Hysterosalpingography

Hysterosalpingography, or HSG, is an x-ray examination of a woman’s uterus and fallopian tubes after a dye is injected.  The procedure is often used to verify that the fallopian tubes are blocked after the Essure procedure or try to find the medical reasons for a woman’s infertility, or repeated miscarriages.  Hystero means uterus and salpingo means tubes, so hysterosalpingography literally means to take pictures of the uterus and fallopian tubes. HSG is a special type of x-ray procedure that uses fluoroscopy and a dye or contrast material that makes it possible to see internal organs in motion.  A fluoroscope is a device that projects x-ray images in a movie-like sequence onto a screen monitor.  In this procedure, the uterus and fallopian tubes are filled with a harmless contrast material which enables the physician to see and assess their ability to function correctly.

When is HSG Used?

Hysterosalpingography is primarily used to examine women who have difficulty becoming pregnant by allowing the physician to observe the shape and structure of the uterus, as well as the openness of the fallopian tubes.  The fallopian tubes are the two tubes extending from the uterus to the ovaries, providing a path by which the egg can travel from the ovary to the uterus during ovulation.  If the path is blocked, it will be impossible for the woman to become pregnant naturally.Besides indicating the openness of the fallopian tubes, HSG is used to monitor the effects of tubal surgery, including:

• blockage of the fallopian tubes due to infection or scarring
• tubal ligation
• the closure of the fallopian tubes in a sterilization procedure (Essure)
• the re-opening of the fallopian tubes following a sterilization or disease-related blockage

HSG can also be used to investigate a cause of repeated miscarriages that result from abnormalities of the uterus and to determine the presence and severity of these abnormalities, including:

• tumors or masses
• adhesions
• uterine fibroids

Preparing for the Procedure

The HSG procedure is best performed one week after menstruation but before ovulation so that the woman can be certain that she is not pregnant during the exam.   It should also not be performed on a woman who has an active inflammatory condition, such as a chronic pelvic infection or an untreated sexually transmitted disease. Prior to the procedure, the woman may be given a mild sedative or pain medication to minimize any potential discomfort.  Some physicians also prescribe an antibiotic prior to and/or after the procedure. 

The Procedure

This examination is usually done in the physician’s office on an outpatient basis.The patient is positioned on her back on the exam table, with her knees bent or her feet held up with stirrups.  At this point, a local anesthetic may be injected into the end of the cervix.  A device called a speculum is inserted into the vagina in order to hold the walls of the vagina apart, allowing a view of the cervix.The cervix is cleaned, and a thin tube is then inserted into the cervix. The speculum is removed and the fluoroscopy device is positioned over the abdomen. Through the thin tube, called a catheter, the contrast material fluid begins to fill the uterus and fallopian tubes. Fluoroscopic images are then taken.  The patient may be asked to change positions several times for different angles for the x-rays.In some cases, if certain abnormalities are encountered, the patient will be asked to rest and wait up to 30 minutes so that a delayed image can be obtained.  This delayed image may provide clues to a patient's condition that the original images with contrast material do not. When the procedure is complete, the catheter will be removed and the patient will be allowed to sit up.  She is usually asked to wait until the radiologist determines that no further images are needed.

After The Test

After the test, minor side effects often occur.  Some of the side effects may include:

• Cramping
• Dizziness or nausea
• Vaginal bleeding
• A vaginal discharge may result if some of the dye used in the procedure leaks out of the vagina Vaginal bleeding can continue for several days after the test.  However, some more severe symptoms may require a physician’s care. 

Call your healthcare provider immediately if you have:

• Heavy vaginal bleeding - using more than one tampon or pad in one hour – or bleeding that lasts for more than 3 or 4 days.
• Fainting, vomiting, fever or chills.
• Severe abdominal pain.

Remember

HSG is used to detect problems with the uterus and fallopian tubes.  It is a diagnostic tool that aids the physician in assessing reproductive problems and recommending the best course of treatment in each case.