A Thin Catheter For Hystrosalpingography
Condition: Infertility
MeSH terms: Infertility
Study type: Interventional

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): device for hysterosalpingography
Intervention type(s): Device
Intervention description(s): a thin catheter originally designed for IUI (sperm processor cat. No. SP/PL/01, Aurangabad, India) connected to a 10 mL syringe filled with urographin 76% (Scherring, Germany) will be introduced through the cervical canal into the lower part of the uterine cavity. After introducing the catheter, the screw of the vaginal speculum will be loosened to allow the two valves of the speculum to press on the portiovaginalis of the cervix to prevent leakage of the dye. Then the dye will be injected slowly and the procedure will be watched on the screen and x-ray films will be taken.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: infertility fallopian tubes