Hysterosalpingography

Alternate names
HSG

What is a Hysterosalpingogram?
Hysterosalpingography is a special form of X-ray examination in which dye (contrast) is used to fill the uterus and fallopian tubes. This is done to view and assess their anatomy and function. This procedure is performed on special X-ray equipment called fluoroscopy, where the radiologist can view the images while the procedure is taking place. The radiologist is a medical doctor specifically trained for performing and reporting on all forms of medical imaging-CT scan, MRI, X-rays, etc.

Common uses:
Hysterosalpingography is primarily used to evaluate women who have difficulty becoming pregnant or have recurrent abortions. The uterus is evaluated for its shape and structure. Potential birth abnormalities and fibroids which may predispose a woman to recurrent abortions or infertility can be identified. It also assesses the openness of the fallopian tubes and looks for dye spillage into the peritoneal (abdominal) cavity. Tubal blockage, mostly secondary to previous infections, is the most common cause of infertility in a woman.

How should I prepare?
Hysterosalpingography is performed one week after menstruation, but before ovulation to ensure that patients are not pregnant during the examination. If you have untreated pelvic infections or sexually transmitted diseases, be sure to tell your doctor. In that case you should not have the examination, as it would worsen the infection. On the night before the procedure, you may be asked to take a laxative so that the uterus and surrounding structures can be seen clearly. Prior to the procedure you may be given a mild sedative or over-the-counter medication to minimize any potential discomfort. Some physicians prescribe an antibiotic prior to and/or after the procedure. You will be given a gown to wear during the examination. You may also be asked to remove jewellery, belts and any metal objects or clothing that might interfere with the X-ray images.

How is the procedure performed?
The patient is positioned on her back on the fluoroscopy table with her feet up in stirrups. A speculum is inserted into the vagina and a fine catheter is then inserted into the cervix. Once the catheter is in the right position, the speculum is removed and the patient is positioned underneath the fluoroscopy device. The contrast material is injected through the catheter to fill the uterine cavity and look for spillage from the tubes. Fluoroscopic images are taken during the procedure. In some cases delayed images may be needed. The catheter is removed once the procedure is complete. The hysterosalpingogram is usually completed within 30 minutes.

Risks:
This procedure is associated with mild discomfort. Most patients complain of lower abdominal pain when the contrast spills into the peritoneal cavity. There might also be mild discomfort when the speculum and the catheter are inserted. The trick is to relax as much as you can, as this will make the insertion of the catheter easier.

As mentioned before, the procedure could cause an abortion in the case of pregnancy and worsen pre-existing untreated infections.

Limitations:
Although this procedure is associated with very little radiation exposure, your doctor will ensure that it is kept to a minimum.HSG is not effective for the evaluation of ovarian problems, endometriosis and male causes of infertility.