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

Abstract

BackgroundTubal 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.MethodsPain perception of 632 infertile women was measured by means of an 11-point numeric rating scale. Side effects and late complications were also recorded.ResultsThe 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.ConclusionsHyCoSy 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.

Pain and side effects associated with 4-dimensional hysterosalpingo-contrast sonography for evaluating of the fallopian tubes patency

“…Most of women encounter pain in the course of the HyCoSy procedure [14][15][16]. Several studies have demonstrated the pain, side effects, and tolerability of HyCoSy, using a variety of materials for air microbubble suspensions [14,15].…”

“…Several studies have demonstrated the pain, side effects, and tolerability of HyCoSy, using a variety of materials for air microbubble suspensions [14,15]. Some investigators have evaluated the diagnostic accuracy of 4 D HyCoSy [13,16].…”

A Novel Cause of Free Intraperitoneal Air in the Emergency Department

“…Mild to moderate pelvic pain has been reported in 24% to 35% of cases; vasovagal reactions, including nausea, pallor, faintness, and hypotension, occurred in less than 5% of cases; vaginal bleeding occurred in approximately 2% of cases; and fewer than 1% of patients experienced postprocedural infections. [3][4][5] To our knowledge, our case represents the first report of pneumoperitoneum as a complication of this procedure and adds to the body of literature about nonsurgical causes of free intraperitoneal air. The radiographic presence of free air usually represents visceral perforation in 85% to 95% of cases, but 5% to 15% of cases, as in our patient, have causes that do not require emergency surgery.…”

B‐flow ultrasound facilitates visualization of contrast medium during hysterosalpingo‐contrast sonography

“…The ability of HyCoSy to detect tubal occlusion has been evaluated in other studies. There is good agreement between the results of HyCoSy and laparoscopy with dye with regard to tubal patency 19,20 , and HyCoSy is recommended as a screening method for tubal occlusion by the Royal College of Obstetricians and Gynaecologists in the UK (RCOG-NICE Clinical guidelines 21 ) and suggested by many as a first-line procedure in standard infertility work-up 18,22,23 . Moreover, laparoscopy with dye may yield false-positive results with regard to tubal occlusion 24 , just as HyCoSy may.…”