Tubal flushing: might it help you get pregnant?

Women having difficulty become pregnant may be invited to have their ‘tubes flushed’, a procedure which uses dye to show whether the fallopian tubes are blocked. It has been reported that women are more likely to become pregnant after this test, but no one knows why.

A Cochrane review has been updated with the best available evidence on tubal flushing and its effect on pregnancy and live birth rates. I asked obstetrician and gynaecologist Dr James Duffy to explain what the procedure, properly known as a hysterosalpingogram, involves:

“Hysterosalpingogram (HSG) is pronounced ‘he-ster-o-sal-ping-o-gram’, but fortunately most doctors call it HSG.  It is a common part of a work up for women having difficulty become pregnant. Normally eggs produced by the ovaries pass down fine, narrow tubes called fallopian tubes to reach the womb. A HSG can determine if these tubes are open or blocked. If either or both of these tubes are blocked then the chances of becoming pregnant are much reduced.

Patients will lie on an x-ray table, generally flat on their back. The procedure will start in the same way as a smear examination.  The doctor places a small tube called a catheter through the neck of the womb to inject dye.

Two kinds of dye are available: dyes which can be dissolved in water (water soluble) and dyes which cannot be easily dissolved in water (oil soluble). Commonly in the United Kingdom and United States doctors use a water soluble dye for HSG.”

If one sort of dye is better than another, this would be helpful to know. It’s also important to ask what evidence there is that tubal flushing improves pregnancy rates and live birth rates and whether this intervention is associated with any harms (adverse events), such as miscarriage.

The evidence for tubal flushing

 The evidence comes from 13 randomized controlled trials with 2494 women, brought together in the Cochrane review. The trials compared oil-soluble contrast media (OSCM) and water-soluble contrast media (WSCM) with each other and with no intervention. Here’s what the reviewers found:

  • Women having OSCM tubal flushing had a higher rate of pregnancy and live birth than women who had no intervention. The evidence suggests that for subfertile women the chance of an ongoing pregnancy will be increased from 17% without intervention to between 29% and 55% if they have tubal flushing with OSCM
  • There was no evidence of a difference in rates of ongoing pregnancy or live birth between women who had WSCM tubal flushing and no intervention, or between OSCM and WBCM when compared with each other, but there was little data available
  • There was no evidence of a difference between any of the interventions in the rates of adverse events but these were very poorly reported
boy counts

Only 4 of 13 studies reported live birth rates

How good is the evidence?

Whilst this is the best we have, there were problems with the studies and the quality of the evidence is low, so the reviewers were not able to draw conclusions with confidence. What we have so far suggests that tubal flushing with oil-soluble contrast media may improve the chance of pregnancy and live birth, compared with doing nothing, but we can’t be at all sure. Only four out of the 13 studies reported live birth rates, although this is a crucial measure of the success of fertility treatments. We don’t know which women are most likely to benefit. We also remain uncertain about possible risks of this procedure and these need to be fully evaluated in future research.

What next?

The reviewers say “tubal flushing with oily media such as lipiodol could represent a simple, less invasive and cost-effective alternative to other modalities of treatment for couples where the woman has normal patent fallopian tubes. Moreover, it is less likely than other options to increase the risk of multiple pregnancy.” Surely worth exploring further in well-designed trials comparing flushing with OSCM and WSCM and reporting live birth rates.

Katie’s story

“In 2007 my husband I decided that after several years of trying for a baby, we needed some help. Our lives were on hold as we lived month-to-month hoping to be pregnant and then facing the disappointment that we weren’t.

After a referral from the doctor our consultant took it all seriously, made us feel important and referred me on to have a laparoscopy with an HSG, where my tubes would be flushed with liquid to identify any blocks. I bought new pajamas for my day in hospital. This was my first general anesthetic. As I came round, fuzzy and woozy, the doctor came to share the results with my husband and I. I was not awake enough to take it all in. He talked about one tube being blocked. We were told we’d have another appointment with the consultant to talk about what next.

woman and baby

Tubal flushing could be “a welcome milestone” for women trying to get pregnant

As we packed up to go a nurse came by to discharge me. She said, “It happens all the time that women get pregnant after getting their tubes flushed. I hope you’ll be pregnant soon.” This was not presented as fact, but an aside based on her years of experience. I took it that she was trying to give some solace after an uncomfortable procedure, not based on any evidence.

The next month, I was pregnant and now I am a mother of two. When we went in for that procedure we had no idea it might be the catalyst that would change everything. It was never presented as an intervention that might help me get pregnant; the focus was on the process and uncovering problems. I think it would be useful for women considering having their tubes flushed to consider that it could help them get pregnant, that it is a procedure that can lead to a happy outcome, a much-desired pregnancy. This would be welcome milestone for a woman who, like me, had been struggling for years with concerns about infertility.

