131 VR for pain relief in HSG 6 Limitations, reasons for caution The study was not blinded. Reasons for study decline were anxiety or wanting full control during HSG, which might have created selection bias. The distraction score possibly indicates that the level of immersiveness during Virtual Reality was not optimal due to the lack of sound and/or the type of VR applications. Future studies should investigate whether more immersive or interactive Virtual Reality applications decrease pain scores during HSG. Wider implications of the findings Virtual Reality does not reduce pain during HSG, and should therefore not be used. Study funding/competing interest(s) All authors have no conflict of interest related to this manuscript. The department of reproductive medicine of the Amsterdam UMC location VUmc has received several research and educational grants from Guerbet, Merck and Ferring not related to the submitted work. Trial registration number The trial was registered prospectively in the Netherlands Trial Register (trialregister.nl, currently accessible on trialsearch.who.int), with corresponding registration number NL9203. Trial registration date 16-01-2021 Date of first patient’s enrolment The first participant was enrolled on January 19th 2021.
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