The aim of this study is to determine whether direct tubal flushing with oil-based contrast at HSG incorporated in the fertility work-up results in 10% more ongoing pregnancies and a shorter time to pregnancy, which will therefore be effective and cost-effective compared to delayed tubal flushing 6 months after fertility work-up is completed in women at low risk for tubal pathology.
Rationale: The investigators hypothesize that direct tubal flushing with oil-based contrast at HSG incorporated in the fertility work-up results in 10% more ongoing pregnancies and a shorter time to pregnancy compared to delayed tubal flushing 6 months after fertility work-up is completed in women at low risk for tubal pathology, which will lead to a reduction in the need for expensive fertility treatments like IVF and/or ICSI, and will therefore be an effective and cost effective strategy. Objective: The aim of this study is to determine whether direct tubal flushing with oil-based contrast at HSG incorporated in the fertility work-up results in 10% more ongoing pregnancies and a shorter time to pregnancy, which will therefore be effective and cost-effective compared to delayed tubal flushing 6 months after fertility work-up is completed in women at low risk for tubal pathology. Study design: The investigators plan a multicentre randomized controlled trial with an economic analysis alongside it. Infertile women at low risk for tubal pathology will be randomized to direct tubal flushing with oil-based contrast incorporated in the fertility work-up or delayed tubal flushing 6 months after fertility work-up is completed. Study population: Infertile women 18-38 years of age, who have a spontaneous menstrual cycle and at low risk for tubal pathology, undergoing fertility work-up. Intervention (if applicable): Direct tubal flushing with oil-based contrast at HSG as part of the fertility work-up compared to delayed tubal flushing 6 months after the fertility work-up is completed. Main study parameters/endpoints: The primary outcome is time to live birth, calculated from positive pregnancy test and within 12 months after randomization. Our hypothesis is that tubal flushing at HSG with oil-based contrast incorporated in the fertility work-up will result in 10% more ongoing pregnancies and a shorter time to pregnancy, and thus reducing the need for ART and reducing costs. Nature and extent of the burden and risks associated with participation, benefit and group relatedness: As two strategies are compared (tubal flushing with oil-based contrast at HSG incorporated in the fertility work-up versus 6 months after completion of fertility work-up) that are already applied in current practice, no additional risks or burdens are expected from the study.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
554
The investigational product is an oil-based contrast medium, Lipiodol® (Guerbet). Lipiodol® is a solution of ethyl esters of iodized fatty acids of poppy seed oil equivalent to 480mg I /ml and is a licensed contrast agent in the Netherlands (RVG 02806, see SmPC D2). The maximum amount of Lipiodol® per HSG procedure is 15 ml.
Amsterdam AMC
Amsterdam, Netherlands
RECRUITINGTime to live birth
Calculated from the last menstrual bleeding within 6 months after randomization
Time frame: 6 months
Time to live birth
Calculated from the last menstrual bleeding within 12 months after randomization
Time frame: 12 months
Number of live births
Defined as the birth of a live born baby, after 24 weeks gestation
Time frame: 6 months
Number of live births
Defined as the birth of a live born baby, after 24 weeks gestation
Time frame: 12 months
Number of ongoing pregnancies
Defined as the presence of a heart beat at 10 to 12 weeks gestation
Time frame: 6 and 12 months
Number of ongoing pregnancies
Defined as the presence of a heart beat at 10 to 12 weeks gestation
Time frame: 6 months
Number of clinical pregnancies
Defined as gestational sac detected on ultrasonography
Time frame: 12 months
Number of miscarriages
Presence of non-vitality on ultrasound or spontaneous loss of pregnancy
Time frame: 6 months
Number of miscarriages
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Presence of non-vitality on ultrasound or spontaneous loss of pregnancy
Time frame: 12 months
Number of ectopic pregnancies
Embryo implanted outside the uterine cavity
Time frame: 6 months
Number of ectopic pregnancies
Embryo implanted outside the uterine cavity
Time frame: 12 months
Number of multiple pregnancies
Pregnancy of two or more foetuses
Time frame: 6 months
Number of multiple pregnancies
Pregnancy of two or more foetuses
Time frame: 12 months
Number of complication after HSG
e.g. intravasation or infection
Time frame: One month after HSG
Number of pregnancy complications
e.g. pre-term birth, hypertension
Time frame: 6 months
Number of pregnancy complications
e.g. pre-term birth, hypertension
Time frame: 12 months
Number of still births
Death or loss of the baby before or during
Time frame: 12 months
Number of still births
Death or loss of the baby before or during
Time frame: 6 months
Incidence of thyroid dysfunction after HSG
TSH and fT4 measurement (blood test)
Time frame: One month after HSG
Number of cycles of artificial reproductive techniques
Number of cycles of IUI and IVF/ICSI
Time frame: 6 and 12 months
Number of cycles of artificial reproductive techniques
Number of cycles of IUI and IVF/ICSI
Time frame: 6 months
Number of cycles of artificial reproductive techniques
Number of cycles of IUI and IVF/ICSI
Time frame: 12 months
Neonatal thyroid dysfunction
Screening on congenital thyroid dysfunction postpartum
Time frame: Within one week after birth