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Mathews DM, Peart JM, Sim RG, Johnson NP, O’Sullivan S, Derraik JGB, Hofman PL. Iodine and other factors associated with fertility outcome following oil-soluble contrast medium hysterosalpingography: a prospective cohort study. Front Endocrinol (Lausanne) 2024; 15:1257888. [PMID: 38974579 PMCID: PMC11224778 DOI: 10.3389/fendo.2024.1257888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 04/29/2024] [Indexed: 07/09/2024] Open
Abstract
Objective To examine factors associated with fertility following hysterosalpingography (HSG) using an oil-soluble contrast medium (OSCM). Design In a prospective cohort study on 196 women undergoing OSCM HSG, we showed that iodine excess was almost universal (98%) and mild subclinical hypothyroidism was frequent (38%). Here, we report the analyses of secondary outcomes examining factors associated with the likelihood of pregnancy following the HSG. Setting Auckland, New Zealand (2019-2021). Sample 196 women with primary or secondary infertility who underwent OSCM HSG. Methods Baseline and serial urine iodine concentrations (UIC) and thyroid function tests were measured over six months following the HSG. Pregnancy and treatment with levothyroxine during the study period were documented. Results Following OSCM HSG, pregnancy rates were 49% in women aged <40 years (77/158) but considerably lower (16%) among those ≥40 years (6/38). Similarly, live birth rates were markedly lower in women ≥40 years (17%; 1/6) versus <40 years (73%; 56/77). 29% of participants were iodine deficient at baseline despite advice recommending iodine fortification. Following HSG, the likelihood of pregnancy in women with moderate iodine deficiency was 64% higher than in women with normal iodine levels (p=0.048). Among women aged <40 years who had subclinical hypothyroidism (n=75), levothyroxine treatment was associated with higher pregnancy rates compared to untreated women [63% (26/48) vs 37% (10/27), respectively; p=0.047]. Conclusion OSCM HSG was associated with higher pregnancy rates in women ≤40 than in those aged >40 years. Iodine deficiency was relatively common in this cohort, and increased iodine levels from OSCM exposure may contribute to the improved fertility observed with this procedure. Trial registration This study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR: 12620000738921) https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000738921.
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Affiliation(s)
- Divya M. Mathews
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Starship Children’s Hospital, Health New Zealand | Te Whatu Ora, Auckland, New Zealand
| | | | | | - Neil P. Johnson
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Repromed Auckland, Auckland, New Zealand
| | - Susannah O’Sullivan
- Endocrinology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - José G B Derraik
- Department of Paediatrics: Child & Youth Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
- Environmental–Occupational Health Sciences and Non-Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Paul L. Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Starship Children’s Hospital, Health New Zealand | Te Whatu Ora, Auckland, New Zealand
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Noorduyn JCA, van de Graaf VA, Willigenburg NW, Scholten-Peeters GGM, Mol BW, Heymans MW, Coppieters MW, Poolman RW. An individualized decision between physical therapy or surgery for patients with degenerative meniscal tears cannot be based on continuous treatment selection markers: a marker-by-treatment analysis of the ESCAPE study. Knee Surg Sports Traumatol Arthrosc 2022; 30:1937-1948. [PMID: 35122496 PMCID: PMC9165275 DOI: 10.1007/s00167-021-06851-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Marker-by-treatment analyses are promising new methods in internal medicine, but have not yet been implemented in orthopaedics. With this analysis, specific cut-off points may be obtained, that can potentially identify whether meniscal surgery or physical therapy is the superior intervention for an individual patient. This study aimed to introduce a novel approach in orthopaedic research to identify relevant treatment selection markers that affect treatment outcome following meniscal surgery or physical therapy in patients with degenerative meniscal tears. METHODS Data were analysed from the ESCAPE trial, which assessed the treatment of patients over 45 years old with a degenerative meniscal tear. The treatment outcome of interest was a clinically relevant improvement on the