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Evidence summaries

Tubal Flushing for Subfertility

Tubal flushing with oil-soluble contrast media appears to be effective in increasing the odds of pregnancy and live birth versus water-baised contrast media or no intervention in women with infertility. Level of evidence: "B"

Comment:The quality of evidence is downgraded by imprecise results (limited study size for each comparison).

A Cochrane review [Abstract] 1 included 15 RCTs involving 3 864 participants. Tubal flushing with oil-soluble media versus no intervention increased the odds of live birth (OR 3.27, 95% CI 1.57 to 6.85, 3 trials, n=204) and pregnancy (OR 3.54, 95% CI 2.08 to 6.02, 4 RCTs, n=506). This suggests that if the chance of live birth following no treatment is assumed to be 11%, the chance following tubal flushing with oil-soluble media would be between 16% and 46%. For the comparison of tubal flushing with oil-soluble media versus water-soluble media the increase in the odds of live birth in two trials (OR 1.64, 95% CI 1.27 to 2.11, n=1119; OR 3.45, 95% CI 1.97 to 6.03, n=398); and one with insufficient evidence of a difference between groups (OR 0.92, 95% CI 0.60 to 1.40, n=533).

A network meta-analysis 2 included 14 RCTs reporting on 3852 women with infertility. Tubal flushing with oil-based contrast media was associated with higher odds of clinical pregnancy within 6 months after randomization and more subsequent live births compared with tubal flushing with water-based media (odds ratio [OR] 1.67, 95% CI 1.38 to 2.03), moderate certainty of evidence; and OR 2.18, 95% CI 1.30 to 3.65), low certainty of evidence, respectively) and compared with no intervention (OR 2.28, 95% CI 1.50 to 3.47), moderate certainty of evidence; and OR 2.85 95% CI 1.41 to 5.74), low certainty of evidence, respectively). These results agreed with those of the pairwise meta-analysis.

    References

    • Wang R, Watson A, Johnson N et al. Tubal flushing for subfertility. Cochrane Database Syst Rev 2020;(10):CD003718. [PubMed]
    • Wang R, van Welie N, van Rijswijk J et al. Effectiveness on fertility outcome of tubal flushing with different contrast media: systematic review and network meta-analysis. Ultrasound Obstet Gynecol 2019;54(2):172-181. [PubMed]

Primary/Secondary Keywords