Comparison of the pain experienced by infertile women undergoing hysterosalpingo contrast sonography or radiographic hysterosalpingography.

OBJECTIVE: To evaluate the pain and cause of pain experienced by women undergoing hysterosalpingography (HSG) and contrast hysterosalpingo sonography (HyCoSy) with air in a saline solution for the assessment of uterine and tubal patency. METHOD: In this prospective study, 121 infertile women undergoing these 2 procedures measured the pain incurred using a digital/analog scale (1-10). We looked for correlations between pain level and variables pertaining to the procedures. Vagal effects and their persistence were also recorded. RESULTS: The pain was less during HSG (median, 5) than during HyCoSy (median, 7). It was greater than menstrual pain for 38.8% of participants during HSG and for 70.5% of participants during HyCoSy. There was no correlation between pain and difficult catheter passage, degree of tubal obstruction, volume of contrast medium injected, or presence of IgG antibodies to Chlamydia when these variables were studied for HyCoSy alone. However, the strong correlation between pain score and volume of contrast medium injected during each procedure seems to explain the significantly higher pain levels during HyCoSy (P<0.001). In 65.3% and 57.8% of participants, respectively, the pain disappeared immediately after the HSG or HyCoSy. Only mild vagal effects were recorded following both procedures, in 0.8% of participants after HSG and 2.5% of participants after HyCoSy. CONCLUSION: Hysterosalpingo contrast sonography is similar to HSG regarding rapidity of pain disappearance, and infrequency and moderation of vagal effects, but the level of pain is slightly higher, probably due to the greater volume of medium injected.

[Sonohysterosalpingography versus hysterosalpingography in the evaluation of uterine and tubal infertility]. / Sonohisterosalpingografia versus histerosalpingografia in evaluarea infertilitatii de cauza uterina si tubara.

OBJECTIVE: The evaluation of the role of sonohysterosalpingography with saline with air as a contrast solution (HYCOSY), in the assessment of uterine cavity and tubal patency, versus hysterosalpingography (HSG) and laparoscopy with dye test combined with hysteroscopy. MATERIAL AND METHOD: Prospective study of 95 infertility patients, with ages 25-40 years (median 31), in which HYCOSY was compared with HSG regarding the diagnostic acuracy for uterine cavity pathology and tubal patency, and compared to laparoscopy with dye test combined with hysteroscopy as gold standard. RESULTS: The sensibility, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the diagnostic of uterine cavity pathology was: HYCOSY versus hysteroscopy of 72.1%, 96.15%, 93.93% and 80.64% respectively; HSG versus hysteroscopy was 83.3%, 60.7%, 63.6% and 81.6%; both methods combined versus hysteroscopy 95.34%, 61.53%, 67.21% and 94.11%. The same parameters for the tubal patency were: HYCOSY versus dye test laparoscopy 81.39%, 87.69%, 67.30% and 97.79%; HSG versus dye test laparoscopy 61.9%, 85.3%, 56.5% and 87.9%; both methods combined versus dye test 86%, 76%, 52.9% and 94.6%. CONCLUSION: HYCOSY can be used in combination with HSG for selecting the patients that need further more invasive investigations, in order to describe uterine and tubal pathology.

[Sono-hysterosalpingography in the assessment of tubal infertility]. / Sonohisterosalpingografia ca metoda de evaluare a infertilitatii tubare.

The assessment of the fallopian tubes patency is an important moment in the investigation for infertility. Vaginal sonographic hydrotubation was assessed in the evaluation of uterine configuration and tubal patency. In addition, technique using "agitated" saline during transvaginal sonography was evaluated. Ultrasound was more effective in detecting abnormalities of both interstitial and distal parts of the tube compared with hysterosalpingography. Sonohysterosalpingography is cheaper, may be performed in the office and also the pelvic irradiation is avoided.