Hysterosalpingocontrast sonography (HyCoSy): evaluation of the pain perception, side effects and complications

Roberto Marci, Immacolata Marcucci, Aurelio Aniceto Marcucci, Nicolina Pacini, Pietro Salacone, Annalisa Sebastianelli, Luisa Caponecchia, Giuseppe Lo Monte, Rocco Rago, Roberto Marci, Immacolata Marcucci, Aurelio Aniceto Marcucci, Nicolina Pacini, Pietro Salacone, Annalisa Sebastianelli, Luisa Caponecchia, Giuseppe Lo Monte, Rocco Rago

Abstract

Background: Tubal and uterine cavity diseases commonly compromise female fertility. At the present time, hysteroscopy, laparoscopy with chromopertubation and RX-Hysterosalpingography (RX-HSG) are widely accepted screening procedures enabling the effective assessment of both tubal patency and uterine cavity. Nevertheless, consistent evidence supports the reliability of Hysterosalpingocontrast sonography (HyCoSy) in uterine cavity and tubal patency investigation, as a part of the standard infertility work-up. This prospective study was aimed at evaluating the tolerability of the technique as well as the incidence of related side effects and complications in a large series of infertile patients.

Methods: Pain perception of 632 infertile women was measured by means of an 11-point numeric rating scale. Side effects and late complications were also recorded.

Results: The mean numeric rating scale was 2.15 ± 2.0 SD. Most of the patients (374/632, 59.17%) rated HyCoSy as a non-painful procedure, whereas 24.36% (154/632) women reported mild pelvic pain and 9.96% (63/632) classified the discomfort as "moderate". Only 6.48% (41/632) of the patient population experienced severe pelvic pain. Fifteen (2.37%) patients required drug administration for pain relief. Twenty-six patients (4.11%) showed mild vaso-vagal reactions that resolved without atropine administration. No severe vaso-vagal reactions or late complications were observed.

Conclusions: HyCoSy is a well-tolerated examination and the associated vagal effects are unusual and generally mild. Consequently, we support its introduction as a first-line procedure for tubal patency and uterine cavity investigation in infertile women.

Figures

Figure 1
Figure 1
HyCoSy: saline contrast medium expanding a morphologically normal uterine cavity.
Figure 2
Figure 2
HyCoSy: direct visualization of bilateral tubal patency. (Black arrow: right tube; white arrow: left tube).
Figure 3
Figure 3
HyCoSy: the periuterine fluid collection (white arrow) is an indirect sign of tubal patency.
Figure 4
Figure 4
Flowchart representing the distribution of women who repeated HyCoSy twice (MNRS, mean numeric rating scale; SD, standard deviation).
Figure 5
Figure 5
Evaluation of pain perception in our series and data reported by Savelli et al., 2009.

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Source: PubMed

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