Hysterosalpingogram – HSG

An HSG (hysterosalpingogram) is an X-ray examination performed for viewing the uterus from inside, the Fallopian tubes and the surrounding area.  It is usually performed on females facing difficulty in achieving pregnancy and confronted with infertility issues.

While performing the examination, a contrast dye is introduced into the uterus using a thin tube. The tube is placed in the uterus through the vagina. As the Fallopian tubes and the uterus are joined together like a curve, the dye will move into the Fallopian tubes.

As the dye moves from the uterus into the Fallopian tubes, fluoroscopic pictures are clicked with the help of stable X-ray beams. In these pictures, the doctor is able to view issues, like unusual shape and size of the uterus or the Fallopian tube structures or an injury. The doctor can also see a blockage that is preventing the movement of an egg via the Fallopian tube into the uterus. Such a blockage may prevent the meeting of the egg and the sperm for the egg fertilization.  The examination may also be helpful in detecting issues in the uterus that is preventing implantation of a fertilized egg in the uterine lining.

Why is HSG performed?

An HSG (hysterosalpingogram) is performed to:

Verifying and confirming a blockage in the Fallopian tubes. The examination is generally performed on the females facing difficulty in achieving pregnancy, despite timely copulation with her male partner. It may be because of an infection that may have caused brutal scarring  in the Fallopian tubes and block the tubes. The condition may prevent the possible pregnancy. In some cases, the pressure exerted by the dye used in the procedure may open the occlusion of the tube.

The procedure is performed for locating issues in the uterus, like unusual structure and shape.  The examination may help in looking for fibroids, polyps, injury, adhesions and alien elements in the uterus.

Such type of issues may result in recurring miscarriages and painful menstrual periods.

The procedure is done for identifying if the intrauterine device (IUD) or the tubal implants used for birth controlling permanently are obstructing the Fallopian tubes. And, also to know if the tubal ligation reversal surgery has been doing well.

Preparing for the Hysterosalpingogram Test:

Before going in for hysterosalpingogram examination, inform your doctor:

  • If you are or may be pregnant
  • If you are having a Pelvic Inflammatory Disease or sexually transmitted infection (SIT) like Gonorrhea or Chlamydia
  • If you are sensitive to the use of iodine dye or other material having iodine element
  • If you are also sensitive to the use of any medication or are confronting asthma
  • If you experienced severe anaphylaxis (allergic reaction) from any material (e.g. Your allergic reaction history of eating shellfish or bee sting)
  • If you have been using medications for thinning your blood, like Coumadin (warfarin) and aspirin or have bleeding issues
  • If you have diabetes and have been taking Glucophage (metformin) for the diabetes or have had kidney issues. The procedural dye may further damage the functioning of the kidneys. Having a past of kidney issues, your doctor may perform blood tests, like blood urea nitrogen and creatinine before the procedure.  He or she may like to ascertain that your kidneys’ working is fine.

The examination is usually performed after the end of your menstrual periods within 2 to 5 days. It is also performed before your ovulation (If ovulation does not take take place, it is known as anovulation) takes place, in case you are not using any contraception. This is for avoiding any harm to the developing fetus of the X-rays in the early stage of pregnancy.

Your doctor may ask you to bring a sanitary pad along for wearing after the procedure. This is required as there is always a possibility of leakage of the X-ray dye accompanied by a small quantity of bleeding.

The doctor may ask you to give your consent for carrying out the procedure by signing in the prescribed form, which declares that you fully understand the involved risks in the procedure and agree to carry it out on you.

Consult your doctor about:

  • The need for the examinations
  • Risks involved
  • The meaning of the results

How is the examination performed?

A hysterosalpingogram procedure is performed by a radiologist in the X-ray wing of a Clinic or a hospital accompanied by a nurse and a technologist. A doctor, particularly infertility specialist, may also lend his or her help for carrying out the procedure.

Before starting the examination, you may be given a tranquilizer for keeping you relaxed during the procedure. You may also be given ibuprofen for relaxing your possible uterine cramping during the examination. You may, perhaps, be asked to remove your lower attire and change into a clinic gown.  For emptying your bladder, you may be asked to visit the cloakroom.  On your return, you may be asked to lie down on the examination table and fold your legs in a stirrup position. The position will help the doctor for observing your genital area closely.

