Severe pain during hysterosalpingo-contrast sonography (HyCoSy): a systematic review and meta-analysis

Purpose To assess the frequency of severe pain perception during hysterosalpingo-contrast sonography (HyCoSy) in infertile women and to assess whether there are differences in the frequency of associated pain according to the contrast used. Design Systematic review and meta-analysis. Patients Women undergoing HyCoSy due to infertility. Interventions Searches were carried out in two databases (Pubmed and Web of Science). We included prospective or retrospective cohort observational studies that specified the type of contrast used during HyCoSy and reported data regarding the number of patients who perceived severe pain during the procedure and the scale used for pain perception score. Main outcome measures Pooled frequency of severe pain perception during HyCoSy and the pooled frequency of severe pain perception based on the contrast used. Results Twenty-nine studies were included in this meta-analysis including a total of 7139 patients. In 10 studies, Saline solution with air was used as contrast EchoVist™ was used in ten studies, in five studies, SonoVue™ was used and in four studies, ExEm-Foam ™ was used as contrast. Pooled estimated frequency of severe pain perception during HyCoSy was 6% (95% CI 4–9). No statistically significant differences have been described regarding frequency of severe pain perception in relation to the different contrasts used. Conclusions HyCoSy is a tolerable outpatient procedure. We did not find any evidence that one specific contrast was better tolerated than any other was.