提示: 手机请竖屏浏览!

不孕症妇女接受油性或水溶性造影剂子宫输卵管造影术的研究
Oil-Based or Water-Based Contrast for Hysterosalpingography in Infertile Women


Kim Dreyer ... 其他 • 2017.05.25
相关阅读
• 油性造影剂、水溶性造影剂和不孕:子宫输卵管造影术中哪种造影剂更好

摘要


背景

据报道,不孕症妇女在子宫输卵管造影术后妊娠率可以提高;但是,所用造影剂的类型(油性或水溶性造影剂)是否影响这种潜在的治疗效果尚不清楚。

 

方法

我们在荷兰的27家医院实施了一项多中心、随机临床试验;在试验中,正在实施子宫输卵管造影术的不孕症妇女被随机分组,使用油性或水溶性造影剂完成此项操作。随后,夫妻双方接受期待疗法,或者妇女接受宫内人工授精。主要结局是随机化后6个月内的持续妊娠。我们根据意向性治疗原则对结局进行分析。

 

结果

共有1,119名妇女接受了随机分组,分别接受油性造影剂(557名妇女)或水溶性造影剂(562名妇女)子宫输卵管造影术。在油性造影剂组的554名妇女中,共有220名(39.7%)妇女持续妊娠;在水溶性造影剂组554名妇女中,共有161名妇女(29.1%)持续妊娠(率比,1.37;95%置信区间[CI],1.16~1.61;P<0.001)。在油性造影剂组552名妇女中,有214人活产(38.8%);而在水溶性造影剂组552名妇女中,有155名活产(28.1%)(率比,1.38;95% CI,1.17~1.64;P<0.001)。两组的不良事件发生率均较低而且相似。

 

结论

与接受水溶性造影剂子宫输卵管造影术的妇女相比,使用油性造影剂完成该项检查的妇女持续妊娠率和活产率均较高(荷兰临床试验注册号[Netherlands Trial Register],NTR3270)。





作者信息

Kim Dreyer, M.D., Ph.D., Joukje van Rijswijk, M.D., Velja Mijatovic, M.D., Ph.D., Mariëtte Goddijn, M.D., Ph.D., Harold R. Verhoeve, M.D., Ph.D., Ilse A.J. van Rooij, M.D., Ph.D., Annemieke Hoek, M.D., Ph.D., Petra Bourdrez, M.D., Annemiek W. Nap, M.D., Ph.D., Henrike G.M. Rijnsaardt-Lukassen, M.D., Ph.D., Catharina C.M. Timmerman, M.D., Mesrure Kaplan, M.D., Angelo B. Hooker, M.D., Anna P. Gijsen, M.D., Ph.D., Ron van Golde, M.D., Ph.D., Cathelijne F. van Heteren, M.D., Ph.D., Alexander V. Sluijmer, M.D., Ph.D., Jan-Peter de Bruin, M.D., Ph.D., Jesper M.J. Smeenk, M.D., Ph.D., Jacoba A.M. de Boer, M.D., Ph.D., Eduard Scheenjes, M.D., Ph.D., Annette E.J. Duijn, M.D., Alexander Mozes, M.D., Marie J. Pelinck, M.D., Ph.D., Maaike A.F. Traas, M.D., Machiel H.A. van Hooff, M.D., Ph.D., Gijsbertus A. van Unnik, M.D., Cornelia H. de Koning, M.D., Ph.D., Nan van Geloven, Ph.D., Jos W.R. Twisk, Ph.D., Peter G.A. Hompes, M.D., Ph.D., and Ben W.J. Mol, M.D., Ph.D.
From the Department of Reproductive Medicine (K.D., J.R., V.M., P.G.A.H.) and the Department of Epidemiology and Biostatistics (J.W.R.T.), VU University Medical Center, the Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Academic Medical Center (M.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (H.R.V.), and the Department of Obstetrics and Gynecology, Slotervaart Medical Center (A.E.J.D.), Amsterdam, and the Department of Obstetrics and Gynecology, TweeSteden Hospital (I.A.J.R.), and the Department of Obstetrics and Gynecology, Sint Elisabeth Hospital (J.M.J.S.), Tilburg, the Department of Reproductive Medicine and Gynecology, University of Groningen, University Medical Center Groningen, Groningen (A.H.), the Department of Obstetrics and Gynecology, VieCuri Medical Center, Venlo (P.B.), the Department of Obstetrics and Gynecology, Rijnstate Hospital, Arnhem (A.W.N.), the Department of Obstetrics and Gynecology, Albert Schweitzer Hospital, Dordrecht (H.G.M.R.-L.), the Department of Obstetrics and Gynecology, Bravis Hospital, Roosendaal (C.C.M.T.), the Department of Obstetrics and Gynecology, Röpcke-Zweers Hospital, Hardenberg (M.K.), the Department of Obstetrics and Gynecology, Zaans Medical Center, Zaandam (A.B.H.), the Department of Obstetrics and Gynecology, Elkerliek Hospital, Helmond (A.P.G.), the Department of Reproductive Medicine, Maastricht University Medical Center, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Canisius–Wilhelmina Hospital, Nijmegen (C.F.H.), the Department of Obstetrics and Gynecology, Wilhelmina Hospital, Assen (A.V.S.), the Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, Den Bosch (J.-P.B.), the Department of Obstetrics and Gynecology, Westfriesgasthuis, Hoorn (J.A.M.B.), the Department of Obstetrics and Gynecology, Hospital Gelderse Vallei, Ede (E.S.), the Department of Obstetrics and Gynecology, Amstelland Hospital, Amstelveen (A.M.), the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (M.J.P.), the Department of Obstetrics and Gynecology, Gelre Hospital, Apeldoorn (M.A.F.T.), the Department of Obstetrics and Gynecology, Sint Franciscus Hospital, Rotterdam (M.H.A.H.), the Department of Obstetrics and Gynecology, Diaconessenhuis (G.A.U.), and the Department of Medical Statistics and Bioinformatics, Leiden University Medical Center (N.G.), Leiden, and the Department of Obstetrics and Gynecology, Tergooi Hospital, Blaricum (C.H.K.) — all in the Netherlands; and the School of Medicine, Robinson Research Institute, University of Adelaide, and the South Australian Health and Medical Research Institute, Adelaide, SA, Australia (B.W.J.M.). Address reprint requests to Dr. Dreyer at VU University Medical Center, PK 5X, Rm. 194, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands, or at k.dreyer@vumc.nl.

