Department of Obstetrics and Gynaecology, Máxima MC, Veldhoven, Eindhoven, The Netherlands.
Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Reproduction and Development, Amsterdam, The Netherlands.
J Obstet Gynaecol. 2022 Aug;42(6):1619-1625. doi: 10.1080/01443615.2022.2054679. Epub 2022 May 23.
Hysterosalpingographies (HSGs) have formed an essential part of the fertility workup for more than a century. More recently, tubal flushing, especially with oil-based contrast, has been shown to significantly improve the natural conception rates. Critically, the mechanism of this fertility-enhancing effect during tubal flushing is still unclear. This article postulates hypotheses, based on published and own research, on the potential mechanisms and root cause of tubal flushing fertility enhancement. Possible explanations for the increased fertility rates, especially with oil-based contrast, are divided into the biochemical and interfacial effects derived from the contrast properties. The biochemical effects may include the immunological response of the endometrium or peritoneum, the impact on the endometrial opioid receptors or the iodine content. The interfacial effects may include improvement of interfacial factors due to the lubricant effect or dislodgement of mucus debris within the Fallopian tubes. Impact Statement Tubal flushing during hysterosalpingographies (HSGs) increases natural conception rates, and using oil-based over water-based contrast increases that effect even further. However, the underlying mechanism of the observed fertility-enhancing effect is still poorly understood. This article postulates different hypotheses on the potential mechanisms and root cause of the fertility enhancement from tubal flushing. We suggest additional research on the different hypotheses, intending to determine which subfertile women will benefit most from tubal flushing using oil-based contrast and at which stage of their subfertility. Furthermore, we suggest research on administering tubal flushing with oil-based contrast, besides in HSG.
子宫输卵管造影术（HSG）在一个多世纪以来一直是生育评估的重要组成部分。最近，输卵管冲洗术，特别是使用油性造影剂，已被证明可以显著提高自然受孕率。至关重要的是，输卵管冲洗术增强生育能力的机制仍不清楚。本文基于已发表和自己的研究结果，提出了关于输卵管冲洗术增强生育能力的潜在机制和根本原因的假说。增加生育力的可能解释，特别是使用油性造影剂，可分为造影剂特性带来的生化和界面效应。生化效应可能包括子宫内膜或腹膜的免疫反应、对子宫内膜阿片受体或碘含量的影响。界面效应可能包括由于润滑剂作用而改善界面因素，或在输卵管内清除粘液碎片。
子宫输卵管造影术（HSG）中的输卵管冲洗术可提高自然受孕率，使用油性造影剂而非水性造影剂可进一步提高受孕率。然而，观察到的增强生育能力的潜在机制仍知之甚少。本文提出了关于输卵管冲洗术增强生育能力的潜在机制和根本原因的不同假说。我们建议对不同的假说进行进一步研究，旨在确定哪些生育能力低下的女性将从使用油性造影剂的输卵管冲洗术获益最多，以及在生育能力低下的哪个阶段获益最多。此外，我们建议研究除 HSG 外，还在油性造影剂下进行输卵管冲洗术。