International Knee Documentation Committee Subjective Knee Form at 3, 12, and 24 months follow-up. Logistic regression models were developed to predict the outcome using baseline characteristics (markers), the treatment (meniscal surgery or physical therapy), and a marker-by-treatment interaction term. Interactions with p < 0.10 were considered as potential treatment selection markers and used these to develop predictiveness curves which provide thresholds to identify marker-based differences in clinical outcomes between the two treatments. RESULTS Potential treatment selection markers included general physical health, pain during activities, knee function, BMI, and age. While some marker-based thresholds could be identified at 3, 12, and 24 months follow-up, none of the baseline characteristics were consistent markers at all three follow-up times. CONCLUSION This novel in-depth analysis did not result in clear clinical subgroups of patients who are substantially more likely to benefit from either surgery or physical therapy. However, this study may serve as an exemplar for other orthopaedic trials to investigate the heterogeneity in treatment effect. It will help clinicians to quantify the additional benefit of one treatment over another at an individual level, based on the patient's baseline characteristics. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Julia C A Noorduyn
- Department of Orthopedic Surgery, Joint Research, OLVG Amsterdam, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
| | - Victor A van de Graaf
- Department of Orthopedic Surgery, Joint Research, OLVG Amsterdam, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
- Department of Orthopedic Surgery, St. Antonius Ziekenhuis, Utrecht, The Netherlands
| | - Nienke W Willigenburg
- Department of Orthopedic Surgery, Joint Research, OLVG Amsterdam, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - Gwendolyne G M Scholten-Peeters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Ben W Mol
- Department of Obstetrics and Gynecology, School of Medicine, Monash University, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
| | - Michel W Coppieters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
| | - Rudolf W Poolman
- Department of Orthopedic Surgery, Joint Research, OLVG Amsterdam, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
- Department of Orthopedic surgery, Leiden University Medical Centre, Leiden, The Netherlands
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van Welie N, Rosielle K, Dreyer K, van Rijswijk J, Lambalk CB, van Geloven N, Mijatovic V, Mol BWJ, van Eekelen R. How long does the fertility-enhancing effect of hysterosalpingography with oil-based contrast last? Reprod Biomed Online 2020; 41:1038-1044. [PMID: 33012658 DOI: 10.1016/j.rbmo.2020.08.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/13/2020] [Accepted: 08/27/2020] [Indexed: 11/16/2022]
Abstract
RESEARCH QUESTION Does the fertility-enhancing effect of tubal flushing during hysterosalpingography (HSG) with oil-based contrast change over time? DESIGN This was a secondary analysis of the H2Oil (long-term follow-up) study, a multicentre randomized controlled trial evaluating the effectiveness of oil-based and water-based contrast during HSG. The main outcome was ongoing pregnancy. Cox proportional hazards models for time to ongoing pregnancy were fitted over 3 years of follow-up. RESULTS Data on 1107 couples were available; 550 couples had oil-based contrast and 557 water-based contrast at HSG. Ongoing pregnancy rates after 3 years were 77% and 71%, respectively. Median follow-up was 9-10 months (5th-95th percentile: <1 to 36). The hazard ratio for ongoing pregnancy for oil versus water over 3 years of follow-up was 1.26 (95% confidence interval [CI] 1.10-1.45). The scaled Schoenfeld residual plots showed a decrease in hazard ratio that was linear with log-transformed time. After including an interaction with log-transformed time, the hazard ratio immediately after HSG was 1.71 (95% CI 1.27-2.31) and reduced to no effect (hazard ratio of 1) at approximately 2 years. There was no evidence for a change in hazard ratio over time in a subgroup of women who experienced pain during HSG. CONCLUSIONS The hazard ratio for ongoing pregnancy of oil-based versus water-based contrast was 1.71 immediately after HSG, gradually decreasing and plateauing towards a hazard ratio of 1 (indicating no effect) after approximately 2 years. This supports the hypothesis that oil-based contrast might dislodge debris or mucus plugs from the Fallopian tubes, but this has yet to be definitively proved.
