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Fertility-related quality of life in subfertile women undergoing tubal testing with transvaginal hydrolaparoscopy or hysterosalpingography. Eur J Obstet Gynecol Reprod Biol 2022; 274:19-22. [PMID: 35561566 DOI: 10.1016/j.ejogrb.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/19/2022] [Accepted: 04/09/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Both subfertility and its management can have significant impact on quality of life (QoL). Tubal patency testing as part of the fertility work-up, is considered to cause more physical complaints and stress than other tests. Pain scores for HSG are higher than for THL, but acceptability of the procedures was found to be comparable. Fertility-related QoL has not yet been studied in women undergoing tubal patency testing. STUDY DESIGN We performed a standardized questionnaire study alongside a previously reported randomized controlled trial comparing THL and HSG in subfertile women, in which 24-month live birth rates occurred in 58.5% versus 55.4%, respectively. We randomly assigned 300 subfertile women to THL or HSG between May 2013 and October 2016. Women were eligible if they were undergoing a fertility work-up with an indication for evaluation of tubal patency. Fertility-related QoL was measured six weeks after the procedure with the validated FertiQoL questionnaire. The scores for the Core scale and subscales between THL and HSG were compared using Mann-Whitney-U test and multiple linear regression analysis. RESULTS The questionnaire was completed by 84 women in the THL group (56%) and 96 women in the HSG group (64%). Core scores were 74.6 ± 12.8 for THL and 73.4 ± 12.4 for HSG (p = 0.39). Scores for the Emotional domain were 64.5 ± 19.0 for THL versus 66.0 ± 16.3 (p = 0.67) for HSG. Scores for the 'Mind-body' domain for THL were 76.9 ± 15.6 versus 74.1 ± 18.0 for HSG (p = 0.42), while scores for the Relational domain were 79.2 ± 12.9 for THL and 76.9 ± 15.6 for HSG (p = 0.21). Scores for the Social domain for THL were 77.9 ± 15.1 versus 76.7 ± 14.1, (p = 0.42). The multiple linear regression analysis showed only a statistical significant positive effect of older age on the score for the Emotional domain (p = 0.015). CONCLUSION In a preselected group of women with low risk for tubal pathology we did not find differences in fertility-related QoL between tubal patency testing with THL versus HSG.
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Jain S, Inamdar DB, Majumdar A, Jain DK. Effectiveness of paracervical block for pain relief in women undergoing hysterosalpingography. J Hum Reprod Sci 2017; 9:230-235. [PMID: 28216910 PMCID: PMC5296826 DOI: 10.4103/0974-1208.197643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate the potential benefit, in terms of pain relief, of the paracervical block with 2% lignocaine in women undergoing hysterosalpingography (HSG). STUDY DESIGN This study was a prospective randomized controlled study. SETTINGS This study was conducted in infertility clinic of a tertiary care center. MATERIALS AND METHODS Four hundred and six patients undergoing HSG as a part of infertility evaluation were included in the study. These women were randomized into two groups: Group I received paracervical block with 2% lignocaine at the time of HSG (n = 53) and Group II (n = 53) served as control. Hyoscine (10 mg) oral tablet was given to all the patients 30 min before the procedure. Pain perception during the procedure was analyzed by the patient between 0 and 10 on a numeric rating scale, immediately after HSG. RESULTS The baseline demographic characteristics of participants in two groups were similar. Mean pain score immediately after HSG in the study group and control group was 4.84 ± 2.56 and 5.21 ± 1.89, respectively (P = 0.21). CONCLUSIONS There is no benefit of paracervical block with 2% lignocaine, in terms of pain relief, in women undergoing HSG.
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Affiliation(s)
- Shikha Jain
- Centre of IVF and Human Reproduction, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Abha Majumdar
- Centre of IVF and Human Reproduction, Sir Ganga Ram Hospital, New Delhi, India
| | - Deepak K Jain
- Senior Resident, Department of Surgical Oncology, TATA Memorial Hospital, Mumbai, Maharashtra, India
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Handelzalts JE, Levy S, Peled Y, Binyamin L, Wiznitzer A, Goldzweig G, Krissi H. Information seeking and perceptions of anxiety and pain among women undergoing hysterosalpingography. Eur J Obstet Gynecol Reprod Biol 2016; 202:41-4. [PMID: 27160813 DOI: 10.1016/j.ejogrb.2016.04.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 04/12/2016] [Accepted: 04/23/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Hysterosalpingography (HSG) is an accepted diagnostic tool for infertility workup and is considered an invasive procedure that is generally regarded as uncomfortable and painful, though research on psychological consequences is scarce and outdated. The study objective was to investigate women's experience of HSG in terms of fear, anxiety and pain, as compared to colposcopy. STUDY DESIGN This cross sectional questionnaire study was conducted at two public women's health clinics in Israel between January 2013 and March 2014. 137 women were included in the study. 42 consecutively sampled women referred for outpatient HSG and 95 consecutively sampled women referred for outpatient diagnostic colposcopy. The main outcome measures were: state-trait anxiety, information seeking behavior, fear of pain, fear of the results, retrospective pain. RESULTS Compared to those undergoing colposcopy, women undergoing HSG expressed significantly higher anxiety prior to the procedure, feared the pain involved more, and rated the procedure as more painful retrospectively. HSG patients tended to report a higher degree of information seeking. Information seeking was correlated with higher anxiety among HSG but not colposcopy patients. CONCLUSION(S) HSG is a highly stressful procedure associated with fear, anxiety, pain and information seeking. Research is needed to find possible ways of ameliorating these emotions and behaviors as they may have negative impact on patient cooperation.
