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Tubal ObstructionNCT02618785

Antispasmodic Drug for Diagnosis Proximal Tubal Occlusion on Hysterosalpingography

A study testing hysterosalpingography in people with Tubal Obstruction, run by Mahidol University at 1 site in Thailand.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This study finds premedication Hyoscine-N-butylbromide before hysterosalpingography have a potential effect for diagnosis of proximal tubal obstruction in infertile women. The investigators did a double-blind, randomized placebo-controlled trial Read more about this study

Who is it for?
Ages 19 to 42 years, women onlyHealthy volunteers can take part
Conditions the study is for
Tubal Obstruction
What is being tested?
hysterosalpingography
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
146 participants
Where
1 siteThailand
Study dates
Jun 2016to Apr 2017
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 19 to 42 years
  • Women only
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • The infertile women who indicated for investigation hysterosalpingography were enrolled.

Who cannot join

  • Known sensitivity to Hyoscine or contrast media
  • Genital tract infection
  • Suspected pregnancy
  • Abnormal uterine bleeding

Trial locations and contacts

1 site in 1 country.

Thailand1 site
  • Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University

    Hat Yai, Changwat Songkhla, 90112

Other trials in Thailand

About this study

Official title: The Effect of Premedication Hyoscine-N-butylbromide Before Hysterosalpingography for Diagnosis of Proximal Tubal Obstruction in Infertile Women : A Randomized Double-Blind Controlled Trial

This study finds premedication Hyoscine-N-butylbromide before hysterosalpingography have a potential effect for diagnosis of proximal tubal obstruction in infertile women. The investigators did a double-blind, randomized placebo-controlled trial

Read the detailed description

Infertility is a common gynecologic problem in reproductive medicine. The causes of female infertile can divided into ovulatory dysfunction, tubal and pelvic pathology, unexplained infertility and unusual problems. About 30-35% of case of infertility are caused by the tubal factor and tubal disease is an important cause of infertility and should be specifically excluded(1). Methods for evaluation of the fallopian tube pathology include the Hysterosalpingography(HSG), Saline infusion sonography(SIS) and Laparoscopy with chromopertubation etc(2-3).

Laparoscopy with chromopertubation is considered the definitive test for evaluating tubal disease and allows for the detection of other intraabdominal causes of infertility. However, laparoscopy is expensive, time consuming, limited in some centers, and unpleasant for the patient. More importantly many patients have anesthetic and surgical complications that require hospital admission(4). Therefore, HSG has been most commonly used for routine screening in infertility for evaluation of tubal patency. It is a simple, noninvasive and inexpensive technique. HSG is the standard first-line test to evaluate tubal patency(5-7).

HSG is an X-ray procedure that is used to view the inside of the uterus and fallopian tubes. HSG for investigating tubal patency has moderate sensitivity 65% but excellent specificity 83% in the infertile population. The PPV and NPV of HSG are 38% and 94%, respectively(8-9). However, it can have a false positive diagnosis if the HSG indicates occlusion, there may be a good chance 60% that the tubes are actually patent, and if the HSG demonstrates patency there is a little chance 5% that the tubes are occluded(10). There are several factors leading to a false diagnosis of tubal occlusion by using HSG. The most common factor cited is a cornual spasm(11), there could simply be a resistance difference between the two tubes(12) and the other factor are an existing of mucous plug at proximal part of the fallopian tube(13).

Diagnostic laparoscope performed after HSG showed a decrease in the rate of diagnoses of initial tubal occlusion by 40-60%(14-16). There are studies about repeat HSG 1 month later in patients whom HSG showed proximal tubal blockage, showed tubal patency about 60%(17). And there are many studies about administration of an antispasmodic or analgesic drug to distinguish tubal spasm from tubal occlusion during HSG. Such as Glucagon, Hyoscine butylbromide, ASA, Terbutaline, Diazepam, Fenoterol and Mitamizole etc(18-21). There is only one prospective study about hyoscine butylbromide use after tubal occlusion occur during HSG, showed that appears to be safe and effective drug to relieve proximal tubal obstruction by 80%(22).

