Hysterosalpingogram - HSG - fertility test for tubal patency and normalcy of uterine cavity

Advanced Fertility Center of Chicago
Gurnee & Crystal Lake, Illinois

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Fertility test for tubal patency and normalcy of uterine cavity.

Normal hysterosalpingogram picture
A smooth triangular uterine cavity and spill from the
ends of both tubes are seen
The bones of the pelvis are seen on the x-ray around the edges of the image

What is a hysterosalpingogram?

A hysterosalpingogram is an important test that is part of the basic infertility evaluation.

The HSG test is a radiology procedure usually done in the radiology department of a hospital (or outpatient radiology setting) in which radiographic contrast (dye) is injected into the uterine cavity through the vagina and cervix. The uterine cavity fills with dye and if the fallopian tubes are open the dye will then fill the tubes and spill out into the abdominal cavity. In this way it can be determined whether the fallopian tubes are open or blocked and whether the blockage is located at the junction of the tube and the uterus (proximal) or whether it is at the end of the fallopian tube (distal). These are the two areas where the tube is most commonly blocked. Very successful treatment for tubal factor infertility is available.

There are other things that potentially can be seen on a hysterosalpingogram other that whether the tubes are open or blocked. The uterine cavity is evaluated for the presence of congenital uterine anomalies, polyps, fibroid tumors or uterine scar tissue. The fallopian tubes are also examined for any defects within them, for suggestion of any partial blockage, and for evidence of pelvic scar tissue in the abdominal cavity around the tubes.

What to expect during a hysterosalpingogram

The hysterosalpingogram study only takes about 5 minutes to actually perform. However as the test is usually done in the radiology department of a hospital there is additional time for the woman to register at the facility and fill out a questionnaire and answer some questions regarding allergies to medication etc. The way the test is done is the following:

• The woman lies on the table on her back and brings her feet up into a "frog leg" position.
• The doctor places a speculum in the vagina and visualizes the cervix.
• Either a soft, thin catheter is placed through the cervical opening into the uterine cavity or an instrument called a tenaculum is placed on the cervix and then a narrow metal cannula is inserted through the cervical opening.
• Contrast is slowly injected through the cannula or catheter into the uterine cavity. An x-ray picture is taken as the uterine cavity is filling and then additional contrast is injected so that the tubes should fill and begin to spill into the abdominal cavity. Additional x-rays are taken as this "fill and spill" occurs.
• When both tubes are demonstrated to be patent (or blocked), the woman is usually asked to roll to one side or the other slightly to give a slightly oblique x-ray image which may help to further delineate her anatomy.
•  The procedure is now complete. The instruments are removed from the cervix and vagina. The woman usually remains on the table for several minutes to recover from the cramping which usually accompanies injection of the contrast.
• After several minutes the woman can get dressed and leave the hospital.

The results of the test are immediately available. The x-ray pictures can be reviewed with the woman several minutes after the procedure has been completed if both she and the physician prefer to do this.

Pregnancy rates in several studies have been reported to be slightly increased in the first months following a hysterosalpingogram. This may be due to the fact that the flushing of the tubes with the contrast could open a minor blockage or clean out some debris that may be a factor that is preventing the couple from conceiving. Some of these studies suggest that using oil based contrast provides a greater increase in pregnancy rates after a hysterosalpingogram than does the use of water based contrast.

Complications

Complications associated with a hysterosalpingogram include the possibility of an allergic reaction to the dye, which is uncommon. This usually manifests as a rash, but can rarely be more serious. Pelvic infection or uterine perforation are also possible complications. Both of these are very uncommon.

If a woman has multiple sexual partners or is otherwise at risk for sexually transmitted diseases, she should be screened with cervical cultures before doing an HSG. Some physicians prescribe several days of antibiotics for their patients to attempt to reduce the risk of infection after HSG.

HSG showing multiple "filling defects" in uterine cavity
These represent numerous endometrial polyps
The polyps were then removed by hysteroscopic resection

HSG showing a normal uterus and blocked tubes
No "spill" of dye is seen at the ends of the tubes
Both tubes are also slightly dilated and fluid filled - hydrosalpinx
This woman went on to have successful in vitro fertilization for her tubal infertility

Abnormal study with a collection of dye in a "pocket" at the end of the left tube
Scar tissue (adhesions) are holding the dye in the pocket
Right tube was previously removed at surgery for a tubal pregnancy

Hysterosalpingogram picture showing a uterus with a fibroid (myoma) that is pushing in to the cavity
Another fibroid on the outside of the uterus is circumscribed by dye along the red line
The myoma inside the cavity could cause reproductive problems including infertility, miscarriage, or preterm birth.

Advanced Fertility Center of Chicago | Gurnee, IL (847) 662-1818 | Crystal Lake, IL (815) 356-1818

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