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Affiliation(s)
- Nienke van Welie
- Department of Reproductive Medicine, Amsterdam UMC, Amsterdam Reproduction and Development Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Kimmy Rosielle
- Department of Reproductive Medicine, Amsterdam UMC, Amsterdam Reproduction and Development Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Kim Dreyer
- Department of Reproductive Medicine, Amsterdam UMC, Amsterdam Reproduction and Development Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Joukje van Rijswijk
- Department of Reproductive Medicine, Amsterdam UMC, Amsterdam Reproduction and Development Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Cornelis B Lambalk
- Department of Reproductive Medicine, Amsterdam UMC, Amsterdam Reproduction and Development Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Nan van Geloven
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Velja Mijatovic
- Department of Reproductive Medicine, Amsterdam UMC, Amsterdam Reproduction and Development Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Rik van Eekelen
- Centre for Reproductive Medicine, Amsterdam UMC, University of Amsterdam Amsterdam, the Netherlands
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van Rijswijk J, van Welie N, Dreyer K, Pham CT, Verhoeve HR, Hoek A, de Bruin JP, Nap AW, van Hooff MHA, Goddijn M, Hooker AB, Bourdrez P, van Dongen AJCM, van Rooij IAJ, van Rijnsaardt-Lukassen HGM, van Golde RJT, van Heteren CF, Pelinck MJ, Duijn AEJ, Kaplan M, Lambalk CB, Mijatovic V, Mol BWJ. Tubal flushing with oil-based or water-based contrast at hysterosalpingography for infertility: long-term reproductive outcomes of a randomized trial. Fertil Steril 2020; 114:155-162. [PMID: 32553471 DOI: 10.1016/j.fertnstert.2020.03.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/02/2020] [Accepted: 03/17/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the impact of oil-based versus water-based contrast on pregnancy and live birth rates ≤5 years after hysterosalpingography (HSG) in infertile women. DESIGN A 5-year follow-up study of a multicenter randomized trial. SETTING Hospitals. PATIENT(S) Infertile women with an ovulatory cycle, 18-39 years of age, and having a low risk of tubal pathology. INTERVENTION(S) Use of oil-based versus water-based contrast during HSG. MAIN OUTCOME MEASURE(S) Ongoing pregnancy, live births, time to ongoing pregnancy, second ongoing pregnancy. RESULT(S) A total of 1,119 women were randomly assigned to HSG with oil-based contrast (n = 557) or water-based contrast (n = 562). After 5 years, 444 of 555 women in the oil group (80.0%) and 419 of 559 women in the water group (75.0%) had an ongoing pregnancy (relative risk [RR] 1.07; 95% confidence interval [CI] 1.00-1.14), and 415 of 555 women in the oil group (74.8%) and 376 of 559 women in the water group (67.3%) had live births (RR 1.11; 95% CI 1.03-1.20). In the oil group, 228 pregnancies (41.1%) were conceived naturally versus 194 (34.7%) pregnancies in the water group (RR 1.18; 95% CI 1.02-1.38). The time to ongoing pregnancy was significantly shorter in the oil group versus the water group (10.0 vs. 13.7 months; hazard ratio, 1.25; 95% CI 1.09-1.43). No difference was found in the occurrence of a second ongoing pregnancy. CONCLUSION(S) During a 5-year time frame, ongoing pregnancy and live birth rates are higher after tubal flushing with oil-based contrast during HSG compared with water-based contrast. More pregnancies are naturally conceived and time to ongoing pregnancy is shorter after HSG with oil-based contrast. CLINICAL TRIAL REGISTRATION NUMBER Netherlands Trial Register (NTR) 3270 and NTR6577(www.trialregister.nl).
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Affiliation(s)
- Joukje van Rijswijk
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Nienke van Welie
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Kim Dreyer
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Clarabelle T Pham
- College of Medicine and Public Health, Flinders University, Adelaide, Victoria, Australia
| | - Harold R Verhoeve
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam; the Netherlands
| | - Annemieke Hoek
- Department of Reproductive Medicine and Gynaecology, University of Groningen, University Medical Centre Groningen, Hanzeplein, the Netherlands
| | - Jan Peter de Bruin
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, Hertogenbosch, the Netherlands
| | - Annemiek W Nap
- Department of Obstetrics and Gynaecology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Machiel H A van Hooff
- Department of Obstetrics and Gynaecology, Franciscus Hospital, Rotterdam, the Netherlands
| | - Mariëtte Goddijn
- Centre for Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Angelo B Hooker
- Department of Obstetrics and Gynaecology, Zaans Medical Centre, Zaandam, the Netherlands
| | - Petra Bourdrez
- Department of Obstetrics and Gynaecology, VieCuri Medical Centre, Venlo, the Netherlands
| | | | - Ilse A J van Rooij
- Department of Obstetrics and Gynaecology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | | | - Ron J T van Golde
- Department of Obstetrics and Gynaecology, Maastricht UMC, Maastricht, the Netherlands
| | - Cathelijne F van Heteren
- Department of Obstetrics and Gynaecology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Marie J Pelinck
- Department of Obstetrics and Gynaecology, Scheper Hospital, Emmen, the Netherlands
| | | | - Mesrure Kaplan
- Department of Obstetrics and Gynaecology, Röpcke-Zweers Hospital, Hardenberg, the Netherlands
| | - Cornelis B Lambalk
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Velja Mijatovic
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ben W J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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