194 Chapter 9 IV. What is the frequency and what are the consequences of complications during and after an HSG with oil-based contrast used in infertile patients? The review we performed to answer this question was presented in Chapter 5. After thorough examination of all published literature since the 1920’s regarding the use of HSG for infertility, the most reported complication was found to be intravasation of contrast, with a pooled overall frequency of 2.7% (95%CI 1.7 – 3.8). This complication led to serious consequences in four cases , out of the 19,339 HSG procedures that were reported in literature. The second most reported complication is infection, occurring in 0.9% of all reported HSG’s with oil-based contrast (95% CI 0.47 – 1.50) and 1.9% after HSG with water-based contrast (95% CI 0.27–4.60). Another complication of interest relates to the iodinecontent of the used HSG contrast. Women with previous subclinical hypothyroidism are more prone to developing overt hypothyroidism after HSG, with a prevalence of 35.7% versus 0–2.2% in euthyroid women (7). Two studies investigated thyroid function in offspring born after an HSG (8, 9). The first, a Japanese studie, showed abnormal neonatal thyroid screening in 2.4% of the children born after HSG. A retrospective analysis of the Dutch children born to mothers that had participated in the H2Oil study showed no abnormalities at the heel prick screening test in the first week after birth. Seven reports were identified that described fatal sequelae of an HSG in infertility, all between 1928 and 1950. The presumed causes of death were infection (prior to standard availability of antibiotics) and allergy. We concluded that safety concerns should not be a reason to withhold tubal flushing with oil-based contrast during HSG in women facing infertility. B. Improving HSG experience The HSG is known to be an uncomfortable and/or painful procedure, and analgesia that is both effective and appropriate is lacking (10). Virtual Reality (VR) is emerging as an alternative to traditional pharmacological analgesics. It diverts attention away from physical sensations by bringing the user into a virtual world (11). Its effectiveness has been proven in medical procedures in various fields (12). This led to the following research question: Can Virtual Reality reduce pain or discomfort during and after HSG?
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