Oil-based vs. water-based contrast medium in hysterosalpingography for older, anovulatory, and infertile women with high-risk of tubal disease.

OBJECTIVE

To compare the effects of oil-based contrast medium (OBCM) and water-based contrast medium (WBCM) during Hysterosalpingography (HSG) on pregnancy outcomes.

DESIGN

We conducted a prospective cohort study with infertile women who underwent HSG between May 4, 2020, and March 30, 2022. Participants were divided into those who received OBCM (ethiodized poppyseed oil) and those who received WBCM)(Ioversol). Women were further classified into subgroups based on advanced age (≥39 years), ovulatory disorders, or high-risk factors for tubal disease. The primary outcome was the live birth rate within six months post-HSG, while secondary outcomes included clinical pregnancy rate, ongoing pregnancy rate, ectopic pregnancy rate, fertility-related treatments, and complications during pregnancy and neonatal outcomes.

RESULTS

A total of 1,187 women were analyzed, with 569 in the OBCM group and 618 in the WBCM group. The live birth rate was significantly higher in the OBCM group compared to the WBCM group (23.4 % vs. 17.0 %, P = 0.01). Additionally, the clinical pregnancy rate (29.9 % vs. 22.3 %, P < 0.001) and ongoing pregnancy rate (23.6 % vs 17.2 %, P = 0.01) were also higher in the OBCM group. However, in high-risk infertile women with advanced age, ovulatory disorders, or tubal disease factors, no significant statistical differences in pregnancy outcomes were observed between the two groups (P > 0.05).

CONCLUSION

Our findings indicate that using OBCM during HSG may significantly enhances pregnancy rates in women with unexplained infertility-those without advanced age, ovulatory disorders, or high-risk factors for tubal disease-compared to WBCM. Nevertheless, the choice of contrast medium does not significantly influence pregnancy outcomes for high-risk groups.

TRIAL REGISTRATION NUMBER: ClinicalTrials.gov ID: NCT06639152.