Tubal flushing for subfertility

摘要: Background Establishing the subgroup analysis of fallopian tubes (tubes) is a commonly undertaken diagnostic investigation for women with subfertility. This usually achieved by flushing contrast medium through and visualising patency on radiographs, ultrasonography or laparoscopy. Many were noted to conceive in first three six months after tubal flushing, raising possibility that could also be treatment infertility. There has been debate about which should used (water-soluble oil-soluble media) as this may influence pregnancy rates. An important adverse event during intravasation (backflow into blood lymphatic vessels),which lead embolism although it asymptomatic most cases. Objectives To evaluate effectiveness safety media (OSCM) water-soluble (WSCM) subsequent fertility outcomes Search methods We searched Cochrane Gynaecology Fertility Group Specialised Register controlled trials, MEDLINE, Embase, CENTRAL, PsycINFO, reference lists identified articles trial registries. The recent search was conducted April 2020. Selection criteria Randomised trials (RCTs) comparing OSCM, WSCM each other no treatment, Data collection Two review authors independently selected assessed risk bias extracted data. contacted study additional information. overall quality evidence using GRADE methods. Main results Fifteen involving 3864 included systematic review. Overall, varied from very low moderate: main limitations bias, heterogeneity imprecision. OSCM versus Four studies (506 women) comparison. Tubal increase odds live birth (odds ratio (OR) 3.27, 95% confidence interval (CI) 1.57 6.85, 3 RCTs, 204 women, I2 = 0, low-quality evidence). suggests if chance following assumed 11%, would between 16% 46%. clinical (OR 3.54, CI 2.08 6.02, 4 506 18%, 9%, 17% 37%. No measured events such infection, haemorrhage congenital abnormalities. Only one (334 are uncertain whether compared 1.13, 0.67 1.91, 1 RCT, 334 21%, 15% 33%. increases 1.14, 0.71 1.84, 27%, 29% 40%. One case pelvic infection reported group women). Meta-analysis not performed due rare events. Six (2598 Three birth, including two higher 1.64, 1.27 2.11, 1119 women; OR 3.45, 1.97 6.03, 398 women); insufficient difference groups 0.92, 0.60 1.40, 533 Given substantial observed (I2 86%), meta-analysis performed. probably increased (asymptomatic) 5.00, 2.25 11.12, 1912 moderate-quality 1%, 2% 9%. 1.42, 1.10 1.85, 6 2598 41%, 26%, 28% 39%. decreases 0.22, 0.04 1.22, 2 662 evidence) 0.65, 0.40 1.06, neonates abnormalities while abnormality (1119 Authors' conclusions pregnancy, improves those outcomes. Compared WSCM, improve impossible heterogeneity. Evidence associated an intravasation. events, especially long-term poorly across studies.