Department of Reproductive Medicine, Amsterdam UMC, Amsterdam Reproduction and Development Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Department of Reproductive Medicine, Amsterdam UMC, Amsterdam Reproduction and Development Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Reprod Biomed Online. 2020 Dec;41(6):1038-1044. doi: 10.1016/j.rbmo.2020.08.038. Epub 2020 Aug 30.
Does the fertility-enhancing effect of tubal flushing during hysterosalpingography (HSG) with oil-based contrast change over time?
This was a secondary analysis of the H2Oil (long-term follow-up) study, a multicentre randomized controlled trial evaluating the effectiveness of oil-based and water-based contrast during HSG. The main outcome was ongoing pregnancy. Cox proportional hazards models for time to ongoing pregnancy were fitted over 3 years of follow-up.
Data on 1107 couples were available; 550 couples had oil-based contrast and 557 water-based contrast at HSG. Ongoing pregnancy rates after 3 years were 77% and 71%, respectively. Median follow-up was 9-10 months (5th-95th percentile: <1 to 36). The hazard ratio for ongoing pregnancy for oil versus water over 3 years of follow-up was 1.26 (95% confidence interval [CI] 1.10-1.45). The scaled Schoenfeld residual plots showed a decrease in hazard ratio that was linear with log-transformed time. After including an interaction with log-transformed time, the hazard ratio immediately after HSG was 1.71 (95% CI 1.27-2.31) and reduced to no effect (hazard ratio of 1) at approximately 2 years. There was no evidence for a change in hazard ratio over time in a subgroup of women who experienced pain during HSG.
The hazard ratio for ongoing pregnancy of oil-based versus water-based contrast was 1.71 immediately after HSG, gradually decreasing and plateauing towards a hazard ratio of 1 (indicating no effect) after approximately 2 years. This supports the hypothesis that oil-based contrast might dislodge debris or mucus plugs from the Fallopian tubes, but this has yet to be definitively proved.
在子宫输卵管造影术（HSG）中使用油性造影剂冲洗输卵管是否会随着时间的推移而改变对生育的促进作用？
这是一项多中心随机对照试验的二次分析，该试验评估了在 HSG 中使用油性和水性造影剂的有效性。主要结局是持续性妊娠。在 3 年的随访期间，使用 Cox 比例风险模型拟合了持续性妊娠的时间。
共有 1107 对夫妇的数据可用；550 对夫妇在 HSG 中使用油性造影剂，557 对夫妇使用水性造影剂。3 年后的持续性妊娠率分别为 77%和 71%。中位随访时间为 9-10 个月（5%到 95%分位数：<1 到 36）。3 年随访期间，油性与水性造影剂的持续性妊娠风险比为 1.26（95%置信区间[CI]1.10-1.45）。Schoenfeld 残差比例图显示，风险比随对数转换时间呈线性下降。在纳入对数转换时间的交互作用后，HSG 后即刻的风险比为 1.71（95%CI 1.27-2.31），并在大约 2 年后降至无效应（风险比为 1）。在 HSG 期间经历疼痛的女性亚组中，没有证据表明风险比随时间发生变化。
HSG 后即刻，油性与水性造影剂的持续性妊娠风险比为 1.71，逐渐下降，并在大约 2 年后趋于 1（表明无效应）。这支持了油性造影剂可能从输卵管中冲掉碎片或黏液栓的假设，但这尚未得到明确证实。
