Abstract

PIP: To determine whether hysterosalpingography (HSG) increases the conception rate and to compare the therapeutic effectiveness of oil and water soluble contrast media, the histories of 744 women who attended the Yale Infertility Clinic in 1965-69 were reviewed. Exclusion of women who had been infertile less than 1 year before coming to the clinic, in whom a HSG was done outside the clinic, and in whom there was no follow-up resulted in a study population of 460. The pregnancy rate for the study group (49%) was identical to that for the larger population. The study group was divided into women who became pregnant during their clinic attendance or within 1 year of terminating clinic care and women who did not become pregnant in this period. These 2 categories were then subdivided according to whether a HSG was done. To determine the relative effectiveness of different media, the conception rate following HSG in the Yale Clinic, where the iodized oil Ethiodol was used, was compared with that among 63 women who had HSG done by a private practitioner with the water soluble dye Salpix. 221 women were in the Ethiodol HSG group, 121 (55%) of whom conceived. Of the 239 Yale Clinic patients who did not have HSG, 103 (43%) became pregnant. Exclusion of couples with organic factors that could account for infertility resulted in a pregnancy rate of 58% for the HSG group and 47% for the non-HSG group. 25 (40%) of the 63 women in the Salpix group conceived, but exclusion of couples with organic factors lowered the pregnancy rate to 38% in this group. The average length of infertility was 0.5 years longer in the non-HSG group than in the Ethiodol HSG group, but shorter in the Salpix HSG group compared to the Ethiodol group. These results suggest that Ethiodol HSG may enhance fertility. Although the oil media has been criticized on the basis that it may cause granuloma formation or embolization, documented complications in the Yale series were rare. In contrast to earlier studies, unilateral nonpatency on x-ray was not found to affect eventual conception (58% pregnancy rate among women in the Ethiodol HSG group with normal tubes compared with 50% in those with filling of only 1 tube).