The research states tubal flushing may improve the chance of getting pregnant. In my case it did result in pregnancy and the birth of my baby. I’d welcome more research into this area, so women could head into a tubal flushing procedure with some confidence that it may help them fall pregnant and with less risk of multiple pregnancy than some of the other options.”

Read more about fertility and women’s health here

Other posts

Endometrial scratching: what’s the latest evidence?

Timed intercourse: will it help you conceive?

Will antioxidants help you get pregnant?

Links:

Mohiyiddeen L, Hardiman A, Fitzgerald C, Hughes E, Mol BWJ, Johnson N, Watson A. Tubal flushing for subfertility. Cochrane Database of Systematic Reviews 2015, Issue 5. Art. No.: CD003718. DOI: 10.1002/14651858.CD003718.pub4.

Plain language summary of this review: http://www.cochrane.org/CD003718/MENSTR_tubal-flushing-for-subfertility

 


Sarah Chapman

About Sarah Chapman

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Sarah's work as a Knowledge Broker at Cochrane UK focuses on disseminating Cochrane evidence through social media, including Evidently Cochrane blogs, blogshots and the ‘Evidence for Everyday’ series for nurses, midwives, allied health professionals and patients. A former registered general nurse, Sarah has a particular interest making evidence accessible and useful to practitioners and to others making decisions about health. Before joining Cochrane, Sarah also worked on systematic reviews for the University of Oxford and the Royal College of Nursing Institute, and obtained degrees in History from the University of Oxford and in the history of women’s health and illness in early modern England (MPhil., University of Reading).

46 Comments on this post

  1. Avatar

    Hi
    Am a mother of one but my son is 3yrs now. I have been trying to conceive again for over a year now but all was not working out. I have tried so many drugs like Clomid, conceptio and others but none didn’t work. Now my midwife suggested I do flushing of tube and she said after that I will conceive. Please how sure am I that after this exercise I ‘ll conceive.

    Deboah Obi / Reply
  2. Avatar

    I find this information helpful

    darkoa Asante / Reply
  3. Avatar

    I had my tubes flushed last Nov before that we had 4 Failed IUI and I’m only 27 years old . It’s been 4 months since I had my tubes flushed and do far no lucky in getting pregnant and my pain and period have become worse they said if you don’t get pregnant within 5 months of having your tubes flush were mostly have to do another IUI and if that doesn’t work we are on the ivf lost for 2018 I’m starting to doubt we will ever get pregnant been trying for 3 years now

    Monique / Reply
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      I feel for you. I haven’t been to have my hsg test done yet. It’s scheduled for next month.! But I’ve read so many blogs and stories from other women who are in the same predicument as us. DONT GIVE UP, AND DONT STOP BELIEVING. My husband and I have been trying for 4 years with no luck. I’m praying this hsg test works out in our favor. I hear it’s the tubal flushing that does the trick. Fingers crossed. #Baby dust to us all. #GodIsTheAnswer

      Faye / (in reply to Monique) Reply
    • Avatar

      Putting dye into your tubes won’t help you to get pregnant. The dye just makes it easier for the doc to see (on x-ray) if your tubes are open enough . Sometimes women can’t get pregnant because their tubes are blocked for one reason or another. I assume that you’ve seen the doctor since then to get the results of that dye test . But you’ve got no more chance of falling pregnant now, than you did before. If your doc is talking about putting you on Clomid, that means he thinks you are not ovulating – the Clomid will help you to ovulate. Sorry but the plan of “getting pregnant before being put on Clomid” probably won’t happen, because you are experiencing infertility, and the Clmid is going to help with that.

  4. Avatar

    Try 15 yrs no luck and clock still ticking…and I’m 32 still have hope had two surgerys got stage 2endometeiosis mentally messed up by it all no reason behind it all birth defect

    Angel / Reply
  5. Avatar

    Will be doing mine tomorrow. ..trying to conceive for d past 8 yrs…I just believe it will work for me…also using Clomid and bromergon. ..was diagnosed of pod last year

    spicinoguan / Reply
  6. Avatar

    i had a test done at one clinic and they told me my tubes were block. I went to a different clinic to have the operation to unblock them, as the put the dye in to check where the blockage is they said my tubes are not blocked and I did not need the operation. good news.
    but I am left wondering if the first test unblocked anything that was there or if they did not do it correct.
    I have been trying to het preg. since I lost a baby in Jan 2016 and no joy. so if my tubes were not blocked in the first place why have I not yet preg.
    I am very confused

    katie osborn / Reply
  7. Avatar

    I had hsg in 2015 abd dr said my tubes are both open 2 months later I got pregnant and it was ectopic and during the operation the dr remove 4small fibroid, 4month later I got pregnant again and it was blighted ovum. I went for D&C in December. The following yearb2016 I had 2 iui my body didn’t respond to the treatment in August I did hystoroscopy diagnosis which the dr discover tissues in my uterus which he tried to remove some and after then I had a normal menstrual flow. In December I went for ivf but it failed. Now I want to try iui and dr want me to go for hsg.