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Affiliation(s)
| | - Sigal Levy
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Israel
| | - Yoav Peled
- The Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
| | - Liat Binyamin
- The Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
| | - Arnon Wiznitzer
- The Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
| | - Gil Goldzweig
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Israel
| | - Haim Krissi
- The Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
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Nahuis MJ, Weiss NS, Van der Velde M, Oosterhuis JJE, Hompes PGA, Kaaijk EM, van der Palen J, van der Veen F, Mol BWJ, van Wely M. Does the postcoital test predict pregnancy in WHO II anovulatory women? A prospective cohort study. Eur J Obstet Gynecol Reprod Biol 2016; 199:127-31. [PMID: 26922384 DOI: 10.1016/j.ejogrb.2016.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 12/03/2015] [Accepted: 01/02/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the capacity of the postcoital test (PCT) to predict pregnancy in WHO II anovulatory women who are ovulatory on clomiphene citrate (CC). In these women, an abnormal PCT result could be associated with lower pregnancy chances, but this has never been proven or refuted. STUDY DESIGN Prospective cohort study was performed between December 2009 and September 2012 for all women who started ovulation induction with CC in one university clinic and two teaching hospitals in the Netherlands. A PCT was performed in one of the first three ovulatory cycles. Ovulation induction with CC was continued for at least six cycles. The PCT was judged to be positive if at least one progressive motile spermatozo was seen in one of five high power fields at 400× magnification. The primary outcome was time to ongoing pregnancy, within six ovulatory cycles. RESULTS In 152 women the PCT was performed. 135 women had a reliable, well-timed PCT. The ongoing pregnancy rate was 44/107 (41%) for a positive and 10/28 (36%) for a negative PCT. The hazard rate for ongoing pregnancy was 1.3 (95% CI 0.64-2.5) for a positive versus a negative PCT. Thirty five of 77 (46%) women with clear mucus had an ongoing pregnancy versus 12 of 45 (27%) women in whom the mucus was not clear (HR 2.0; 95% CI 1.02-3.84, p=0.04). CONCLUSION The present study suggests that the outcome of the postcoital test in women with WHO-II anovulation that undergo ovulation induction with CC does not have a large effect on ongoing pregnancy chances over time.
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Affiliation(s)
- Marleen J Nahuis
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, The Netherlands; Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, VU Medical Center, The Netherlands.
| | - Nienke S Weiss
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Minke Van der Velde
- Department of Obstetrics and Gynaecology, Medisch Spectrum Twente Hospital Group, Enschede, The Netherlands
| | - Jur J E Oosterhuis
- Department of Obstetrics and Gynaecology, Antonius Ziekenhuis, Utrecht, The Netherlands
| | - Peter G A Hompes
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, VU Medical Center, The Netherlands
| | - Eugenie M Kaaijk
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands; Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands
| | - Fulco van der Veen
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Ben Willem J Mol
- The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Australia
| | - Madelon van Wely
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, The Netherlands
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Comparison of four different pain relief methods during hysterosalpingography: a randomized controlled study. Pain Res Manag 2016; 20:107-11. [PMID: 25848848 PMCID: PMC4391438 DOI: 10.1155/2015/306248] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Hysterosalpingography (HSG) is the most commonly used method for evaluating the anatomy and patency of the uterine cavity and fallopian tubes, and is an important tool in the evaluation of infertility. The most frequent side effect is the pain associated with the procedure. OBJECTIVES To evaluate four analgesic methods to determine the most useful method for reducing discomfort associated with HSG. METHODS In the present prospective study, 75 patients undergoing HSG for evaluation of infertility were randomly assigned to four groups: 550 mg of a nonsteroidal anti-inflammatory drug (NSAID) (group 1); 550 mg NSAID + paracervical block (group 2); 550 mg NSAID + paracervical analgesic cream (group 3); or 550 mg NSAID + intrauterine analgesic instillation (group 4). A visual analogue scale was used to assess the pain perception at five predefined steps. RESULTS Instillation of the liquids used for HSG was found to be the most painful step of HSG, and this step was where the only significant difference among groups was observed. When comparing visual analogue scale scores, group 2 and group 3 reported significantly less pain than the other groups. Group 1 reported significantly higher mean (± SD) scores (7.2 ± 1.6) compared with groups 2 and 3 (4.7 ± 2.5 and 3.8 ± 2.4, respectively) (P<0.001). In addition, group 2 reported significantly less pain than group 4 (4. 7 ± 2.5 versus 6.7 ± 1.8, respectively) (P<0.02). CONCLUSIONS For effective pain relief during HSG, in addition to 550 mg NSAID, local application of lidocaine cream to the posterior fornix of the cervix uteri and paracervical lidocaine injection into the cervix uteri appear to be the most effective methods.
