Luttjeboer F, Harada T, Hughes E, Johnson N, Lilford R, Mol B W J
Maxima Medical Centre, Department of Obstetrics and Gynaecology, Wilhelminapark 3, Valkenswaard, Noord-Brabant, Netherlands, 5554JD.
Cochrane Database Syst Rev. 2007 Jul 18(3):CD003718. doi: 10.1002/14651858.CD003718.pub3.
A possible therapeutic effect of diagnostic tubal patency testing has been debated in the literature for half a century. Further debate surrounds whether oil-soluble or water-soluble contrast media might have the bigger fertility-enhancing effect.
To evaluate the effect of flushing a woman's fallopian tubes with oil- or water-soluble contrast media on subsequent fertility outcomes in couples with infertility.
We searched the Cochrane Menstrual Disorders and Subfertility Group's specialised register of trials (searched 31 January 2007), MEDLINE, EMBASE, Biological Abstract and reference lists of articles.
All randomised trials comparing tubal flushing with oil-soluble contrast media or tubal flushing with water-soluble media or with no treatment in women with subfertility.
Four authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We collected adverse effects information from the trials.
Twelve trials involving 2079 participants were included. Tubal flushing with oil-soluble media versus no intervention was associated with a significant increase in the odds of live birth (Peto OR 2.98, 95% CI 1.40 to 6.37) and of pregnancy (Peto OR 3.30, 95% CI 2.00 to 5.43). For the comparison of tubal flushing with oil-soluble media versus tubal flushing with water-soluble media, the increase in the odds of live birth for tubal flushing with oil-soluble versus water-soluble media (Peto OR 1.49, 95% CI 1.05 to 2.11) was based on two trials where statistical heterogeneity was present and the higher quality trial showed no significant difference; there was no evidence of a significant difference in the odds of pregnancy (Peto OR 1.21, 95% CI 0.95 to 1.54). The addition of oil-soluble media to flushing with water-soluble media showed no evidence of a significant difference in the odds of pregnancy (Peto OR 1.28, 95% CI 0.92 to 1.79) or live birth (Peto OR 1.06, 95% CI 0.64 to 1.77). There were no serious adverse event reported.
AUTHORS' CONCLUSIONS: There is evidence of effectiveness of tubal flushing with oil-soluble contrast media in increasing the odds of pregnancy and live birth versus no intervention. Future robust randomised trials, comparing oil-soluble versus water-soluble media, water-soluble media versus no intervention and tubal flushing versus established treatments for infertility would be a useful further guide to clinical practice.
半个世纪以来，诊断性输卵管通畅性测试可能具有的治疗效果一直是文献中争论的焦点。关于油溶性或水溶性造影剂是否可能具有更大的提高生育能力的效果，也存在进一步的争论。
评估用油性或水溶性造影剂冲洗女性输卵管对不孕夫妇后续生育结局的影响。
我们检索了Cochrane月经紊乱和亚生育问题小组的专门试验注册库（检索日期为2007年1月31日）、MEDLINE、EMBASE、生物学文摘以及文章的参考文献列表。
所有比较输卵管冲洗使用油溶性造影剂、输卵管冲洗使用水溶性造影剂或对不育女性不进行治疗的随机试验。
四位作者独立评估试验质量并提取数据。我们联系研究作者以获取更多信息。我们从试验中收集不良反应信息。
纳入了12项试验，涉及2079名参与者。与不进行干预相比，用油性介质进行输卵管冲洗与活产几率（Peto比值比2.98，95%可信区间1.40至6.37）和妊娠几率（Peto比值比3.30，95%可信区间2.00至5.43）的显著增加相关。对于用油性介质进行输卵管冲洗与用水溶性介质进行输卵管冲洗的比较，用油性介质而非水溶性介质进行输卵管冲洗时活产几率的增加（Peto比值比1.49，95%可信区间1.05至2.11）基于两项存在统计学异质性的试验，且质量较高的试验未显示出显著差异；妊娠几率方面没有显著差异的证据（Peto比值比1.21，95%可信区间0.95至1.54）。在用水溶性介质冲洗时添加油性介质，在妊娠几率（Peto比值比1.28，95%可信区间0.92至1.79）或活产几率（Peto比值比1.06，95%可信区间0.64至1.77）方面没有显著差异的证据。未报告严重不良事件。
有证据表明，与不进行干预相比，用油性造影剂进行输卵管冲洗在增加妊娠几率和活产几率方面是有效的。未来进行有力的随机试验，比较油溶性与水溶性介质、水溶性介质与不进行干预以及输卵管冲洗与已确立的不育治疗方法，将为临床实践提供有益的进一步指导。
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