Abstract
<title>Abstract</title> <p>Objective Different techniques have been developed to optimize hysterosalpingography (HSG) methodology. Our aim is to compare the advantages and disadvantages of these three different techniques in terms of both patient satisfaction and clinician’s interpretation. Methods In a total of 251 infertile cases undergoing HSG, n = 158 for metal cannula, n = 50 for active balloon, and n = 43 for passive balloon groups were formed. All HSG scans included in the study were performed and assessed by the same physician. Results The procedural time did not differ between the groups. The amount of contrast agent used was greater in the metal cannula group. The VAS score noted after the procedure did not differ. Pain assessment score based on the patient’s verbal and physical behavior during the procedure, which is evaluated by the gynecologist, was higher in the metal cannula group. Overall, the most painful phase was the contrast agent distribution phase. Clinicians were able to clearly assess the uterine margins (86.7%), uterine cavity (85.4%), and uterine isthmus (75.9%) with high accuracy in the metal cannula group. The patency of the fallopian tubes was assessed with equal accuracy within groups. Conclusion When premedicated, pain scores do not differ based on the methodology of HSG. The balloon catheter technique has significant disadvantages including difficulty in application due to uterine position, high cost, and the negative impact of the balloon's location in the isthmus on image quality. The best image quality seems to be obtained with the metal cannula method. Trial Registration: This study was registered to the ClinicalTrials.gov on 2026-04-25 as the “MethodHSG Study” and assigned with the identifier which is NCT07583758.</p>