What do systematic reviews say?

Misoprostol vs osmotic dilator before operative hysteroscopy

Misoprostol may leads to higher ease of dilatation: need for mechanical dilatation compared with osmotic dilator before operative hysteroscopy (low certainty).

• Preoperative ripening of the cervix before operative hysteroscopy 2015 · Cochrane Headline outcomes only
  OR 5.96 [2.61, 13.59]
  1 study · 110 participants
  Low

Misoprostol vs osmotic dilator before operative hysteroscopy

Misoprostol showed no clear difference in intraoperative complications compared with osmotic dilator before operative hysteroscopy (low certainty).

• Preoperative ripening of the cervix before operative hysteroscopy 2015 · Cochrane Headline outcomes only
  OR 5.14 [0.24, 109.01]
  3 studies · 354 participants
  Low

Misoprostol vs placebo or no treatment before operative hysteroscopy

Misoprostol probably leads to lower intraoperative complications compared with placebo or no treatment before operative hysteroscopy (moderate certainty).

• Preoperative ripening of the cervix before operative hysteroscopy 2015 · Cochrane Headline outcomes only
  OR 0.37 [0.18, 0.77]
  12 studies · 901 participants
  Moderate

Misoprostol vs placebo or no treatment before operative hysteroscopy

Misoprostol probably leads to lower specific intraoperative complications ‐ Cervical laceration/tear compared with placebo or no treatment before operative hysteroscopy (moderate certainty).

• Preoperative ripening of the cervix before operative hysteroscopy 2015 · Cochrane Headline outcomes only
  OR 0.25 [0.11, 0.57]
  9 studies · 669 participants
  Moderate

Misoprostol vs placebo or no treatment before operative hysteroscopy

Misoprostol probably leads to lower specific intraoperative complications ‐ False track compared with placebo or no treatment before operative hysteroscopy (moderate certainty).

• Preoperative ripening of the cervix before operative hysteroscopy 2015 · Cochrane Headline outcomes only
  OR 0.34 [0.12, 0.97]
  7 studies · 560 participants
  Moderate

Misoprostol vs placebo or no treatment before operative hysteroscopy

Misoprostol showed no clear difference in specific intraoperative complications ‐ Uterine perforation compared with placebo or no treatment before operative hysteroscopy (low certainty).

• Preoperative ripening of the cervix before operative hysteroscopy 2015 · Cochrane Headline outcomes only
  OR 0.42 [0.13, 1.38]
  7 studies · 455 participants
  Low

Misoprostol vs placebo or no treatment before operative hysteroscopy

Misoprostol showed no clear difference in specific intraoperative complications ‐ Uterine bleeding compared with placebo or no treatment before operative hysteroscopy (low certainty).

• Preoperative ripening of the cervix before operative hysteroscopy 2015 · Cochrane Headline outcomes only
  OR 0.51 [0.1, 2.49]
  4 studies · 340 participants
  Low

Misoprostol vs placebo or no treatment before operative hysteroscopy

Misoprostol probably leads to higher side effects compared with placebo or no treatment before operative hysteroscopy (moderate certainty).

• Preoperative ripening of the cervix before operative hysteroscopy 2015 · Cochrane Headline outcomes only
  OR 2.59 [1.15, 5.79]
  4 studies · 272 participants
  Moderate

Misoprostol vs dinoprostone before operative hysteroscopy

Misoprostol may leads to lower ease of dilatation: need for mechanical dilatation compared with dinoprostone before operative hysteroscopy (low certainty).

• Preoperative ripening of the cervix before operative hysteroscopy 2015 · Cochrane Headline outcomes only
  OR 0.58 [0.34, 0.98]
  1 study · 310 participants
  Low

Misoprostol vs dinoprostone before operative hysteroscopy

Misoprostol may leads to lower intraoperative complications compared with dinoprostone before operative hysteroscopy (low certainty).

• Preoperative ripening of the cervix before operative hysteroscopy 2015 · Cochrane Headline outcomes only
  OR 0.32 [0.12, 0.83]
  1 study · 310 participants
  Low

Primary outcome: topical local anaesthetics vs placebo or no treatment

• Pain relief in hysterosalpingography 2015 · Cochrane Headline outcomes only
  no estimate extracted
  9 studies · 613 participants
  Low
• Pain relief in hysterosalpingography 2015 · Cochrane Headline outcomes only
  no estimate extracted
  5 studies · 373 participants
  Very low
• Pain relief in hysterosalpingography 2015 · Cochrane Headline outcomes only
  no estimate extracted
  2 studies · 166 participants
  Very low

Locally injected anaesthetics vs placebo or no treatment

• Pain relief in hysterosalpingography 2015 · Cochrane Headline outcomes only
  no estimate extracted
  2 studies · 125 participants
  Low
• Pain relief in hysterosalpingography 2015 · Cochrane Headline outcomes only
  no estimate extracted
  2 studies · 125 participants
  Low

Opioids vs non‐opioid analgesics

• Pain relief in hysterosalpingography 2015 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 91 participants
  Low
• Pain relief in hysterosalpingography 2015 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 91 participants
  Low
• Pain relief in hysterosalpingography 2015 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 91 participants
  Low

Primary outcome: topical local anaesthetics vs paracervical block

• Pain relief in hysterosalpingography 2015 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 20 participants
  Moderate
• Pain relief in hysterosalpingography 2015 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 20 participants
  Low
• Pain relief in hysterosalpingography 2015 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 20 participants
  Low

Primary outcome: topical local anaesthetics vs non‐opioid analgesics

• Pain relief in hysterosalpingography 2015 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 100 participants
  Very low

Primary outcome: topical local anaesthetics vs non‐opioid analgesics

• Pain relief in hysterosalpingography 2015 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 100 participants
  Very low

Oral opioid analgesics vs placebo or no treatment

• Pain relief in hysterosalpingography 2015 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 128 participants
  Low
• Pain relief in hysterosalpingography 2015 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 128 participants
  Moderate

Intravenous opioid analgesics vs placebo or no treatment

• Pain relief in hysterosalpingography 2015 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 62 participants
  Moderate

Oral non‐opioid analgesics vs placebo or no treatment

• Pain relief in hysterosalpingography 2015 · Cochrane Headline outcomes only
  no estimate extracted
  3 studies · 133 participants
  Low
• Pain relief in hysterosalpingography 2015 · Cochrane Headline outcomes only
  no estimate extracted
  2 studies · 45 participants
  Very low
• Pain relief in hysterosalpingography 2015 · Cochrane Headline outcomes only
  no estimate extracted
  3 studies · 133 participants
  Low

Long protocol vs short protocol

Long protocol showed no clear difference in live birth or ongoing pregnancies per woman randomised compared with short protocol (low certainty).

• Gonadotrophin‐releasing hormone agonist protocols for pituitary suppression in assisted reproduction 2015 · Cochrane Headline outcomes only
  OR 1.3 [0.94, 1.81]
  12 studies · 976 participants
  Low