{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T22:53:43Z","timestamp":1791932023041,"version":"4.3.4"},"reference-count":57,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2019,6,26]],"date-time":"2019-06-26T00:00:00Z","timestamp":1561507200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Australian Government Research Training Program (RTP) Scholarship"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To compare, in women with infertility, the effectiveness and safety of tubal flushing using oil\u2010based contrast medium, water\u2010based contrast medium or their combination, and no tubal flushing, and to evaluate the effectiveness of tubal flushing on fertility outcome over time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a systematic review and network meta\u2010analysis, searching the electronic databases MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials, and trial registries, up to 25 September 2018. We included randomized controlled trials (RCTs) comparing the following interventions with each other or with no intervention in women with infertility: tubal flushing using water\u2010based contrast medium, tubal flushing using oil\u2010based contrast medium or additional tubal flushing with oil\u2010based medium following diagnostic tubal flushing with water\u2010based medium. The outcomes included clinical pregnancy, live birth, ongoing pregnancy, miscarriage, ectopic pregnancy and adverse events.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 283 studies identified through the search, 14 RCTs reporting on 3852 women with infertility were included. Network meta\u2010analysis showed that tubal flushing using oil\u2010based contrast medium was associated with higher odds of clinical pregnancy within 6\u2009months after randomization and more subsequent live births compared with tubal flushing using water\u2010based medium (odds ratio (OR), 1.67 (95% CI, 1.38\u20132.03), moderate certainty of evidence; and OR, 2.18 (95% CI, 1.30\u20133.65), low certainty of evidence, respectively) and compared with no intervention (OR, 2.28 (95% CI, 1.50\u20133.47), moderate certainty of evidence; and OR, 2.85 (95% CI, 1.41\u20135.74), low certainty of evidence, respectively). These results agreed with those of the pairwise meta\u2010analysis. For clinical pregnancy within 6 months,  there was insufficient evidence of a difference between tubal flushing with water\u2010based contrast medium and no intervention (OR, 1.36 (95% CI, 0.91\u20132.04), low certainty of evidence). For fertility outcomes after 6 months, there was insufficient evidence of a difference in any comparison (low to very low certainty of evidence). Compared with tubal flushing using water\u2010based contrast medium, the use of oil\u2010based contrast medium was associated with higher odds of asymptomatic intravasation (OR, 5.06 (95% CI, 2.29\u201311.18), moderate certainty of evidence).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In women with  infertility  undergoing fertility workup, tubal flushing using oil\u2010based  contrast medium probably increases clinical pregnancy rates within 6\u2009months after randomization and may increase subsequent live\u2010birth rates, compared with tubal flushing using water\u2010based contrast medium and compared with no intervention. Evidence on fertility outcomes beyond 6\u2009months is inadequate to draw firm conclusions. Copyright \u00a9 2019 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.20238","type":"journal-article","created":{"date-parts":[[2019,2,11]],"date-time":"2019-02-11T06:54:12Z","timestamp":1549868052000},"page":"172-181","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":59,"title":["Effectiveness on fertility outcome of tubal flushing with different contrast media: systematic review and network meta\u2010analysis"],"prefix":"10.1002","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6622-8134","authenticated-orcid":false,"given":"R.","family":"Wang","sequence":"first","affiliation":[{"name":"Robinson Research Institute and Adelaide Medical School The University of Adelaide  North Adelaide Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"van Welie","sequence":"additional","affiliation":[{"name":"Department of Reproductive Medicine, Amsterdam UMC Vrije Universiteit Amsterdam  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"van Rijswijk","sequence":"additional","affiliation":[{"name":"Department of Reproductive Medicine, Amsterdam UMC Vrije Universiteit Amsterdam  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. P.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Robinson Research Institute and Adelaide Medical School The University of Adelaide  North Adelaide Australia"},{"name":"Department of Obstetrics and Gynaecology University of Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. J.","family":"Norman","sequence":"additional","affiliation":[{"name":"Robinson Research Institute and Adelaide Medical School The University of Adelaide  North Adelaide Australia"},{"name":"Fertility SA  Adelaide Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Dreyer","sequence":"additional","affiliation":[{"name":"Department of Reproductive Medicine, Amsterdam UMC Vrije Universiteit Amsterdam  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Mijatovic","sequence":"additional","affiliation":[{"name":"Department of Reproductive Medicine, Amsterdam UMC Vrije Universiteit Amsterdam  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. W.","family":"Mol","sequence":"additional","affiliation":[{"name":"Robinson Research Institute and Adelaide Medical School The University of Adelaide  North Adelaide Australia"},{"name":"Department of Obstetrics and Gynaecology, Monash Medical Centre Monash University and Monash Health  Clayton Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,6,26]]},"reference":[{"key":"e_1_2_6_2_1","volume-title":"Fertility problems: assessment and treatment","author":"National Institute for Health and Care Excellence (NICE)","year":"2013"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2015.03.019"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(49)90378-6"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0015-0282(16)30725-7"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1259\/0007-1285-38-448-301"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0015-0282(16)46388-0"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0015-0282(16)55880-4"},{"key":"e_1_2_6_9_1","first-page":"203","article-title":"Morphology