Tubal flushing with oil-based or water-based contrast at hysterosalpingography for infertility: long-term reproductive outcomes of a randomized trial

J. van Rijswijk*, N. van Welie, K. Dreyer, C.T. Pham, H.R. Verhoeve, A. Hoek, J.P. de Bruin, A.W. Nap, M.H.A. van Hooff, M. Goddijn, A.B. Hooker, P. Bourdrez, A.J.C.M. van Dongen, I.A.J. van Rooij, H.G.M. van Rijnsaardt-Lukassen, R.J.T. van Golde, C.F. van Heteren, M.J. Pelinck, A.E.J. Duijn, M. KaplanC.B. Lambalk, V. Mijatovic, B.W.J. Mol

*Corresponding author for this work

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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% con fi dence 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 signi fi cantly 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 fl ushing 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). (Fertil Steril (R) 2020;114:155-62. (C) 2020 by American Society for Reproductive Medicine.)

Original languageEnglish
Pages (from-to)155-162
Number of pages8
JournalFertility and Sterility
Issue number1
Publication statusPublished - 1 Jul 2020


  • female infertility
  • hysterosalpingography
  • media
  • oil-based contrast medium
  • ongoing pregnancy
  • water-based contrast medium
  • Female infertility

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