium (OSCM) use. Recent reviews of OSCM's fertility-enhancing benefits have prompted rapid clinical uptake by fertility specialists worldwide. This instigates increased concern for intravasation and its associated sequelae. We aim to assess the prevalence of intravasation in fluoroscopic HSGs and its reporting in Western Australia (WA). METHODS A two-year retrospective analysis of all fluoroscopic HSGs in one public teaching hospital within WA was conducted. All HSGs were retrieved from the public radiology information system and a blinded method was utilised to verify the presence and grading of intravasation in captured HSG images. Grading of intravasation was attributed by anatomical spread: 1 to myometrium, 2 to parametrium and 3 to para-iliac vessels. Results were subsequently compared with reported intravasation to assess for discrepancies. RESULTS Of 308 successful HSGs, an intravasation rate of 7.1% was identified. Of these cases, 45% were reported and 32% were graded. Majority (73%) of intravasation events were classified as grade 1, with 9.0% and 18% of cases classified as grade 2 and 3, respectively. CONCLUSION Under-reporting of intravasation emphasises a need for increased vigilance of radiologists. Standardised classification can provide interpretational consistency and should be considered to improve safety in future practice.
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Affiliation(s)
- Ci Yue Chia
- Royal Perth Hospital, Perth, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
| | - Emmeline Lee
- Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Western Ultrasound for Women, Perth, Western Australia, Australia
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Yang JJ, Chapman M. What are the risks associated with lipiodol hysterosalpingography? A literature review. Radiography (Lond) 2023; 29:1041-1045. [PMID: 37714068 DOI: 10.1016/j.radi.2023.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 09/17/2023]
Abstract
INTRODUCTION Hysterosalpingography is widely used as a first-line investigation for infertility, and may also be therapeutic, increasing pregnancy rates. Aqueous and oil-based contrast agents can be used. Some studies suggest Lipiodol hysterosalpingography has a greater therapeutic effect on fertility than aqueous contrast, though this is contentious. There are additionally safety concerns surrounding Lipiodol hysterosalpingography. This review summarises the adverse effects associated with Lipiodol hysterosalpingography, particularly on thyroid function. KEY FINDINGS 331 articles were identified. Of these, 46 met inclusion criteria. 3 further articles were identified from reference lists. Complications typically cited in the literature include pain, intravasation, life-threatening oil embolism, and lipogranuloma formation. Emerging evidence suggests that Lipiodol hysterosalpingography may also impact maternal and neonatal thyroid function. Women may develop hypo- or hyperthyroidism. Thyroid dysfunction is clinically significant as even subclinical hypothyroidism reduces fertility, increases the risk of pregnancy complications including miscarriage, pre-eclampsia and perinatal mortality, and adversely impacts foetal neurodevelopment. One study suggested a possible link with neonatal congenital hypothyroidism. CONCLUSION There is emerging evidence to suggest that Lipiodol hysterosalpingography can cause hypo- or hyperthyroidism, in addition to known adverse effects of pain, intravasation, oil embolism, and lipogranuloma formation. IMPLICATIONS FOR PRACTICE Given the significance of these risks, and contention surrounding whether Lipiodol truly increases pregnancy rates compared to aqueous mediums, careful consideration is required in the selection of contrast agent. In particular, Lipiodol hysterosalpingography may not be suitable for women with pre-existing thyroid dysfunction.
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Affiliation(s)
- J J Yang
- Discipline of Women's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Women's and Children's Health, St George Hospital, Sydney, Australia.
| | - M Chapman
- Discipline of Women's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Women's and Children's Health, St George Hospital, Sydney, Australia; IVF Australia, St George Private Hospital, Sydney, Australia
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Chen J, Liu S, Lu J. Comparison of fertility outcomes between oil‑based and water‑based contrast media during hysterosalpingography: A meta‑analysis. Exp Ther Med 2023; 26:449. [PMID: 37614430 PMCID: PMC10443060 DOI: 10.3892/etm.2023.12148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/08/2023] [Indexed: 08/25/2023] Open
Abstract
Water-based and oil-based contrast media are both widely used in clinical practice for patients receiving hysterosalpingography (HSG). However, minor controversy exists about whether the oil-based contrast medium has a superior fertility-enhancing effect during HSG. The present meta-analysis intended to comprehensively compare the fertility outcomes of patients receiving either an oil-based or a water-based contrast medium during HSG. Web of Science, PubMed, Excerpta Medica Database, Cochrane, China National Knowledge Infrastructure, Wanfang Data and China Science and Technology Journal Database were examined for literature comparing the fertility enhancement between oil-based and water-based contrast media during HSG up to November 10, 2022 and there was no cut off for studies published earlier than any given year. Data for clinical pregnancy, ongoing pregnancy, live birth, miscarriage and ectopic pregnancy were extracted and analyzed. A total of 11 studies with 2,462 patients receiving oil-based contrast medium and 2,830 patients receiving water-based contrast medium during HSG were included. Relative risks (RRs) and 95% confidence intervals (CIs) were presented for outcome assessment, and the random effects model was utilized for all analyses. Publication bias was analyzed using Egger's and Begg's tests. The results indicated that the rate of clinical pregnancy was increased using oil-based contrast medium compared with water-based contrast medium [relative risk (RR) (95% CI), 1.29 (1.07, 1.54); P=0.006]. In addition, the rate of ongoing pregnancy [RR (95% CI), 1.39 (1.22, 1.59); P#x003C;0.001] and live birth [RR (95% CI), 1.41 (1.07, 1.87); P=0.016] were also increased using oil-based contrast medium compared with water-based contrast medium. However, miscarriage [RR (95% CI), 1.06 (0.61, 1.86); P=0.833] and ectopic pregnancy [RR (95% CI), 0.66 (0.18, 2.36); P=0.518] were not affected by using oil-based or water-based contrast medium. Begg's test and Egger's test suggested that no publication bias of clinical pregnancy, ongoing pregnancy, live birth, miscarriage and ectopic pregnancy existed (all P>0.05), which indicated the stability of the present meta-analysis. In conclusion, the oil-based contrast medium enhances fertility outcomes compared with the water-based contrast medium in patients receiving HSG.
