Hysterosalpingography

The hysterosalpingogram is the primary screening test for the female reproductive anatomy. The test consists of the injection of liquid dye into the uterine cavity during x-ray imaging. The dye demonstrates the shape of the uterine cavity and, if the fallopian tubes are open, follows the dye as it spills from the fallopian tubes. Once the dye spills from the tubes, the manner in which it spreads through the abdomen can provide information regarding the presence or absence of adhesions or scarring around the tubes.

FREQUENTLY ASKED QUESTIONS

Q. How exactly is the procedure performed?
A. You lie on a firm examining table, with your hips elevated by a pillow or two towels. Alternatively, some tables have installed stirrups.

  1. A speculum is inserted into the vagina

  2. The cervix and vagina are dabbed with an antiseptic

  3. A small amount of local anesthetic is injected into the cervix. (This does not hurt)

  4. A clip is placed on the numbed area of the cervix and a catheter inserted into the cervix.

  5. The speculum is removed

  6. The fluoroscope (x-ray device) is placed over the abdomen

  7. The dye is slowly injected into the uterus and x-ray images are recorded.

  8. As the dye spills from the fallopian tubes, you may be asked to lean to one side or the other.

  9. When the initial x-rays are complete, the instruments are removed.

  10. You may be asked to roll complete 360 degree turn prior to a final x-ray.

Q. What are the risks of the procedure?
A. Approximately 1% of people will develop an infection. Rarely these infections can be quite serious, requiring hospitalization for intravenous antibiotics.

Q. Can I have an allergy to the dye?
A. Yes. If you have had a previous allergic reaction to intravenous contrast material you should let your doctor know this in advance. In addition, if you have had strong allergic responses to shellfish, let your doctor know.

Q. Is the HSG done at any particular time of the cycle?
A. We prefer to perform the test after the menstrual flow ad stopped but before ovulation, usually day 5-10 of the cycle.

Q. What about taking antibiotics prior to the procedure?
A. There are two conditions that require consideration of antibiotics. The first is mitral valve prolapse, or any heart valve abnormality. The other is a prior history of pelvic inflammatory disease.

Q. I have heard that this test is exceptionally painful. Is this true?
A.

  1. Like any invasive procedure, the HSG can be uncomfortable. However, there are steps that we can take to eliminate or minimize this discomfort. These include:

  2. Prescribing or recommending an analgesic an hour prior to the procedure. Ibuprofen is the most common (Advil, Motrin etc.)

  3. Injecting a small amount of local anesthesia (Lidocaine or Novocain) into the cervix prior to attaching any instruments

  4. Injecting the dye very, very slowly

  5. Not trying to force the dye into the cavity if it appears that the fallopian tubes are blocked. Forcing the liquid this way causes the uterus to expand and causes terrible cramping.

  6. Waiting 2-3 minutes if the tubes do not open immediately to allow for the passage of a tubal spasm, an involuntary temporary closure of the tubes due to the presence of the dye in the uterus.

Q. Does the HSG cure infertility? I have heard that many women conceive during the first month after the procedure.
A. To the best of our knowledge, the HSG does not enhance fertility. Some women `o conceive after an HSG, although the cause-and effect relationship has not been established. Some have claimed that using an oil-based instead of a water-based dye can increase fertility during the months immediately after the procedure although this too is unproved.

Q. My HSG is normal. What does that mean?
A. It tells us:

  1. That the shape of your uterine cavity is normal.

  2. The fallopian tubes are open. Nothing inside the tubes will block passage of the egg and sperm, or movement of the fertilized egg (the embryo) to the uterus.

  3. There are no obvious areas of adhesion or scarring in the abdomen.

It does not tell us:

  1. That the uterine lining develops correctly each month

  2. That a subsequent pregnancy will go to term

  3. Whether or not the tubes may be stuck to the uterus other pelvic organs in a way that might compromise fertility

  4. Anything about the ovaries

Q. My HSG showed an abnormal cavity. What is the next step?
A. Depending on the abnormality, the next step may be an ultrasound examination, an MRI scan, or a hysteroscopy.

Q. My HSG showed blocked tubes. What is my next step?
A. Depending on the abnormality, the next step may be surgery or in vitro fertilization. If only one tube is blocked, the next step may be to ignore the blocked tube and treat any other fertility factors that were found.

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