1
|
Kamphuis D, Rosielle K, van Welie N, Roest I, van Dongen AJCM, Brinkhuis EA, Bourdrez P, Mozes A, Verhoeve HR, van der Ham DP, Vrouenraets FPJM, Risseeuw JJ, van de Laar T, Janse F, den Hartog JE, de Hundt M, Hooker AB, Huppelschoten AG, Pieterse QD, Bongers MY, Stoker J, Koks CAM, Lambalk CB, Hemingway A, Li W, Mol BWJ, Dreyer K, Mijatovic V. The effectiveness of immediate versus delayed tubal flushing with oil-based contrast in women with unexplained infertility (H2Oil-timing study): study protocol of a randomized controlled trial. BMC Womens Health 2023; 23:233. [PMID: 37149639 PMCID: PMC10164300 DOI: 10.1186/s12905-023-02385-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/21/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND In women with unexplained infertility, tubal flushing with oil-based contrast during hysterosalpingography leads to significantly more live births as compared to tubal flushing with water-based contrast during hysterosalpingography. However, it is unknown whether incorporating tubal flushing with oil-based contrast in the initial fertility work-up results to a reduced time to conception leading to live birth when compared to delayed tubal flushing that is performed six months after the initial fertility work-up. We also aim to evaluate the effectiveness of tubal flushing with oil-based contrast during hysterosalpingography versus no tubal flushing in the first six months of the study. METHODS This study will be an investigator-initiated, open-label, international, multicenter, randomized controlled trial with a planned economic analysis alongside the study. Infertile women between 18 and 39 years of age, who have an ovulatory cycle, who are at low risk for tubal pathology and have been advised expectant management for at least six months (based on the Hunault prediction score) will be included in this study. Eligible women will be randomly allocated (1:1) to immediate tubal flushing (intervention) versus delayed tubal flushing (control group) by using web-based block randomization stratified per study center. The primary outcome is time to conception leading to live birth with conception within twelve months after randomization. We assess the cumulative conception rate at six and twelve months as two co-primary outcomes. Secondary outcomes include ongoing pregnancy rate, live birth rate, miscarriage rate, ectopic pregnancy rate, number of complications, procedural pain score and cost-effectiveness. To demonstrate or refute a shorter time to pregnancy of three months with a power of 90%, a sample size of 554 women is calculated. DISCUSSION The H2Oil-timing study will provide insight into whether tubal flushing with oil-based contrast during hysterosalpingography should be incorporated in the initial fertility work-up in women with unexplained infertility as a therapeutic procedure. If this multicenter RCT shows that tubal flushing with oil-based contrast incorporated in the initial fertility work-up reduces time to conception and is a cost-effective strategy, the results may lead to adjustments of (inter)national guidelines and change clinical practice. TRIAL REGISTRATION NUMBER The study was retrospectively registered in International Clinical Trials Registry Platform (Main ID: EUCTR2018-004153-24-NL).
Collapse
Affiliation(s)
- D Kamphuis
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV, Amsterdam, 1081 HV, The Netherlands.