Your treating doctor may place a curvy and smooth device, known as speculum into the vagina for widening the vaginal walls gently. This facilitates the doctor’s viewing of the cervix and the interior vagina. For holding the cervix in place, a clamp known as tanaculum is used. The cervix is cleansed using an unusual soap.

Either a catheter (flexible tube) or a cannula (stiff tube) is placed into the uterus through your cervix. The tubes are used for introducing the X-ray dye into the uterus. In case of the open Fallopian tubes, the dye will spill out of them and flow into the abdomen and get absorbed in the body. In case of blocked Fallopian tubes, the dye may not move through them. During the procedure, the X-ray photos are seen on a computer screen. In case another view is required for getting the confirmation, you are either told to change your position or the examination table is tilted.

After the procedure, the catheter or the cannula, besides the speculum are taken out.  The examination generally takes 15 – 30 minutes.

How the procedure feels?

Most probably, you will experience abdominal cramps during the procedure similar to that of menstrual cramps. The enormity of pain you may experience depending on the issues the doctor detects and undertakes to treat them during the procedure.

Risks involved

Although radiations of lower levels are used in the procedure, you run a risk of harming the sensitive tissues and cells that remain exposed to the radiations. The probability of any harm from the X-rays is usually low if compared to the likely benefits of the procedure.

There is a little probability of developing a pelvic infection after the procedure, e.g.

  • salpingitis and
  • endometritis 
  • Salpingitis

In this condition, your Fallopian tubes, located between the ovaries and the uterus get inflamed. This crops up as a fertility barrier because of the infection developed in the female reproductive system.

Besides infertility, Salpingitis may be the reason of unusual vaginal discharge, fever, cramping and dull pain in the lower abdomen and other symptoms. For treating this condition, antibiotics and, at times, surgery may be required.

  • Endometritis

In the Endometritis condition, the uterine lining develops inflammation because of the infection complication. Indications of endometritis are:

  • Lower abdominal pain
  • Fever
  • Bleeding between the periods

Endometritis occurs because of uterine infection linked to the birth of a child or because of an infection, which multiplies from some other body organ, like the vagina.

Antibiotic treatments generally cleanse the infection and the inflammation within a period of a few days. If left untreated, the infection may penetrate into the bloodstream and serious ailments may develop.

There is an increased probability of developing a pelvic infection, in case it had also happened earlier. To ward off the probability of repeated pelvic infection, your doctor may prescribe you antibiotics in advance.

While undergoing the procedure, there is a little probability of puncturing or damaging the Fallopian tubes or the uterus.

There is a little probability of developing an allergic reaction because of X-ray dye containing iodine. The chances of it will be more if you are sensitive to shellfish.

Although rare, the oil used in the oil-based dye may seep out into the bloodstream causing blood flow blockage to a region of the lungs.  The condition is known as pulmonary embolism. It occurs when a lung artery unexpectedly gets blocked. Such a blockage happens when a leg vein is unfastened by a blood clot preventing movement of blood flow to a pulmonary (lung) artery. The condition is termed as a deadly serious.

But generally, the water-based dyes instead of oil dyes are used in most of the cases.

After the hysterosalpingogram examination

After performing the examination, there is a probability of leaking out some of the dye from vagina. You may also experience some quantity of vaginal bleeding for many days after the procedure. Straight away contact your doctor in case you experience:

  • Fever
  • Vaginal bleeding heavily (If more than one pad or tampon gets soaked in one hour)
  • Severe abdominal pain
  • Bleeding from the vagina lasting more than three-to-four days.

Outcomes

An HSG (hysterosalpingogram) is a procedure that uses X-ray wherein the Fallopian tubes, the interior uterus and their surrounding areas are examined.

Hysterosalpingogram
Normal: The structure of both the Fallopian tubes and the uterus are found normal. The Fallopian tubes are neither damaged nor scarred. The dye moves without restraint from the uterus and via the Fallopian tubes and then drops usually into the abdominal cavity.
No growths or tumors or articles like Intrauterine Device or IUD are viewed in the uterus.
Abnormal: The Fallopian tubes are found to be blocked; deformed or scarred in such a manner that the dye does not move via the tubes does not fall into the abdominal cavity. The blockage  of the Fallopian tubes may have occurred because of the presence of endometriosis or the pelvic inflammatory disease.
The dye may seep out of the uterine wall, suggesting a hole or tear of the uterus.
An unusual uterus may reveal the presence of septum (tissue) that split the uterus.
The presence of fibroids, polyps or other growths.
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