Complementary and alternative medicine use in infertility: cultural and religious influences in a multicultural Canadian setting.

OBJECTIVES: To explore the use of complementary and alternative medicine (CAM) for infertility in a multicultural healthcare setting and to compare Western and non-Western infertility patients' reasons for using CAM and the meanings they attribute to CAM use. DESIGN: Qualitative semi-structured interviews using thematic analysis. SETTINGS/LOCATION: Two infertility clinics in Montreal, Quebec, Canada. PARTICIPANTS: An ethnoculturally varied sample of 32 heterosexual infertile couples. RESULTS: CAM used included lifestyle changes (e.g., changing diet, exercise), alternative medicine (e.g., acupuncture, herbal medicines), and religious methods (e.g., prayers, religious talismans). Patients expressed three attitudes toward CAM: desperate hope, casual optimism, and amused skepticism. PARTICIPANTS' CAM use was consistent with cultural traditions of health and fertility: Westerners relied primarily on biomedicine and used CAM mainly for relaxation, whereas non-Westerners' CAM use was often influenced by culture-specific knowledge of health, illness and fertility. CONCLUSIONS: Understanding patients' CAM use may help clinicians provide culturally sensitive, patient-centered care.

A randomized trial of outpatient hysteroscopy with and without intrauterine anesthesia.

STUDY OBJECTIVE: To evaluate the amount of pain during office hysteroscopy and endometrial biopsy with and without intrauterine anesthesia. DESIGN: Prospective randomized study (Canadian Task Force classification I). SETTING: Academic teaching center. PATIENTS: A total of 82 women underwent outpatient hysteroscopy for evaluation of their uterine cavity. INTERVENTIONS: Randomization to local cervical or combined cervical and intrauterine anesthesia. MEASUREMENTS AND MAIN RESULTS: Amount of pain experienced during the procedure; 10, 30, and 60 minutes after the procedure; and during endometrial biopsy. We used a visual analog scale ranging from 0 to 10 (0: no pain, 10: excruciating pain). Of 82 patients, 4 patients were excluded, 36 patients underwent hysteroscopy using local cervical anesthesia, and 42 others with combined cervical and intrauterine anesthesia. The mean age of the patients in the local group was 37.4 +/- 0.8 years and in the combined group was 38.3 +/- 0.7 years. In both groups, patients experienced significantly more pain during and 10 minutes after the procedure than 30 and 60 minutes after. No significant differences occurred in the pain scores during the hysteroscopy, and 10, 30, and 60 minutes after between the 2 anesthesia groups. The pain score in the local group during endometrial biopsy was significantly higher than during (p <.05), 10 minutes after (p <.001), 30 minutes after (p <.001), and 60 minutes after (p <.001) the procedure, respectively. In the combined group, compared with the pain score during endometrial biopsy, the scores during the hysteroscopy (p <.05), 10 minutes after (p <.01), 30 minutes after (p <.001), and 60 minutes after (p <.001) the procedure were also less, respectively. CONCLUSION: Intrauterine anesthesia with medicated saline as a distending medium is ineffective. Endometrial biopsy is associated with more pain than hysteroscopy.

A randomized trial comparing local intracervical and combined local and paracervical anesthesia in outpatient hysteroscopy.

STUDY OBJECTIVE: To compare the amount of pain during and after hysteroscopy using local intracervical and combined local and paracervical anesthesia. DESIGN: Prospective randomized trial (Canadian Task Force classification I). SETTING: University teaching hospital. PATIENTS: Eighty-four women who underwent outpatient hysteroscopy for evaluation of the uterine cavity at McGill University Health Center. INTERVENTIONS: Randomization to local intracervical or combined local and paracervical anesthesia. MEASUREMENTS AND MAIN RESULTS: Amount of pain experienced during the procedure and at 10, 30, and 60 minutes after the procedure was measured using a visual analog scale ranging from zero to 10 (zero = no pain; 10 = excruciating pain). The mean age of the patients in the local anesthesia group was 36.1 +/- 0.7 years and in the combined local and paracervical anesthesia group was 35.2 +/- 0.7 years. Patients experienced significantly more pain during than after the procedure. The mean pain scores in the local anesthesia group were significantly higher than in the combined anesthesia group during the procedure (3.2 +/- 0.3 vs 2.1 +/- 0.2; p <.01; 95% CI 0-2), 10 minutes after the procedure (1.9 +/- 0.2 vs 1.5 +/- 0.3; p = .03; 95% CI 0-1), and 30 minutes after the procedure (1.7 +/- 0.2 vs 1.0 +/- 0.2; p = .02; 95% CI 0-1). However, there was no significant difference in pain scores at 60 minutes after the procedure between the local anesthesia and combined anesthesia groups (0.9 +/- 0.2 and 0.7 +/- 0.1, respectively). CONCLUSIONS: Outpatient hysteroscopy with local or combined local and paracervical anesthesia was well tolerated by patients. However, combined anesthesia was associated with less pain during and at 10 and 30 minutes after the procedure. Most patients considered the pain as mild.

A randomized study of laparoscopic chromopertubation with lipiodol versus saline in infertile women.

Eighty-eight infertile patients undergoing laparoscopy were randomized to undergo chromopertubation with lipiodol or with normal saline. The cumulative probability of conception at 1, 3, and 6 months following laparoscopy was not statistically different between the lipiodol group (21%, 31% , and 43%, respectively) and the saline group (18%, 21%, and 33%, respectively).