Diagnostic and therapeutic consequences of evaluating the fallopian tubes in infertility

As this thesis showed an fertility-enhancing effect of an HSG with oil-based contrast, we would suggest to perform an HSG with oil-based contrast in couples with unexplained or mild male infertility during fertility work-up. More research is needed to investigate the underlying mechanism of action and whether these results are also applicable to couples who suffer from other causes of infertility. We found no clear effect of preconception exposure to iodinated contrast (oil-based or water-based) on neonatal thyroid function. However, we advise keeping the amount of contrast used as low as possible. Future studies must assess the safety of iodinated contrast media for mother and neonatal thyroid function, and its indirect effects on neurodevelopment. Furthermore, this thesis showed that clinical management based on the results of HyFoSy versus HSG leads to similar pregnancy outcomes, with HyFoSy experienced as significantly less painful. Therefore, HyFoSy can replace HSG as first choice diagnostic tubal patency test during fertility work-up. Future studies which incorporate the assessment of the fertility-enhancing effect of HyFoSy are needed. We believe shared decision making is key in current daily practice, couples should be counselled for the diagnostic purpose of the tubal patency test and its fertility-enhancing effects.