Carbon dioxide versus normal saline as a uterine distension medium for diagnostic vaginoscopic hysteroscopy in infertile patients: a prospective, randomized, multicenter study

OBJECTIVE: To evaluate the satisfaction rate, efficacy, and complication rate of carbon dioxide (CO(2)) versus normal saline as a uterine distension medium for outpatient diagnostic vaginoscopic hysteroscopy in infertile patients.

DESIGN: Prospective, randomized multicenter study.

SETTING: Hysteroscopy units in two university hospitals and in a private center.

PATIENT(S): One hundred eighty-nine infertile women undergoing outpatient hysteroscopy.

INTERVENTION(S): Outpatient hysteroscopy was performed with CO(2) (group A) or normal saline (group B) and with endometrial biopsy when indicated.

MAIN OUTCOME MEASURE(S): Quality of the visualization of the uterine cavity, procedure time, complications, patient discomfort, and satisfaction rate.

RESULT(S): Significantly lower abdominal and shoulder tip pain and a lower incidence of vasovagal reactions were observed in group B in comparison with group A. A higher satisfaction rate and a lower operative time were obtained in the normal saline group in comparison with the CO(2) group. Moreover, group A required significantly more analgesics after the procedure than group B.

CONCLUSION(S): Uterine distension with normal saline seems to have less adverse effects and is better tolerated by patients. Moreover, it allows operative procedures to be performed with the new bipolar instruments.