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Affiliation(s)
- Jun Chen
- Department of Medical Imaging, People's Hospital of Fengjie, Chongqing 404600, P.R. China
| | - Shushu Liu
- Department of Medical Imaging, People's Hospital of Fengjie, Chongqing 404600, P.R. China
| | - Jianguo Lu
- Department of Medical Imaging, People's Hospital of Fengjie, Chongqing 404600, P.R. China
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Tsui S, Sofy AA. A meta-analysis of fertility and adverse outcomes in oil- and water-based contrast for hysterosalpingography. Turk J Obstet Gynecol 2023; 20:64-73. [PMID: 36908096 PMCID: PMC10013086 DOI: 10.4274/tjod.galenos.2023.67750] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Infertility is the inability to conceive after one year of regular unprotected intercourse. There is a debate about the therapeutic effect of hysterosalpingography (HSG) and whether the selection of contrast materials makes a difference in the chance of subsequent conception. In this study, we aimed to compare the fertility-enhancing outcomes and adverse effects of oil and water-based contrasts in patients who underwent HSG. This systematic review and meta-analysis was conducted following the PRISMA guidelines. We searched the Web of Science, PubMed, and Scopus until September 2022. We included all primary randomized controlled trials evaluating the fertility-enhancing benefits of HSG in oil-based versus water-based contrast media in women of childbearing age with infertility. Eleven studies with 4,739 patients were selected. The pregnancy rate in the oil group was significantly higher than that in the water group [odds ratio (OR)=1.51 (1.23, 1.86), p<0.0001]. Our meta-analysis favored the oil group in abdominal pain and vaginal bleeding with the odd ratios of 0.73 (0.58, 0.91), (p=0.006) and 0.91 (0.46, 1.81), (p=0.79), respectively. Water-based contrast was associated with less intravasation [OR=2.09 (1.09-4.02), p=0.03]. There were no differences between the contrasts for miscarriage [OR=1.02 (0.71, 1.46), p=0.92], and ectopic pregnancy [OR=0.84 (0.27, 2.63), p=0.77]. HSG with oil-based contrast was related to a higher pregnancy rate, live birth rate, and intravasation rate. While HSG using a water-based contrast medium was associated with increased abdominal discomfort, vaginal bleeding, and the visual-analogue scale pain score.
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Affiliation(s)
- Stewart Tsui
- Addenbrooke's Hospital, Cambridge, United Kingdom
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11
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Huang Q, Yang Y, Yuan L, Zhao Y, Qin A. Oil-based contrast for hysterosalpingography-regulated Th1/Th2-type cytokines and alleviated inflammation in rats with LPS-induced chronic endometritis. J Obstet Gynaecol Res 2023; 49:243-252. [PMID: 36281209 DOI: 10.1111/jog.15451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/21/2022] [Accepted: 09/19/2022] [Indexed: 01/19/2023]
Abstract
AIM The chronic endometritis (CE) prevalence in people experiencing infertility is 2.8-56.8%, pregnancy rates in patients with infertility increase after hysterosalpingography with oil-based contrast, but the effect and mechanism are not clear. Here, we analyzed the effects of intrauterine ethiodized poppyseed oil (EPO) bathing on a rat model of CE and the possible underlying mechanism. METHODS CE rats were induced by lipopolysaccharide (LPS) exposure, and rats were subjected to intrauterine bathing with EPO or phosphate-buffered saline (PBS) after model verification. Serum and uterus levels of IFN-γ, IL-4, TNF-α, and IL-1β were detected by ELISA kit, and the number of CD138+ and CD68+ cells and uterine IFN-γ, IL-4, TNF-α, IL-1β, and NF-κB P65 expression were detected by immunohistochemistry after bathing. RESULTS LPS exposure induced the typical CE phenotype with CD138+ phagocyte infiltration of the endometrial stroma. Compared with PBS bathing, bathing with EPO in CE rats showed decreases in the CD138+ and CD68+ cells populations and significant decreases in serum and uterine IFN-γ levels, moreover, uterine IL-4 levels were slightly higher, and the IFN-γ/IL-4(Th1/Th2-type cytokine ratio) in the uterus was significantly lower. Local IFN-γ, TNF-α, and NF-κB P65 expression in the endometrium was significantly downregulated, while IL-4 expression was upregulated. CONCLUSION Intrauterine oil-based contrast bathing significantly alleviated local inflammation in the rat CE model by downregulating NF-κB P65 expression, reducing IFN-γ (Th1), increasing IL-4 levels (Th2) in the endometrium, and regulating the Th1/Th2-type cytokine trends toward Th2.
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Affiliation(s)
- Qiuyan Huang
- Reproductive Medicine Center, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China.,Reproductive Medicine Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yihua Yang
- Reproductive Medicine Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lifang Yuan
- Reproductive Medicine Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yunxiao Zhao
- Reproductive Medicine Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Aiping Qin
- Reproductive Medicine Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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