Effect of different ultrasound contrast materials and temperatures on patient comfort during intrauterine and tubal assessment for infertility.

Hysterosalpingo-contrast sonography (HyCoSy) is safe and easy to perform outpatient method in the evaluation of female infertility. During this procedure a certain level of discomfort and pain are experienced by patients. On the basis of reducing avoidable pain inductors the aim of this study was to compare pain sensation due to different warmth of applied contrasts (sterile saline and Echovist(®)). Prospective and randomized study was performed on patients requiring tubal and uterine assessment during standard infertility work up. One group of patients was examined using both contrasts at room temperature and the other group using preheated contrasts at body temperature. Pain experience of the procedure was rated by patients for each contrast by numerical scale (0-10) immediately after the procedure. There was significant statistical difference between pain scores during application of two contrasts in each group; Echovist induces significantly less pain in comparison to sterile saline at the same temperature (P=0.002, 0.001). Between two groups there is also statistically significant difference in pain during introduction of the same contrast at different temperature (P<0.001). The most tolerable for the patient is body temperature of the applied contrasts although their structure and concentrations can be another factor associated with tolerability of the procedure.