Therapeutic effect of oil-soluble and water-soluble media used for tubal patency testing (hysterosalpingography or laparoscopy) on pregnancy rates in infertility patients

There has been debate in the literature for more than 40 years as  to whether flushing of the Fallopian tubes enhances fertility and  whether this presumed therapeutic effect is greater with oil-soluble media than with water-soluble media.

 According to Evidence Based Medicine (EBM) :-

 In comparison with no treatment, a significant benefit on pregnancy rates was seen by flushing the tubes with  oil-soluble media but not with water-soluble media. In the direct comparison of oil- and water-soluble media the former lead to significantly higher pregnancy rates. The treatment effect appeared similar in RCTs and non-RCTs. Further analysis suggested the therapeutic benefit was greatest for patients suffering from unexplained infertility and least for those with tubal factor infertility.

 In conclusions: Flushing of the tubes with oil-soluble media increases subsequent pregnancy rates in infertility patients. The hypothesis that tubal "plugs" are a cause of proximal tubal  occlusion and that oil-soluble media may flush them out, is  supported by new techniques such as falloposcopy. Clinicians should consider flushing the tubes with OSCM before contemplating more invasive therapies.

 Further readings:

Ramussen F, Lindequist S, Larsen C, Justesen P.  Therapeutic effect of hysterosalpingography: oil- versus  water-soluble contrast media - a randomized prospective study. Radiology 1991;179:75-8.

 Ogata R, Nakamura G, Uchiumi Y, et al. Therapeutic efficacy of hysterosalpingography (HSG) in infertility, a prospective, randomized, clinical study.  Jpn J Fertil Steril 1993;38:91-4.

 Sawatari Y, Horii T, Hoshiai H. Oily contrast medium as a therapeutic agent for infertility  because of mild endometriosis.  Fertil Steril 1993;59:907-11.