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
| | - K Rosielle
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV, Amsterdam, 1081 HV, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - N van Welie
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV, Amsterdam, 1081 HV, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, OLVG, Amsterdam, 1091 AC, The Netherlands
| | - I Roest
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV, Amsterdam, 1081 HV, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Máxima Medisch Centrum, Veldhoven, Eindhoven, 4600 DB, The Netherlands
- Grow research school for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, Maastricht, 6229 ER, The Netherlands
| | - A J C M van Dongen
- Department of Obstetrics and Gynaecology, Ziekenhuis Gelderse Vallei, Ede, 6716 RP, The Netherlands
| | - E A Brinkhuis
- Department of Obstetrics and Gynaecology, Meander Medisch Centrum, Amersfoort, 3813 TZ, The Netherlands
| | - P Bourdrez
- Department of Obstetrics and Gynaecology, VieCuri Medisch Centrum, Venlo, 5912 BL, The Netherlands
| | - A Mozes
- Department of Obstetrics and Gynaecology, Ziekenhuis Amstelland, Amstelveen, 1186 AM, The Netherlands
| | - H R Verhoeve
- Department of Obstetrics and Gynaecology, OLVG, Amsterdam, 1091 AC, The Netherlands
| | - D P van der Ham
- Department of Obstetrics and Gynaecology, Martini Ziekenhuis, Groningen, 9728 NT, The Netherlands
| | - F P J M Vrouenraets
- Department of Obstetrics and Gynaecology, Zuyderland Medisch Centrum, Heerlen, 6419 PC, The Netherlands
| | - J J Risseeuw
- Department of Obstetrics and Gynaecology, St. Jansdal Ziekenhuis, Harderwijk, 3844 DG, The Netherlands
| | - T van de Laar
- Department of Obstetrics and Gynaecology, Elkerliek Ziekenhuis, Helmond, 5707 HA, The Netherlands
| | - F Janse
- Department of Obstetrics and Gynaecology, Rijnstate Ziekenhuis, Arnhem, 6815 AD, The Netherlands
| | - J E den Hartog
- Department of Obstetrics and Gynaecology, Maastricht Universitair Medisch Centrum +, Maastricht, 6229 HX, The Netherlands
| | - M de Hundt
- Department of Obstetrics and Gynaecology, Noordwest Ziekenhuisgroep, Alkmaar, 1815 JD, The Netherlands
| | - A B Hooker
- Department of Obstetrics and Gynaecology, Zaans Medisch Centrum, Zaandam, 1502 DV, The Netherlands
| | - A G Huppelschoten
- Department of Obstetrics and Gynaecology, Catharina Ziekenhuis, Eindhoven, 5623 EJ, The Netherlands
| | - Q D Pieterse
- Department of Obstetrics and Gynaecology, Haga Ziekenhuis, Den Haag, 2545 AA, The Netherlands
| | - M Y Bongers
- Department of Obstetrics and Gynaecology, Máxima Medisch Centrum, Veldhoven, Eindhoven, 4600 DB, The Netherlands
- Grow research school for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, Maastricht, 6229 ER, The Netherlands
| | - J Stoker
- Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands
| | - C A M Koks
- Department of Obstetrics and Gynaecology, Máxima Medisch Centrum, Veldhoven, Eindhoven, 4600 DB, The Netherlands
| | - C B Lambalk
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV, Amsterdam, 1081 HV, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - A Hemingway
- Department of Radiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, W12 0HS, England
| | - W Li
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, 3168, Australia
| | - B W J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, 3168, Australia
- Aberdeen Centre for Women's Health Research, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - K Dreyer
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV, Amsterdam, 1081 HV, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - V Mijatovic
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV, Amsterdam, 1081 HV, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| |
Collapse
|
2
|
Kayiira A, Zaake D, Lwetabe MW, Sekweyama P. Impact of genital Chlamydia trachomatis infection on reproductive outcomes among infertile women undergoing tubal flushing: a retrospective cohort at a fertility centre in Uganda. Fertil Res Pract 2020; 5:16. [PMID: 31890236 PMCID: PMC6909488 DOI: 10.1186/s40738-019-0069-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/05/2019] [Indexed: 12/20/2022]
Abstract
Background The impact of current C. trachomatis on clinical pregnancy and live birth rates among women undergoing tubal flushing is largely unknown. This study aimed to investigate whether current female genital C. trachomatis infection affects the chance of achieving a clinical pregnancy and a live birth, among infertile women undergoing tubal flushing, at a fertility centre in Uganda. Methods A retrospective Cohort study at a peri-urban fertility centre. A total of 253 eligible women with tubal factor infertility, who underwent tubal flushing, were enrolled and categorised according to their exposure to current genital C. trachomatis infection. These women were followed up for a period of 12 months, with the primary outcome measure being clinical pregnancy and live birth. Secondary outcome measures included pregnancy loss and procedural related adverse events. Results Exposure to current genital C. trachomatis infection reduced chance of clinical pregnancy (adjusted relative risk 0.42; 95% confidence interval, 0.18–0.96) and a live birth (adjusted relative risk 0.37; 95% confidence interval, 0.14–0.95) after tubal flushing. Women with current C. trachomatis infection had an increased risk of adverse events (adjusted relative risk, 1.20; 95% confidence interval, 1.08–1.34). However, current C. trachomatis infection did not affect the risk of spontaneous abortion and ectopic pregnancy. Conclusion Current genital C. trachomatis infection in women with tubal factor infertility, undergoing tubal flushing, lowers their chance of pregnancy and live birth.