of in vitro sperm phagocytosis by rat peritoneal macrophages under influence of oily contrast medium (Lipiodol)","volume":"25","author":"Mikulska D","year":"1994","journal-title":"Acta Eur Fertil"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.183.6.01831725"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.12141"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.1600498"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0015-0282(16)56578-9"},{"key":"e_1_2_6_14_1","first-page":"CD003718","article-title":"Tubal flushing for subfertility","volume":"5","author":"Mohiyiddeen L","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2018.03.021"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14-2385"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-12-9"},{"key":"e_1_2_6_18_1","unstructured":"HigginsJPT GreenS. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. 2011. The Cochrane Collaboration. Available from:www.handbook.cochrane.org."},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0099682"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0076654"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/1536867X1501500402"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1044"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.3767"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1177\/1536867X1501500403"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.03.016"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2005.07.1309"},{"key":"e_1_2_6_27_1","first-page":"6","article-title":"Pregnancy rates after hysterosalpingography with oil\u2010 and water\u2010soluble contrast media","volume":"68","author":"Alper MM","year":"1986","journal-title":"Obstet Gynecol"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/0028-2243(88)90060-3"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1612337"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deh418"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-199012000-00008"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/den485"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.191.2.8153331"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0015-0282(01)02925-9"},{"key":"e_1_2_6_35_1","first-page":"91","article-title":"Therapeutic efficacy of hysterosalpingography (HSG) in infertility, a prospective, randomized, clinical study","volume":"38","author":"Ogata R","year":"1993","journal-title":"Jpn J Fertil Steril"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.179.1.1848716"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.214.1.r00ja2353"},{"key":"e_1_2_6_38_1","first-page":"109","article-title":"Oil\u2010soluble contrast during hysterosalpingography in women with proven tubal patency","volume":"101","author":"Steiner AZ","year":"2003","journal-title":"Obstet Gynecol"},{"key":"e_1_2_6_39_1","first-page":"293","article-title":"The therapeutic effects of oil\u2010soluble hysterosalpingography contrast medium following water\u2010soluble hysterosalpingography contrast medium","volume":"44","author":"Yang KN","year":"1989","journal-title":"Zhonghua Yi Xue Za Zhi (Taipei)"},{"key":"e_1_2_6_40_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.179.1.1848715"},{"key":"e_1_2_6_41_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dem275"},{"key":"e_1_2_6_42_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deu024"},{"key":"e_1_2_6_43_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12905-018-0556-6"},{"key":"e_1_2_6_44_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/der046"},{"key":"e_1_2_6_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2018.05.001"},{"key":"e_1_2_6_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0015-0282(16)45133-2"},{"key":"e_1_2_6_47_1","doi-asserted-by":"publisher","DOI":"10.4103\/2156-7514.124105"},{"key":"e_1_2_6_48_1","first-page":"309","article-title":"Intravasation during hysterosalpingography using oil\u2010base contrast medium\u00a0\u2013\u00a0a second look","volume":"70","author":"Nunley WC","year":"1987","journal-title":"Obstet Gynecol"},{"key":"e_1_2_6_49_1","doi-asserted-by":"publisher","DOI":"10.1002\/jum.14594"},{"key":"e_1_2_6_50_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006254-196704000-00028"},{"key":"e_1_2_6_51_1","doi-asserted-by":"publisher","DOI":"10.1159\/000439381"},{"key":"e_1_2_6_52_1","doi-asserted-by":"publisher","DOI":"10.1080\/09513590.2017.1307960"},{"key":"e_1_2_6_53_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004424-199509000-00005"},{"key":"e_1_2_6_54_1","doi-asserted-by":"publisher","DOI":"10.1080\/09513590802246364"},{"key":"e_1_2_6_55_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/den003"},{"key":"e_1_2_6_56_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-009897"},{"key":"e_1_2_6_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rbmo.2018.11.005"},{"key":"e_1_2_6_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2018.07.128"}],"updated-by":[{"DOI":"10.1002\/uog.21879","type":"erratum","label":"Erratum","source":"publisher","updated":{"date-parts":[[2019,11,5]],"date-time":"2019-11-05T00:00:00Z","timestamp":1572912000000}}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fuog.20238","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.20238","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/uog.20238","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.20238","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T11:25:49Z","timestamp":1693826749000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.20238"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,26]]},"references-count":57,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2019,8]]}},"alternative-id":["10.1002\/uog.20238"],"URL":"https:\/\/doi.org\/10.1002\/uog.20238","archive":["Portico"],"relation":{"erratum":[{"id-type":"doi","id":"10.1002\/uog.21879","asserted-by":"object"}]},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6,26]]},"assertion":[{"value":"2018-11-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-02-06","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-06-26","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}