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DOI:10.2214/AJR.07.0194
AJR 2007; 189:W49
© American Roentgen Ray Society

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João F. L. de Mello, Sr., Mauricio S. Abrao and Giovanni G. Cerri

University of São Paulo School of Medicine São Paulo, Brazil



 
WEB—This is a Web exclusive article.

We thank Dr. Silberzweig [1] for his comments related to our article. He points out the importance of the location of the balloon insufflation for the high incidence of pain or discomfort experienced in the catheter group. In his explanation, he considers the internal cervical os as part of the uterine isthmus.

This parameter was not controlled in our study, but some aspects of the group and the technique need to be taken into consideration: We had a high incidence of secondary infertility [2]: around one third of the group [3]. The most important reason for the failure of the cervical location, in our experience, is previous normal delivery; therefore it is also possible that the location of the isthmus balloon may frequently have been too high.

We would first try to locate and insufflate the balloon in the cervical canal (even in the case of patients with a previous normal delivery). If the balloon were not firmly located [3], we would introduce it a little further into the uterine isthmus.

Because of the above reasons, we think our results would not change even in the light of Dr. Silberzweig's information, making further studies necessary to confirm this hypothesis. However, we recommend avoiding insufflating the balloon in the uterine isthmus in future examinations.


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 References
 

  1. Silberzweig JE. Incidence of pain during hysterosalpingography using a balloon catheter. (letter) AJR2007; 189:W48[Free Full Text]
  2. Nachtigal RD. International disparities in access to infertility services. Fertil Steril 2006;85 : 871-875[CrossRef][Medline]
  3. de Mello JFL Sr, Abrao MS, Cerri GG, Barros N. Evaluation of pain in three hysterosalpingography techniques: metal cannula with and without paracervical blockage and balloon catheter. AJR2006; 187:86 -89[Abstract/Free Full Text]

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This Article
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