    kyels bea / Reply
  8. Avatar

    I had hsg last month, now I don’t know what next coz my tubes were not blocked

    annita / Reply
  9. Avatar

    I will be going for hsg but cant exactly know why d doctor recommended it. My main problem established is pcos so i hav been focussing on it as i hav not been ovulating. Just last week my doctor suggested hsg but after reading about it on dis block my mind is now on puzzle

    maryam mikail usman / Reply
  10. Avatar

    i had a HSG done in September 2017. I have not yet tried to conceive, however will try closer to the end of the month as thats when my ovulation period is. I hope it will work out for me as it is my desire.

    Kade / Reply
    • Avatar

      I pray so for you and wish sane for me as a 40 years old lady and praying to God to bless me with a child after 18 years.

      Yves / (in reply to Kade) Reply
    • Avatar

      We have been trying for 4yrs and nothing. So went for my hsg test 6 days ago. So we are trying to concieve again this month. So many positive stories about this hsg test. Fingers crossed !

      Ricsha / (in reply to Kade) Reply
  11. Avatar

    Im 25 of age and been trying to get pregnant for the last two years. Im scheduled to go in for my hsg next week on the 26 my fingers is crossed and I’m hoping for the better. I’m just ready to start my own lil family

    Lez / Reply
  12. Avatar

    Hi, I have PCOS and got mine flushed and report said they were clear. I fell pregnant after 3 months and have an 18 old boy now. I was trying for three years prior to this.

    Lil Kavz / Reply
  13. Avatar

    I’ve been trying for 22years My son will be 23 years old November my Husband desperately wants kids every Month when my cycle comes on I’m very depressed My left tube is block My doctor said I can still get pregnant with 1 tube but it haven’t happened yet i was diagnosed with fibroids My gynecologist told me it was unnecessary for surgery now im here wondering what’s next to do and why im not getting pregnant im now 41years old im really going through it about getting pregnant my husband has no kids and he is not the problem so please can someone give me some hope i been reading a lot need help on getting so more things done only thing been done was me on clomiphene no other tests or anything i been reading on people getting tubal flushing etc etc in need of help please!!!!!!!!!

    Maribel Saldana / Reply
    • Avatar

      Are you writing about me? Omg same predicament I’m 40 , with two kids 21& 19 and hubby doesn’t have any and he’s good down there it’s my tubes that are blocked.
      Taking serraptease pills ( found on YouTube) this is so draining

      Sonya / (in reply to Maribel Saldana) Reply
  14. Avatar

    the posts are such an encouragement to me.I was diagnosed with blocked tubes in 2014,ever since,av tried things like herbal treatment,massage ,exercise but have not yet succeeded,am thinking of repeating hsg and if it fails again i can try surgery though am hoping that its now Gods time for me and for us.all the best my dears.

    roselyn / Reply
  15. Avatar

    Hi, I have be trying to get conceive for 7years now all to no avail am 27 years of age my doctor recommend hsg test for me of which I did yesterday. And it was really painful I just hope I will get pregnant soon just as I have heard from so many women in this blog that after their hsg they really got pregnant. I just pray mine to be the same as theirs.

    Racheal / Reply
  16. Avatar

    I fell pregnant exactly 2months of my hsg that was October 2013 and i delivered my lil damsel in 2014,since then i have been trying for another baby and is not just happening,doctor suggest i do hsg to help flush my tubes and i thank God my tubes ‘re clear. Hope it will work for me again as before.

    chenwan / Reply
  17. Avatar

    Hello everyone I have been trying to get pregnant for 15yr I’m 37yr of age and I go for my hsg in October of 2018 just hope for the best.

    Dawn Hill / Reply
    • Avatar

      I wish u the best I went for mine September 20, 2018 and they said both of my tubes are blocked.. I was so depressed now I’m trying to fine another way around it

      Siobhan / (in reply to Dawn Hill) Reply
  18. Avatar

    Hello I am 39, i had my first son at 22, and have been trying to get pregnant since. In March of 2016 i had a HSG done which revealed that my tubes were blocked. Fast forwarding 2 years i always can hear my doctor say there is no chance. My last period was June 23, 2018 I have an appointment with the OB September 17, i think i am pregnant but dont know the possibility, and scared to find out. Meanwhile i have all the symptoms except morning sickness. Is there anyone else who have been through this?

