Predictive Factors for the Severity of Procedure-Associated Pain in Infertile Women Undergoing Hysterosalpingography in Bayelsa State, South-South Nigeria

Background: Hysterosalpingography is the most commonly used investigative modality for the evaluation of tubal patency. It is cheap, readily available and reliable. However, its main drawback is associated pain.

Objective: To determine the predictive factors for the severity of procedure-associated pain in infertile women undergoing hysterosalpingography.

Materials and Methods: This prospective, descriptive, cross-sectional study was conducted at the infertility clinics and radiology departments of the Federal Medical Centre, Yenagoa and Niger Delta University Teaching Hospital, Okolobiri, both in Bayelsa State, Nigeria, between July, 2021 and February, 2022. Hysterosalpingography was done after written informed consent by the patient. The Visual Analogue Scale and Numerical Rating Scale were used to grade pain levels during and after the procedure, respectively. Data were analysed using Statistical Product and Service Solutions for Windows®, version 25. Results were presented in frequencies and percentages for categorical variables, and mean and standard deviation for continuous variables. Student’s t-test was used to compare sample means, and Chi-square, for testing associations.

Results: The odds of experiencing pain increased with increasing age (Crude OR = 3.48 – 5.34; p = < 0.05). Women with tertiary level of education were three times more likely to report pain (Crude OR = 3.58; p = 0.029) than those with primary level of education. Parity (ꭓ2 = 19.85; p – 0.001), type of infertility (ꭓ2 = 5.93; p = 0.015) and duration of infertility (ꭓ2 = 11.08; p = 0.004) had significant relationships with the severity of pain perception. Dysmenorrhoea (Crude OR = 1.99; p = 0.001) was also significantly associated with pain perception. Pain was two times more likely to be experienced by women with abnormal hysterosalpingography findings.

Conclusion: Our study established that the predictors of pain perception in hysterosalpingography were age, level of education, duration of marriage, duration of infertility, parity, number of children, type of infertility, dysmenorrhoea and abnormal findings on hysterosalpingography.