Hyoscine-N-butylbromide(Buscopan®), an antispasmodic drug commonly used for relief of smooth muscle spasms and can use to relieve genito-urinary spasm. Hyoscine exerts a spasmolytic action, peripheral anticholinergic effects result from a ganglion-blocking action within the visceral wall as well as from anti-muscarinic activity, could decrease pain during uterine cramping. And about relief tubal obstruction in HSG procedure, no previous studies investigate compared its efficacy in randomized double-blind controlled trial. And there are inexpensive, safe with minimal side effects, then there are studies reported hyoscine can relieve dysmenorrhea too(23-24).

In Thailand, reported that one of the most common causes of female infertility is tubal pathology which accounted for 27% of the cases(25). And at Infertile clinic of Songklanagarind Hospital, mostly use HSG for standard first-line to evaluate tubal patency. We hypothesized that Hyoscine-N-butylbromide use before HSG can relieve the tubal occlusion that not true occlusion. It is possible to decrease the false positive rate of diagnosis of tubal occlusion cause from cornual spasm. So it can apply to use to decrease the necessity of laparoscopy with chromopertubation for definitive test tubal occlusion or repeated. And it will also reduce the medical cost of further more expensive investigation and medical complication.

Being tested
hysterosalpingography
Keywords
Hysterosalpingography, antispasmodic drug, infertile women
Medical subject headings
Fallopian Tube Diseases

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • hysterosalpingographyProcedure or surgery

    Also called HSG

    Starting procedure by using largest appropriate speculum for maximum cervical exposure. Cleanse the cervix with povidone iodine. A tenaculum was applied to the anterior cervix to help for stabilization and counter-traction. Then insert a sterile Rubin's cannula into the cervix uteri. A scout radiograph of the pelvis was obtained with the catheter in place before contrast material was instilled. After that the water soluble contrast media was slowly instilled through the cannula appropriate volume range 10-15 ml., with fluoroscopic images obtained intermittently to evaluate the uterus, fallopian tubes and tubal patency

Study groups in NCT02618785
Study groupRoleWhat they receive
HyoscineExperimentalThe experiment group receive Hyoscine 10 mg 2 tablets by mouth before hysterosalpingography procedure
Receives: Procedure: hysterosalpingography
PlaceboPlacebo comparatorThe control group receive placebo by mouth before hysterosalpingography procedure
Receives: Procedure: hysterosalpingography

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. number result diagnosis of proximal tubal occlusion

    To evaluate rate diagnosis of proximal tubal occlusion compare between Hyoscine group and placebo group before HSG.

    Measured: up to 24 weeks

Secondary outcomes (2)
  1. number of true occlusion or false occlusion

    To evaluate false positive results of proximal tubal occlusion from HSG compare between study and control groups.

    Measured: up to 24 weeks

  2. number of participants with treatment-related adverse effects of drug and procedure

    such as dizziness, syncope, tachycardia, nausea, vomiting, pelvic pain, bleeding

    Measured: up to 24 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted1 Dec 2015 (estimated)
  2. Study startJun 2016
  3. Primary completionMar 2017
  4. Study completionApr 2017

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
146 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02618785
Sponsor's protocol ID
562441242
Status last verified
Nov 2016
First submitted
21 Nov 2015
Last updated
18 Apr 2017
Results posted
No
Data monitoring committee
Yes
Individual data sharing
No

Publications

  • Hindocha A, Beere L, O'Flynn H, Watson A, Ahmad G. Pain relief in hysterosalpingography. Cochrane Database Syst Rev. 2015 Sep 20;2015(9):CD006106. doi: 10.1002/14651858.CD006106.pub3.

    PubMed 26387564
  • Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile female: a committee opinion. Fertil Steril. 2015 Jun;103(6):e44-50. doi: 10.1016/j.fertnstert.2015.03.019. Epub 2015 Apr 30.

