The Hysterosalpingogram (HSG) Uncovered



What is a Hysterosalpingogram?


A Hysterosalpingogram (HSG) is a special fluoroscopic x-ray procedure operated in order to evaluate the openness of the fallopian tubes as well as the shape of the uterine cavity. This test usually takes less than 5 minutes, the doctor operates this test, in general, after a woman’s period since she is less likely to get pregnant during that time. The test will be made during the first half of the cycle between day 1 and day 14.


What Makes HSG Helpful?


HSG is a crucial diagnostic element of the basic infertility evaluation as the main reason for infertility is blocked fallopian tubes. Other explanations for HSG may also involve repeated miscarriages, abnormal vaginal bleeding or some uterine abnormalities. 


Does a Hysterosalpingogram Boost Fertility?


It is questionable whether this procedure boosts fertility or not. Some studies suggest a minor increase in fertility that lasts around 3 months after undergoing an HSG test. 


What are the Preparations for HSG?

A woman might be advised to take pain medication an hour before having an HSG test. She may also need to take an antibiotic, depending on the doctor’s recommendations. She will be able to go by herself or even driving her car after the procedure, however, it would be better if a friend or a family member drive her home. 


How is the HSG Performed?


HSG is an outpatient procedure that takes less than half an hour. It is made in the follicular phase of the menstrual cycle (right before ovulation) after the stop of the menstruation. A thin needle (catheter) is inserted inside the cervix and uterus to grant access to the injection of the radio-opaque contrast media. 


What are the Benefits of HSG?


HSG can affirm if there are abnormalities in the uterus or fallopian tubes that reduce fertility. A tubal disease such as adhesions or scar tissue is the major reason causing around 20% of infertility cases. As a matter of fact, some studies have suggested increased rates of pregnancy for women who have undergone an HSG procedure. This may happen simply because of the fact that when the contrast medium is injected into the uterus and fallopian tubes by a catheter, the flow of dye displaces anything that is blocking them. 


What are the Risks?


HSG is quite safe, but all the procedures include some risks. Some women may have issues if they have an allergic reaction to the dye. Not to mention, pelvic infection or some injuries in the uterus can also happen. A woman should contact her doctor right away if she has any of the following symptoms, such as:

  • Severe pain
  • Cramps in the abdomen
  • Vaginal discharge 
  • Vomiting
  • Heavy bleeding in the vagina
  • Fever
  • Feeling dizzy
  • Spotting; it could happen for 1 or 2 days right after the procedure 
  • Fainting; women may get light-headed after the procedure
  • Radiation exposure is very low and has not shown to cause any harm. However, if pregnancy is suspected, the HSG should not be operated. 

What are the Common Uses of the HSG Procedure?


Hysterosalpingography is mainly used to check women who have trouble getting pregnant by helping the radiologist evaluate the shape of the uterus and the opening of the fallopian tubes and monitoring the effects of tubal surgery including: 

  • Blockage in the fallopian tubes because of the scarring
  • Tubal ligation
  • The re-opening of the fallopian tubes following sterilization blockage

What are the Safety Tips before Hysterosalpingogram Test?


  • Women should tell their doctors about any allergies
  • If they are going to the hospital alone, leave their valuables at home
  • They should bring a list of their current medications


Preparation for the Procedure


  • The test should take place after the beginning of the last menstrual bleeding.
  • Women should arrive 15 minutes earlier before the scheduled time


During the Procedure


  • The procedure’s duration will vary, but there is an average of 45 minutes.
  • The technologist will position the patient on the exam table.
  • The technologist and radiologist will be available to answer any questions.


After the Procedure


  • Some patients may experience vaginal spotting and pelvic cramps for 1 day after the procedure


Will there be any Pain as a Side Effect from the HSG Test?


Women may have mild to moderate cramps during the HSG procedure; however, in some rare cases, some women suffer from severe pain. Another possible side effect is having an allergic reaction to the dye itself. 

Is HSG Radiation Safe?


In general, when having an x-ray, the first thing that the technician does is covering up the patient’s pelvic area. HSG involves a limited amount of radiation which has not been found to cause any harmful effects. 


What to Expect after HSG?


After the HSG test, the patient should recover quickly and get back to her normal life activities the following day. If any of the side effects become severe, she should contact the doctor immediately. While undergoing an HSG test may be a little exhausting experience. Some women can find out that they become pregnant naturally so soon right after their HSG test. 


What’s the difference between a hysterosalpingogram (HSG), a hysteroscopy and a sonohysterogram?


There are some similarities between the three terms that can be a little bit confusing. First of all, a hysteroscopy checks the uterine cavity with an endoscope. This procedure usually uses a general anesthetic and in some cases, the procedure can be more difficult for the woman than HSG. Hysteroscopy has broadly been replaced by the sonohysterogram, which is also called a hysterosonogram (HSN). 

Are there Other Options?


Laparoscopy can also identify if tubes are open, using a procedure called chromopertubation. Sonohysterosalpingogram (SHG) is an alternative procedure to evaluate tubal patency. For SHG, a catheter (tiny needle) is inserted inside the uterus through the vagina and saline and air are injected. 


What to do Next if the Tubes are Blocked?

If the tubes are blocked, the patients are usually recommended to undergo either a surgical procedure to check the tubes or to omit the tubes and perform in vitro fertilization (IVF). 

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