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ORIGINAL RESEARCH article

Front. Endocrinol.
Sec. Reproduction
Volume 15 - 2024 | doi: 10.3389/fendo.2024.1257888
This article is part of the Research Topic Endocrine and Metabolic Effects on Maternal-fetal and Neonatal Outcomes, Volume II View all 8 articles

Iodine and other factors associated with fertility outcome following oil-soluble contrast medium hysterosalpingography: A prospective cohort study

Provisionally accepted
Divya M. Mathews Divya M. Mathews 1Jane M. Peart Jane M. Peart 2Robert G. Sim Robert G. Sim 3Neil P. Johnson Neil P. Johnson 4Susannah O'Sullivan Susannah O'Sullivan 5José G. Derraik José G. Derraik 6Paul Hofman Paul Hofman 1*
  • 1 Liggins Institute, The University of Auckland, Auckland, New Zealand
  • 2 Auckland Radiology Group, Auckland, New Zealand
  • 3 Auckland Radiology Group, Auckland, Auckland, New Zealand
  • 4 Auckland Gynaecology Group, Auckland, Auckland, New Zealand
  • 5 Greenlane Clinical Centre, Auckland District Health Board, Auckland, Auckland, New Zealand
  • 6 Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand

The final, formatted version of the article will be published soon.

    Objective: To examine factors associated with fertility following hysterosalpingography (HSG) using an oil-soluble contrast medium (OSCM). Design: In a prospective cohort study on 196 women having OSCM HSG, we showed that iodine excess was almost universal (98%) and mild subclinical hypothyroidism was frequent (38%). Here, we report the analyses of secondary outcomes examining factors associated with the likelihood of pregnancy following the HSG. Setting: Auckland, New Zealand (2019–2021) Sample: 196 women with primary or secondary infertility and underwent OSCM HSG Methods: Baseline and serial urine iodine concentrations (UIC) and thyroid function tests were measured over six months following the HSG. Pregnancy and treatment with levothyroxine during the study period were documented. Results: Following OSCM HSG, pregnancy rates were 49% in women aged <40 years (77/158) but considerably lower (16%) among those ≥40 years (6/38). Similarly, live birth rates were markedly lower in women ≥40 years (17%; 1/6) versus <40 years (73%; 56/77). 29% of participants were iodine deficient at baseline despite advice suggesting iodine fortification. Following HSG, women with moderate iodine deficiency had higher pregnancy rates than those with normal iodine levels (64%; p=0.048). Among women aged <40 years who had subclinical hypothyroidism (n=75), levothyroxine treatment was associated with higher pregnancy rates compared to untreated women [63% (26/48) vs 37% (10/27), respectively; p=0.047]. Conclusions: OSCM HSG was associated with higher pregnancy rates in women ≤40 than in those aged >40 years. Iodine deficiency was relatively common in this cohort, and increased iodine levels from OSCM exposure may contribute to the improved fertility observed with this procedure.

    Keywords: Fertility, Hysterosalpingography, Iodine, oil-soluble contrast medium, Pregnancy, age, Tubal patency, Hypothyroidism

    Received: 13 Jul 2023; Accepted: 29 Apr 2024.

    Copyright: © 2024 Mathews, Peart, Sim, Johnson, O'Sullivan, Derraik and Hofman. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Paul Hofman, Liggins Institute, The University of Auckland, Auckland, New Zealand

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.