    PubMed 25936238
  • Steinkeler JA, Woodfield CA, Lazarus E, Hillstrom MM. Female infertility: a systematic approach to radiologic imaging and diagnosis. Radiographics. 2009 Sep-Oct;29(5):1353-70. doi: 10.1148/rg.295095047.

    PubMed 19755600
  • Hajishafiha M, Zobairi T, Zanjani VR, Ghasemi-Rad M, Yekta Z, Mladkova N. Diagnostic value of sonohysterography in the determination of fallopian tube patency as an initial step of routine infertility assessment. J Ultrasound Med. 2009 Dec;28(12):1671-7. doi: 10.7863/jum.2009.28.12.1671.

    PubMed 19933481
  • Kodaman PH, Arici A, Seli E. Evidence-based diagnosis and management of tubal factor infertility. Curr Opin Obstet Gynecol. 2004 Jun;16(3):221-9. doi: 10.1097/00001703-200406000-00004.

    PubMed 15129051
  • Moore DE. Pain associated with hysterosalpingography: Ethiodol versus Salpix media. Fertil Steril. 1982 Nov;38(5):629-31. doi: 10.1016/s0015-0282(16)46647-1. No abstract available.

    PubMed 6290276
  • Marjoribanks J, Ayeleke RO, Farquhar C, Proctor M. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev. 2015 Jul 30;2015(7):CD001751. doi: 10.1002/14651858.CD001751.pub3.

    PubMed 26224322
  • Kemp JH. "Buscopan" in spasmodic dysmenorrhoea. Curr Med Res Opin. 1972;1(1):19-25. doi: 10.1185/03007997209111141. No abstract available.

    PubMed 4589399
  • Rohwer AC, Khondowe O, Young T. Antispasmodics for labour. Cochrane Database Syst Rev. 2013 Jun 5;2013(6):CD009243. doi: 10.1002/14651858.CD009243.pub3.

    PubMed 23737030
  • Alper MM, Garner PR, Spence JE. Hyoscine butylbromide to relieve utero-tubal obstruction at hysterosalpingography. Br J Radiol. 1985 Sep;58(693):915. doi: 10.1259/0007-1285-58-693-915-a. No abstract available.

    PubMed 3842296
  • Moro F, Selvaggi L, Sagnella F, Morciano A, Martinez D, Gangale MF, Ciardulli A, Palla C, Uras ML, De Feo E, Boccia S, Tropea A, Lanzone A, Apa R. Could antispasmodic drug reduce pain during hysterosalpingo-contrast sonography (HyCoSy) in infertile patients? A randomized double-blind clinical trial. Ultrasound Obstet Gynecol. 2012 Mar;39(3):260-5. doi: 10.1002/uog.11089.

    PubMed 22223598
  • Jareethum R, Suksompong S, Petyim S, Prechapanich J, Laokirkkiat P, Choavaratana R. Efficacy of mefenamic acid and hyoscine for pain relief during saline infusion sonohysterography in infertile women: a double blind randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2011 Apr;155(2):193-8. doi: 10.1016/j.ejogrb.2010.11.021. Epub 2010 Dec 30.

    PubMed 21194827
  • Jitchanwichai A, Soonthornpun K. Effect of Premedication Hyoscine-N-Butylbromide before Hysterosalpingography for Diagnosis of Proximal Tubal Obstruction in Infertile Women: A Randomized Double-Blind Controlled Trial. J Minim Invasive Gynecol. 2019 Jan;26(1):110-116. doi: 10.1016/j.jmig.2018.03.034. Epub 2018 Apr 24.

    PubMed 29702271

Questions about this trial

What is this clinical trial studying?

A study testing hysterosalpingography in people with Tubal Obstruction, run by Mahidol University at 1 site in Thailand.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 18 Apr 2017. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Thailand. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

number result diagnosis of proximal tubal occlusion (time frame: up to 24 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02618785, which also lists 13 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Apr 2017.

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