 

参考文献

1. Thoma ME, McLain AC, Louis JF, et al. Prevalence of infertility in the United States as estimated by the current duration approach and a traditional constructed approach. Fertil Steril 2013;99:1324-1331.e1

2. Cundiff G, Carr BR, Marshburn PB. Infertile couples with a normal hysterosalpingogram: reproductive outcome and its relationship to clinical and laparoscopic findings. J Reprod Med 1995;40:19-24

3. Weir WC, Weir DR. Therapeutic value of salpingograms in infertility. Fertil Steril 1951;2:514-522

4. Johnson NP, Farquhar CM, Hadden WE, Suckling J, Yu Y, Sadler L. The FLUSH trial — flushing with lipiodol for unexplained (and endometriosis-related) subfertility by hysterosalpingography: a randomized trial. Hum Reprod 2004;19:2043-2051

5. Nugent D, Watson AJ, Killick SR, Balen AH, Rutherford AJ. A randomized controlled trial of tubal flushing with lipiodol for unexplained infertility. Fertil Steril 2002;77:173-175

6. Ogata R, Nakamura G, Uchiumi Y, et al. Therapeutic efficacy of hysterosalpingography (HSG) in infertility: a prospective, randomized, clinical study. Jap J Fertil Steril 1993;38:91-94

7. Mohiyiddeen L, Hardiman A, Fitzgerald C, et al. Tubal flushing for subfertility. Cochrane Database Syst Rev 2015;5:CD003718-CD003718

8. Alper MM, Garner PR, Spence JE, Quarrington AM. Pregnancy rates after hysterosalpingography with oil- and water-soluble contrast media. Obstet Gynecol 1986;68:6-9

9. de Boer AD, Vemer HM, Willemsen WN, Sanders FB. Oil or aqueous contrast media for hysterosalpingography: a prospective, randomized, clinical study. Eur J Obstet Gynecol Reprod Biol 1988;28:65-68

10. Lindequist S, Rasmussen F, Larsen C. Use of iotrolan versus ethiodized poppy-seed oil in hysterosalpingography. Radiology 1994;191:513-517

11. Rasmussen F, Lindequist S, Larsen C, Justesen P. Therapeutic effect of hysterosalpingography: oil- versus water-soluble contrast media — a randomized prospective study. Radiology 1991;179:75-78

12. Spring DB, Barkan HE, Pruyn SC. Potential therapeutic effects of contrast materials in hysterosalpingography: a prospective randomized clinical trial. Radiology 2000;214:53-57

13. National guideline for the fertility work-up: Dutch guidelines for obstetrics and gynaecology. Utrecht, the Netherlands: Dutch Society of Obstetrics and Gynaecology, 2004 (http://www.med-info.nl/Richtlijnen/Gynecologie/Voortplantingsgeneeskunde/Orienterend%20Fertiliteitsonderzoek%20(OFO).pdf).

14. Hunault CC, Habbema JD, Eijkemans MJ, Collins JA, Evers JL, te Velde ER. Two new prediction rules for spontaneous pregnancy leading to live birth among subfertile couples, based on the synthesis of three previous models. Hum Reprod 2004;19:2019-2026

15. van der Steeg JW, Steures P, Eijkemans MJ, et al. Pregnancy is predictable: a large-scale prospective external validation of the prediction of spontaneous pregnancy in subfertile couples. Hum Reprod 2007;22:536-542

16. Johnson JV, Montoya IA, Olive DL. Ethiodol oil contrast medium inhibits macrophage phagocytosis and adherence by altering membrane electronegativity and microviscosity. Fertil Steril 1992;58:511-517

17. Johnson NP. Review of lipiodol treatment for infertility — an innovative treatment for endometriosis-related infertility? Aust N Z J Obstet Gynaecol 2014;54:9-12

18. Uzun O, Findik S, Danaci M, Katar D, Erkan L. Pulmonary and cerebral oil embolism after hysterosalpingography with oil soluble contrast medium. Respirology 2004;9:134-136

19. Court KA, Dare AJ, Weston-Webb M, Hadden WE, Sim RG, Johnson NP. Establishment of lipiodol as a fertility treatment — prospective study of the complete innovative treatment data set. Aust N Z J Obstet Gynaecol 2014;54:13-19

20. Dijkman AB, Mol BW, van der Veen F, Bossuyt PM, Hogerzeil HV. Can hysterosalpingocontrast-sonography replace hysterosalpingography in the assessment of tubal subfertility? Eur J Radiol 2000;35:44-48

21. Emanuel MH, van Vliet M, Weber M, Exalto N. First experiences with hysterosalpingo-foam sonography (HyFoSy) for office tubal patency testing. Hum Reprod 2012;27:114-117

服务条款 | 隐私政策 | 联系我们