The use of oil‐soluble contrast media for tubal flushing in infertility: A consensus statement from ACCEPT (Australasian CREI Consensus Expert Panel on Trial evidence)

Abstract

Good evidence that oil-soluble contrast media (OSCM) enhances pregnancy rates when used to assess fallopian tube patency by hysterosalpingogram has prompted rapid clinical uptake by some fertility doctors and imaging specialists in Australia and New Zealand. The ACCEPT group met in July 2019 to develop a consensus document outlining the indications for and safe use of OSCM, to inform and guide clinicians interested in offering procedures using this media to couples with infertility.

Lipiodol flushing under ultrasound guidance at time of hystero‐salpingo contrast sonography (HyCoSy): A retrospective observational study

“…The Australasian Certificate of Reproductive Endocrinology Consensus Expert Panel on Trial Evidence group has found there is good‐quality evidence to support the use of OBCM for diagnostic and therapeutic purposes in couples who have unexplained fertility 9 . In a carefully selected cohort with proven tubal patency, our experience is that Lipiodol flushing under ultrasound is possible and may be an efficacious and acceptable method of assessing and possibly enhancing fertility when performed alongside HyCoSy.…”

“…is good-quality evidence to support the use of OBCM for diagnostic and therapeutic purposes in couples who have unexplained fertility. 9 In a carefully selected cohort with proven tubal patency, our experience is that Lipiodol flushing under ultrasound is possible and may be an efficacious and acceptable method of assessing and possibly enhancing fertility when performed alongside HyCoSy. Lipiodol also appears to be as visible as agitated saline in vivo under ultrasound visualisation.…”

“…7,8 A number of factors have led to the universal use of WBCM with HyCoSy, including the limited access and higher costs associated with OBCM, as well as the complications attributable to OBCM such as thyroid dysfunction, contrast extravasation leading to allergic reaction, pulmonary or cerebral embolus, chronic lipogranuloma formation, and death. 9,10 Systematic reviews have demonstrated that tubal flushing with OBCM is associated with increased pregnancy rates, particularly within six months postprocedure. [11][12][13] Lipiodol (ethiodised oil) is an OBCM made from a form of poppyseed oil that contains iodine.…”

Assessment of contrast intravasation in patients investigated by fluoroscopic hysterosalpingograms: A two‐year retrospective audit in Western Australia

“…In recent years, there has been a notable shift towards utilising OSCMs due to increasing research demonstrating their fertility-enhancing benefits in both spontaneous and artificially induced pregnancies. [5][6][7][8][9][20][21][22][23][24][25][26] In 2017, a multi-centre randomised controlled trial comparing OSCM against WSCM 20 found significant benefit in ongoing pregnancy rates with OSCM, later supported by similar studies. 23,24 (Ongoing pregnancy is defined as a positive foetal heartbeat on ultrasound after 12 weeks of gestation.…”

“…1 In recent years, there has been a well-documented association with increased pregnancy rates following HSGs. [5][6][7][8][9]…”