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Karaman E, Çim N, Alkış İ, Yıldırım A, Yıldızhan R. Rectal indomethacin use in pain relief during hysterosalpingography: A randomized placebo controlled trial. J Obstet Gynaecol Res 2015; 42:195-201. [PMID: 26711715 DOI: 10.1111/jog.12863] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 07/31/2015] [Accepted: 08/23/2015] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the effectiveness of a rectal nonsteroidal anti-inflammatory drug (indomethacin) for pain relief during a hysterosalpingography (HSG). MATERIALS AND METHODS This prospective, randomized study included 82 women divided randomly into two groups. The study group received self-administered rectal indomethacin, while the control group received a placebo before the procedure. Degrees of pain were evaluated using the visual analog scale (VAS) at four different steps during the procedure and 30 min afterwards. The anxiety-depression status of the patients was evaluated using a validated Turkish version of the Beck anxiety-depression form before the procedure. RESULTS There were no statistically significant differences in the demographic characteristics of patients. The mean pain scores during tenaculum application (step 2), cervical traction (step 3), contrast injection (step 4) and 30 min after the procedure, were significantly lower in the study than the control group (P < 0.05). Step 4 was the most painful in both groups (VAS scores 3.2 ± 0.6 study vs. 5.3 ± 1.1 control). The mean pain score in step 4 for patients with abnormal HSG results was significantly higher than in patients with normal HSG results (P < 0.05). The mean anxiety and depression scores immediately before the procedure were not statistically different between the groups (P = 0.610 and P = 0.129, respectively). CONCLUSION Our study demonstrated a significant reduction in pain in patients who received a single rectal dose of indomethacin; therefore, we recommend the use of rectal indomethacin for reducing pain during a HSG procedure.
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Affiliation(s)
- Erbil Karaman
- School of Medicine, Department of Obstetric and Gynecology, Yuzuncu Yıl University, Van, Turkey
| | - Numan Çim
- School of Medicine, Department of Obstetric and Gynecology, Yuzuncu Yıl University, Van, Turkey
| | - İsmet Alkış
- School of Medicine, Department of Obstetric and Gynecology, Yuzuncu Yıl University, Van, Turkey
| | - Abdullah Yıldırım
- School of Medicine, Department of Psychiatry, Yuzuncu Yıl University, Van, Turkey
| | - Recep Yıldızhan
- School of Medicine, Department of Obstetric and Gynecology, Yuzuncu Yıl University, Van, Turkey
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Hsu PY, Lin MW, Hwang JL, Lee MS, Wu MH. The fertility quality of life (FertiQoL) questionnaire in Taiwanese infertile couples. Taiwan J Obstet Gynecol 2014; 52:204-9. [PMID: 23915852 DOI: 10.1016/j.tjog.2013.04.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2011] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To characterize the fertility quality of life (QoL) in Taiwanese infertile couples using an objective measurement tool-the FertiQoL questionnaire, and establish a reference level of QoL for clinical applications and future studies. MATERIALS AND METHODS The FertiQoL tool, a self-report questionnaire, was distributed to seven infertility centers across Taiwan for infertile couples who were undergoing the treatment of in vitro fertilization. The online version of the FertiQoL questionnaire was issued on the website of Taiwan Society for Reproductive Medicine and was opened to the public. RESULTS A total of 534 copies of eligible FertiQoL questionnaires were collected. The total scores for the Core FertiQoL and Treatment FertiQoL are 55.12 ± 13.72 and 56.40 ± 10.96, respectively. Both the Core and Treatment FertiQoL were significantly higher in the males of infertile couples than the females (60.63 ± 14.07 vs. 54.39 ± 13.52, p = 0.001, and 59.13 ± 12.44 vs. 56.03 ± 10.71, p = 0.035, respectively). Significantly better QoL was found in infertile patients in the Southern Taiwan, with a Core FertiQoL of 58.21 ± 12.70 and a Treatment FertiQoL of 58.79 ± 10.15. CONCLUSION The results of this study provide a baseline QoL in infertile couples in Taiwan, and could potentially be used as a guide for clinical counseling and future works.
