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Tubal Flushing — Does It Get You Pregnant?

Tubal Flushing — Does It Get You Pregnant?

Nicole Knight, AHCJ | June 23, 2021 | trying to conceive
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For more than 100 years, doctors have used tubal flushing to check for blocked fallopian tubes. Yet, these days it’s increasingly clear that this tried-and-true diagnostic test may also help women get pregnant (1).

If you’ve ever wondered — Can tubal flushing get me pregnant? — read on for the latest evidence on tubal flushing and fertility. We’ll explain whether using an oil-based or water-based solution in the procedure leads to greater pregnancy success. And we’ll get to the bottom of whether the apparent fertility-enhancing benefits of tubal flushing last for months or years.

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What is tubal flushing?

Hysterosalpingogram (HSG) is the official name for tubal flushing. The outpatient procedure may be done as part of a fertility workup for women who are having difficulty becoming pregnant (2).  

Normally, the ovaries produce eggs that travel through the fallopian tubes to reach the uterus. HSG is an x-ray procedure to see whether the tubes are clear or not. In most cases, doctors recommend HSG to evaluate “tubal patency.” In doctor-speak, “patent” tubes are open ones  (2).

Tubal issues account for 25-35% of female factor infertility. Sometimes the fallopian tubes are seriously damaged or completely blocked because of a past infection, previous surgery, or advanced endometriosis. In other cases, however, tubes may be partially blocked by small cobweb-like adhesions, cellular debris, or mucus. These are typically the cases (often where infertility is otherwise unexplained) where tubal flushing may help (2, 3).

Still, some experts consider it controversial to perform tubal flushing for fertility purposes. But the latest, high-quality research suggests doing so may increase pregnancy rates. And now the American Society for Reproductive Medicine, a leading fertility organization, is acknowledging the potential fertility benefits of tubal flushing, per the group’s 2021 committee opinion (1,3) .

 

What happens during tubal flushing?

Tubal flushing is brief, usually taking around 5 minutes. It’s performed with an x-ray device called a fluoroscope that takes images of your reproductive organs. The procedure is typically done after your period is over, but before ovulation (2).

You start by resting on an x-ray table, generally flat on your back. Similar to getting a Pap test, your provider uses a speculum to access your vagina, then inserts a small tube into the opening of your uterus and injects a contrast solution (2). 

Two kinds of solution are used in tubal flushing, either water-soluble or oil-soluble. The solution creates a contrast that appears as white on the x-ray screen. It shows the contour of the uterus as the fluid travels into the uterus and through the fallopian tubes (2). 

During diagnostic HSG, your provider looks for abnormalities. As the fluid enters the tubes, it outlines the length of the tubes and spills out at the end if they’re open (2). 

The procedure may cause brief cramping and light spotting. You can usually get back to all of your usual activities afterward, but you may be asked to put sex on hold for a few days (2).

Overall, tubal flushing is considered very safe. Complications, like a pelvic infection, occur less than 1% of the time. However, the procedure might not be right for you if you’re allergic to iodine, intravenous contrast dyes, or seafood (2).

Is tubal flushing with oil better than with water?

In recent years, research has found tubal flushing may increase pregnancy rates when compared to doing nothing, but the evidence hasn’t always been rock solid. For example, one review reported that the evidence for the effectiveness of the water-based method was just a single, low-quality paper (4).

Now, however, we have high-quality evidence from the large-scale “H2Oil study” published in the New England Journal of Medicine. It suggests oil-based flushing, rather than water-based flushing, helps “infertile” women to get pregnant more quickly (1). 

Researchers randomly assigned 1,199 women in the Netherlands into two groups — one group had tubal flushing with water-based fluid and the other with an oil-based solution. The women, all under age 39, had unexplained infertility and had been trying to conceive for at least a year (1).

Six months later, researchers found higher pregnancy and delivery rates in the oil group than in the water group. A total of 220 of 554 women in the oil group (39.7%) and 161 of 554 women in the water group (29.1%) conceived after the procedure. Additionally, 38% of women in the oil group went on to have a live birth compared with 28% in the other group (1).

The oil-based group also conceived a bit more quickly — a median of 2.7 months compared to 3.1 months in the water group (1).

How does tubal flushing increase fertility?

It’s not entirely clear why the procedure may boost fertility, but some scientists think the oil solution might wash away mucus plugs and cellular debris that could interfere with the egg's journey through the fallopian tubes. Other experts suggest that flushing helps to supercharge the tiny hairlike cilia in the tubes to aid in egg transport (1, 5).

As a study by Oxford University recently pointed out, oil-based flushing fluid is made from poppy seed oil, which contains opium alkaloids. Recent research shows that receptors for these opioids are expressed in cells in the uterine lining during the menstrual cycle and appear to peak around the time of implantation. This suggests the receptors play a role in implantation, which may help explain the increase in pregnancy rates after flushing with oil-based fluid (5).

How long does tubal flushing last?

It’s unclear how long the possible fertility-enhancing effects of tubal flushing may last. A top fertility organization says 3 months after the procedure, some studies say 6 months, but one recent paper suggests the effects may persist for up to 5 years (3, 6). 

The paper, published in Fertility and Sterility, tracked “infertile” women for 5 years after their tubal flushing procedure. It found 80% of women in the oil group and 75% of women in the water group had gone on to conceive. Additionally, 74.8% of women in the oil group and 67.3% of women in the water group had live births during the study period (6).

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Will tubal flushing work for me?

HSG may work for some women with unexplained infertility, but probably not everyone. Certain women were excluded from the largest study to date, such as those with polycystic ovary syndrome, diabetes, high prolactin levels, endometriosis, and hyperthyroidism. So, unfortunately, we don’t know about the effectiveness of the procedure

 under those conditions (1).

Hopefully, future research will be more inclusive to help us to better understand who may benefit from tubal flushing. In the meantime, you may wish to discuss tubal flushing with your provider as part of a larger conversation about
fertility alternatives for you and your partner.

References +
How Not to Waste Another Month When Trying to Conceive
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