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.