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Affiliation(s)
- Pei-Yang Hsu
- Department of Obstetrics and Gynecology, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan
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Effectiveness of a single education and counseling intervention in reducing anxiety in women undergoing hysterosalpingography: a randomized controlled trial. ScientificWorldJournal 2014; 2014:598293. [PMID: 24574902 PMCID: PMC3915489 DOI: 10.1155/2014/598293] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 11/04/2013] [Indexed: 12/03/2022] Open
Abstract
Hysterosalpingography (HSG) is generally considered a stressful and painful procedure; we aimed to evaluate whether a single education and counseling intervention could reduce women's distress and pain after undergoing HSG for infertility. Patients were randomized into control group (n = 108) and intervention group (n = 109). All patients filled the following questionnaires before and after HSG: Zung self-rating anxiety scale (Z-SAS), Zung self-rating depression scale (Z-SDS), and an ad hoc questionnaire designed to evaluate HSG procedure knowledge. Pain was scored using a visual analog scale. The intervention consisted in a 45-minute individualised session 48 h before HSG. We observed a reduction of anxiety and depression scores in the intervention arm compared to the control group. After controlling for potential confounding variables, intervention was an independent predictor of the difference of Z-SAS score before and after HSG. This is the first randomised controlled trial to assess the potential effectiveness of a single education and counseling intervention to lower anxiety in a diagnostic setting.
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Matsubayashi H, Hosaka T, Izumi SI, Suzuki T, Kondo A, Makino T. Increased depression and anxiety in infertile Japanese women resulting from lack of husband's support and feelings of stress. Gen Hosp Psychiatry 2004; 26:398-404. [PMID: 15474640 DOI: 10.1016/j.genhosppsych.2004.05.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2003] [Accepted: 05/26/2004] [Indexed: 10/26/2022]
Abstract
We report that infertile women in Japan as well as in the Western world have high levels of emotional distress, anxiety, and depression. The reasons for anxiety and depression in infertile women are easy to presume but remain unclear. We conducted the present study to assess the relationship between the anxiety and depression of infertile Japanese women and their thought processes and emotional well-being with regard to their infertility. A cross-sectional questionnaire was administered to 101 infertile Japanese women who visited the infertility clinic at Tokai University. Inventories included the Hospital Anxiety and Depression Scale (HADS) and our original infertility questionnaire, which is composed of 22 questions to assess attitudes and emotional status in facing the stigma of infertility. After factor analysis, comparison between the HADS and the infertility questionnaire was made with simultaneous multiple regression analyses. Anxiety and depression in childless Japanese women were significantly associated with lack of husband's support and feeling stress. Our findings should prove useful in designing and implementing psychological support programs for infertile Japanese women. Psychological interventions to relieve or diminish these conditions might have significant therapeutic benefits for women attending infertility clinics in Japan.
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Affiliation(s)
- Hidehiko Matsubayashi
- Department of Obstetrics and Gynecology, Center for Specialized Clinical Science, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan.
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Matsubayashi H, Hosaka T, Izumi S, Suzuki T, Makino T. Emotional distress of infertile women in Japan. Hum Reprod 2001; 16:966-9. [PMID: 11331646 DOI: 10.1093/humrep/16.5.966] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Although recent papers have suggested that psychological factors are implicated in the experience of infertility, few studies have assessed this relationship in a sample of Japanese infertile women. This study was carried out in order to clarify whether Japanese infertile women experience emotional distress. A cross-sectional questionnaire study was performed to assess the psychological states of 101 infertile women compared to 81 healthy pregnant women. The hospital anxiety and depression scale (HADS) and the profile of mood states (POMS) were administered. These questionnaires produced scores for depression/dejection, anxiety, aggression/hostility, lack of vigour, fatigue, tension anxiety, and confusion. The HADS and the POMS scores of infertile women were significantly higher than those of pregnant women, except for fatigue score. Infertile women with positive HADS indicating emotional disorders (39/101, 38.6%) were significantly (P = 0.0008, chi(2) test) more than those of pregnant women (13/81, 16.0%) when the threshold was set at 12/13 of total HADS scores. The HADS scores were not affected by the women's age, duration of infertility, experience of conception, routine tests, and work states. In this Japanese population, infertile women reported higher levels of emotional distress than pregnant women, suggesting psychological support is needed for infertile women.
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Affiliation(s)
- H Matsubayashi
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa, 259-1193, Japan.
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