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

What is a hysterosalpingogram?

A hysterosalpingogram, or HSG is an important test of female fertility potential.

The HSG test is a radiology procedure usually done in the radiology department of a hospital (or outpatient radiology facility). 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 fill the tubes and spill into the abdominal cavity.

This determines if the fallopian tubes are open or blocked and whether the blockage is located at the junction of the tube and uterus (proximal) or whether it is at the other end of the fallopian tube (distal). These are the areas where the tube is most commonly blocked. Very successful treatment for tubal factor infertility is available.

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

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 defects within them, for suggestion of partial blockage, and for evidence of pelvic scar tissue in the abdominal cavity near 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. More x-ray pictures are taken as this "fill and spill" occurs.
• When both tubes spill dye, the woman is often asked to roll to one side or the other slightly to give a slightly oblique x-ray image which can further delineate the anatomy.
•  The procedure is now complete. The instruments are removed from the cervix and vagina.
• The woman usually remains on the table for a few minutes to recover from the cramping caused by injection of the contrast.
• The results of the test can be immediately available. The x-ray pictures can usually be reviewed with the woman several minutes after the procedure is done.

Does having a dye test improve the chance for getting pregnant?

Some studies suggest that using oil based contrast provides a slightly larger increase in pregnancy rates than does use of water based contrast. However, the large majority of HSGs are done with 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 might be screened with cervical cultures before doing an HSG. Some physicians prescribe several days of antibiotics to reduce 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 uterus with a fibroid that is pushing in to the cavity
Another fibroid on the outside of the uterus is circumscribed by dye along the red line
Fibroids inside the cavity can cause infertility, miscarriage or preterm birth

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