What are the recommended management and follow-up instructions for a patient experiencing discomfort, cramping, pelvic tenderness, and bleeding after a tubal patency scan as part of her In Vitro Fertilization (IVF) process?

Management of Post-Tubal Patency Scan Discomfort

The patient's symptoms of cramping, pelvic tenderness, and bleeding after a tubal patency scan are expected normal responses, and she should be managed with NSAIDs for pain control, rest for the day, and reassurance with clear instructions on warning signs that would require urgent evaluation. 1, 2

Immediate Pain Management

First-line analgesia should be NSAIDs taken with food:

• Naproxen sodium 550 mg every 6-8 hours with food for the next 24-72 hours 3, 4
• Alternative: Ibuprofen 600-800 mg every 6-8 hours with food if naproxen is unavailable 3, 4
• NSAIDs should be combined with adequate hydration to support kidney function 3

Adjunctive non-pharmacological measures:

• Heat therapy applied to the abdomen or lower back to reduce cramping 3
• Acupressure on "Large Intestine-4" (LI4) point on the dorsum of the hand or "Spleen-6" (SP6) point above the medial malleolus for additional pain relief 3, 4
• Rest in a comfortable position with legs elevated if needed 5

Expected Post-Procedure Course

Normal symptoms that should resolve within 24-48 hours:

• Mild to moderate cramping similar to menstrual cramps 4, 2
• Light vaginal bleeding or spotting 1
• Pelvic tenderness that improves with rest and analgesia 2
• Most patients (75%) experience absent or tolerable pain after tubal patency testing 1

Work Excuse and Activity Restrictions

The medical certificate for the day is appropriate because:

• Post-procedure discomfort and cramping are legitimate reasons for temporary work absence 5
• Patients should be allowed to decide whether to return to work or take time off based on their comfort level 5
• Rest facilitates recovery and allows symptoms to resolve 4

Activity recommendations:

• Resume normal activities when comfortable, typically within 24-48 hours 4
• Avoid strenuous physical activity for the remainder of the day 5
• Sexual intercourse can be resumed when comfortable, generally after a few days 4

Red Flag Symptoms Requiring Urgent Evaluation

Instruct the patient to seek immediate medical attention if she develops:

• High fever >38°C (100.4°F) within days following the procedure, which could indicate infection 4
• Severe pelvic pain that does not improve with NSAIDs or progressively worsens 4
• Heavy vaginal bleeding (soaking through more than one pad per hour) 4
• Unusual or foul-smelling vaginal discharge suggesting infection 4
• Persistent nausea, vomiting, or inability to tolerate oral intake 5

Follow-Up Instructions

Routine follow-up:

• No specific follow-up is required if symptoms resolve as expected within 24-48 hours 1, 2
• Patient should contact her fertility clinic if symptoms persist beyond 48 hours 2
• Continue with scheduled IVF process as planned once symptoms resolve 1

Important Clinical Context

HyFoSy (tubal patency scan) is generally well-tolerated:

• Studies show 75% of patients experience absent or tolerable pain during and after the procedure 1
• HyFoSy is considered less painful than traditional hysterosalpingography and typically does not require analgesics 2
• The procedure does not require routine prophylactic antibiotics in low-risk patients 2

Common pitfall to avoid:

• Do not minimize the patient's pain experience, as this can lead to feelings of mistrust 5
• Validate her symptoms while providing reassurance that they are expected 5
• Ensure she understands the difference between normal post-procedure discomfort and warning signs of complications 4