Collapse
Affiliation(s)
- Anthony Kayiira
- Life Sure Fertility and Gynaecology centre, St. Francis Hospital Nsambya, postgraduate medical school, Uganda Martyr's University Nkozi, Nsambya, Uganda
| | - Daniel Zaake
- Life Sure Fertility and Gynaecology centre, St. Francis Hospital Nsambya, postgraduate medical school, Uganda Martyr's University Nkozi, Nsambya, Uganda
| | | | - Peter Sekweyama
- Life Sure Fertility and Gynaecology centre, St. Francis Hospital Nsambya, postgraduate medical school, Uganda Martyr's University Nkozi, Nsambya, Uganda
| |
Collapse
|
3
|
Maheux-Lacroix S, Dodin S, Moore L, Bujold E, Lefebvre J, Bergeron MÈ. Preovulatory uterine flushing with saline as a treatment for unexplained infertility: a randomised controlled trial protocol. BMJ Open 2016; 6:e009897. [PMID: 26739737 PMCID: PMC4716241 DOI: 10.1136/bmjopen-2015-009897] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION In vitro fertilisation (IVF) is the treatment of choice for unexplained infertility. Preovulatory uterine flushing could reduce intrauterine debris and inflammatory factors preventing pregnancy and constitute an alternative to IVF. Our objective is to assess the efficacy of preovulatory uterine flushing with physiological saline for the treatment of unexplained infertility. METHODS AND ANALYSIS We will perform a randomised controlled trial based on consecutive women aged between 18 and 37 years consulting for unexplained infertility for at least 1 year. On the day of their luteinising hormone surge, 192 participants will be randomised in two equal groups to either receive 20 mL of physiological saline by an intrauterine catheter or 10 mL of saline intravaginally. We will assess relative risk of live birth (primary outcome), as well as pregnancy (secondary outcome) over one cycle of treatment. We will report the side effects, complications and acceptability of the intervention. ETHICS AND DISSEMINATION This project was approved by the Ethics committee of the Centre Hospitatlier Universitaire de Quebec (no 2015-1146). Uterine flushing is usually well tolerated by women and would constitute a simple, affordable and minimally invasive treatment for unexplained infertility. We plan to communicate the results of the review by presenting research abstracts at conferences and by publishing the results in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT02539290; Pre-results.
Collapse
Affiliation(s)
- Sarah Maheux-Lacroix
- Département d'obstétrique, gynécologie et reproduction, Université Laval, Québec, Canada
- Centre de recherche du CHU de Québec, Québec, Canada
| | - Sylvie Dodin
- Département d'obstétrique, gynécologie et reproduction, Université Laval, Québec, Canada
- Centre de recherche du CHU de Québec, Québec, Canada
| | - Lynne Moore
- Centre de recherche du CHU de Québec, Québec, Canada
| | - Emmanuel Bujold
- Département d'obstétrique, gynécologie et reproduction, Université Laval, Québec, Canada
- Centre de recherche du CHU de Québec, Québec, Canada
| | - Jessica Lefebvre
- Département d'obstétrique, gynécologie et reproduction, Université Laval, Québec, Canada
- Centre de recherche du CHU de Québec, Québec, Canada
| | - Marie-Ève Bergeron
- Département d'obstétrique, gynécologie et reproduction, Université Laval, Québec, Canada
- Centre de recherche du CHU de Québec, Québec, Canada
| |
Collapse
|