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.