    Sexymefromdc / Reply
  19. Avatar

    My husband and I been married for 3yrs I never been on birth control and have regular cycles. We decided to go to a fertility specialist. I got my baseline assessment and everything looks great this far. I have a scheduled HSG tomorrow and I hope that has good results. I have a friend who got pregnant a couple months after the HSG. Keeping my fingers crossed. Will keep an update

    Planteater / Reply
  20. Avatar

    I have been told that I have blocked tubes, and and also PCOS, whatta combination. So my question is how much is this to have done. True my husband and I have kids from another marriage but we deserve our own family. So do I go to a specialist or can a regular ob/gny do rhis.?
    I need answers

    Olga Schramm / Reply
  21. Avatar

    Hi I’m 36 years old and me and my husband been trying for a year and nothing has happen for us. So I went to get my HSG test done it was kind of painful, but I was a trooper lol.. but the news they gave me was very depressing both of my tubes are blocked and I wasn’t happy to hear that. Now they want me to do IVF which is very expensive and my insurance will not cover it at all.. so I’m going to fine another doctor to make sure. I’m just praying b4 the year is out that me and my husband can have our family. I wish all y’all the best of luck.

    Siobhan / Reply
    • Avatar

      I’m in the same predicament. 40, tubes blocked. I had an HSG today. I left in tears. I got pregnant three years ago but miscarried. Insurance doesn’t cover IVF.

      Kat / (in reply to Siobhan) Reply
  22. Avatar

    I am 33yrs old my son is 12yrs old an am trying to get pregnant again,I did my HSG test 3wks ago that show that my tubes are not blocked, the doctor say see you in 3 months pregnant an I can’t wait for it to happen.

    Dennis / Reply
  23. Avatar

    is there change of ectopic pregnancy in test tube baby?

    ms azm / Reply
  24. Avatar

    I just did mine 3 days ago I pray I get pregnant, is really painful

    Ogoo / Reply
  25. Avatar

    I’m Mrs Abdullah trying to get pregnant , they said my tubes is block & unvisualise. Can clomid help me to increase d chance?

    Fatima / Reply
    • Sarah Chapman

      Thank you for your question, but this is something your clinician will need to advise on.
      Best wishes,
      Sarah (Editor)

      Sarah Chapman / (in reply to Fatima) Reply
  26. Avatar

    I’m having my tube done on Friday to be flushed threw I haven’t been able to get pregnant for about 11 years i had a operation and said my tube was blocked and that they couldn’t do anything cause I would hemrage then I saw a different gygoligist and he thinks by having this done it will or could flush me threw and to stop the pains and the periods cause I’m so heavy sometimes and other times nothing and my periods can be inregula so I hope it does work I realy do I realy want a baby

    Chantelle Abbott / Reply
  27. Avatar

    Hey..me its now 7months in mariage buh without à kid, i went for an hsg and my tubes ur both fine .dont know wat nxt

    Nancy diana / Reply
  28. Avatar

    My Gynecologist recommended me to go for an HSG test and i did it but the result were not that Good. Tubal blockage and Partially blocked. Am much confused, Disappointed .I hate myself caused I and My husband badly need a child.
    God have mercy on us.

    Zakie / Reply
  29. Avatar

    I have a history of an ectopic pregnancy with tube removed 12 years ago. Nearly 2 years of not falling pregnant and after a hycosy (tubal flushing) in Feb to determine if my remaining tube was blocked which I was told it wasn’t… I fell pregnant the next month. I can o my think the hycosy must have had something to do with it.

    Shona Lawson / Reply
  30. Avatar

    My doctor told me to go for ivf, i did and during six mounth the baby came out thus miscarrage. I wanted to go for another one but i was told fibriod has grown in my womb . What should i do?

    Naomi / Reply
    • Sarah Chapman

      I’m afraid this is something you’d need to return to your health professional to discuss.
      Best wishes,
      Sarah Chapman [Editor]

      Sarah Chapman / (in reply to Naomi) Reply
  31. Avatar

    Hey..what remedy did you finally use? Did it work for you? Am in the same dilemma😭

    Lucy / Reply
  32. Avatar

    i am 23 years old
    recently i had an ectopic pregnancy due to that my tube got ruptured doctors remove my tube by laprotomy
    one of my tube is removed n dr is saying other one is seems blocked i am very tensed about it i really want to have my own child by natural way..
    would be hsg useful for me n if u have any advise about it so plx give me guys

    komal / Reply
    • Sarah Chapman

      I’m afraid we can’t make recommendations or give clinical advice, so you would need to go to your doctor or other health professional.
      I hope things work out well for you.
      Sarah Chapman [Editor]

      Sarah Chapman / (in reply to komal) Reply

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