Modified hysterosalpingography during infertility work-up: use of contrastmedium and saline to investigate mechanical factors

Objective: To evaluate the effectiveness of modified hysterosalpingography using <3 mt amount of contrast medium followed by injection of saline to mi nimize the adverse effects associated with the procedure. Design: For modified hysterosalpingography, 1-2 mL of water-soluble contras t medium were injected to visualize the uterine cavity, followed by injecti on of 10 mt of saline to check tubal patency and spillage. A control group of patients underwent hysterosalpingography with undiluted contrast medium. Setting: Teaching hospital. Patient(s): Seventy-eight infertile women [study (n = 40)/control (n = 38) groups]. Intervention(s): Modified and standard hysterosalpingography. Main Outcome Measure(s): Assessment of uterine cavity, tubal patency, and s ensation of pain during modified hysterosalpingography was compared with th at during standard hysterosalpingography. Result(s): Uterine cavity and tubal potency were properly visualized during modified hysterosalpingography. Saline pushed the contrast medium successf ully from the uterine cavity through the open fallopian tubes and into the pelvic cavity. The study group reported significantly less pain than did th e control group. Between-group differences were statistically significant w hen pain perception (no pain vs. minimal pain vs. severe pain; no pain vs. any kind of pain) was analyzed by type of adnexal pathology (bilateral pass age or unilateral passage). Conclusion(s): Modified hysterosalpingography was sufficient to diagnose tu bal and pelvic mechanical factors. The procedure was associated with a sign ificant reduction in self-reported pain and no medical complications. (C)20 00 by American Society for Reproductive Medicine.