Infertility Clinical Trial
Official title:
A Simple Technique to Reduce the Pain in Hysterosalpingography Using A Thin Catheter
The investigators will use a thin catheter for HSG and apply pressure on the cervix with the vaginal speculum to prevent leakage of the dye during injection to study the uterine cavity and fallopian tubes and reduce the pain as compared to a standard metal cannula.
Hysterosalpingography (HSG) remains one of the most reliable methods to study tubal patency
and the uterine cavity (1-3). The relative indications and importance of HSG and laparoscopy
in the diagnosis of tubal factor infertility have been extensively discussed. Recently a
multicenter randomized controlled trial (4) has demonstrated that the routine use of HSG at
an early stage of infertility work up, prior to laparoscopy and dye, does not influence the
cumulative pregnancy rate compared with the routine use of laparoscopy and dye alone.
However, HSG is an efficient method which is less invasive and less costly than laparoscopy
(5), and than transvaginal hydrolaparoscopy (6). The main disadvantages of HSG are being
unable to confirm adhesions, endometriosis and being a painful procedure (7,8). Different
cannulas and catheters have been tried to reduce pain such as the Rubin cannula (9), Jorcho
cannula (10), and Whitehead cannula or Foley catheter (11). Minimal difference in the degree
of pain was found when the balloon catheter was compared with the cervical cup (12). General
and local medications have been tried to alleviate pain during the procedure. (3,13).
HSG is widely practiced in our country, however, for cost effective reasons, the standard
metal cannula is the only method used at our hospital. It is painful procedure because it
requires grasping the cervix with a tenaculum and inducing some cervical dilatation during
introduction of the cannula. The aim of this pilot study was to develop a simple and
painless technique for HSG using a thinner than normal catheter, and without grasping the
cervix with a tenaculum. Leakage of the dye through the cervix was prevented by pressing on
the portiovaginalis of the cervix using the vaginal speculum. This technique for performing
HSG is a novel one and has not been described previously in the medical literature.
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Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Diagnostic
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