Hysterosalpingography is a type of X-ray used to examine a woman’s uterus and fallopian tubes. Uterine abnormalities are one of the many reasons for women experiencing problems with conceiving. This X-ray procedure helps the doctor diagnose if there are any underlying uterine abnormalities. Read this post to understand how hysterosalpingography is done, contraindications for the procedure, what to expect after the procedure. We also discuss the complications, alternatives, and limitations of this procedure.
What Is Hysterosalpingography?
Hysterosalpingography (HSG) is an X-ray procedure that helps evaluate the uterine cavity and the fallopian tube. This non-invasive medical test, which provides a video image, is also referred to as uterosalpingography or fluoroscopy. This x-ray method uses water-soluble contrast material to provide the internal images of the uterus that a radiologist can interpret.
When Is Hysterosalpingography Considered?
The procedure is commonly considered when the woman has infertility or pregnancy issues. It helps determine the (1):
- Shape and structure of the uterus
- How open the fallopian tubes are
- Scarring within the uterine or peritoneal (abdominal) cavity
- Investigation of repeated miscarriages due to acquired and congenital abnormalities.
It is also used for determining the uterine abnormalities such as:
- Tumor masses
- Uterine fibroids
Hysterosalpingography can be used to evaluate the effects of tubal surgeries including:
- Fallopian tube blockage due to scarring or infection
- Tubal ligation
- Fallopian tube closures during sterilization and sterilization reversal
- Re-opening of the fallopian tubes blocked due to a disease or sterilization
Who Should Not Be Considered For HSG?
Women who are pregnant or having one of the following conditions should not be considered for this procedure (2):
- Pelvic infection
- Heavy uterine bleeding at the time of the procedure
- Untreated sexually transmitted diseases
- In case of recent illness, allergies, or medical conditions
How Does Hysterosalpingography Work?
During the procedure, the fluoroscopy machine passes a continuous beam of x-ray to create moving images that are recorded by the detector and then projected on the monitor. The contrast material used for the procedure is injected into the uterine cavity. It makes the examination area appear dark.
What Equipment Is Used For This Procedure?
Equipment used for this procedure includes:
- A radiographic table
- One or two x-ray tubes and a detector suspended above the radiographic table
- A television-like monitor
How Should You Prepare For HSG?
The procedure is usually performed one week after your period but before ovulation. This rules out any chances of pregnancy. Here is how you need to prepare for Hysterosalpingography:
- You will be advised to take a laxative or an enema to clear your bowels a day before the procedure is done (1). This helps to see the uterine cavity clearly.
- You will be given an over-the-counter medication or a mild sedative to relieve any discomfort or pain caused during HSG. It includes 600-800mg of ibuprofen (Advil or Motrin) that needs to be taken about one to two hours before the procedure. If you are allergic to ibuprofen and aspirin or aspirin-like drugs, you will be advised to take two extra strength Tylenol. In some cases, the physician may also prescribe an antibiotic (generally doxycycline) before the procedure. (3).
- You will be asked to remove your jewelry, eyeglasses, or dental accessories to avoid any interference of metals with the x-rays. Also, you will be asked to wear a gown before the procedure.
How Is HSG Done?
Here is how this medical test is carried out in the clinic (2):
- The patient will be asked to lie on her back, with the knees bent or held with stirrups.
- A speculum will be inserted into the vagina to hold the vaginal walls apart and make the cervix visible.
- The cervix is then cleaned, and local anesthesia is injected.
- Further, a cannula or a catheter with a balloon at its end (which is inflated during the procedure) is inserted into the vagina. The catheter carries the contrast material (dye) into the uterus, fallopian tube, and the peritoneal cavity. If the fallopian tubes are blocked, then the fluid will try to stretch the tube.
- After that, the speculum is carefully removed and you will be positioned under the x-ray machine. The images will be taken by the fluoroscopy camera.
- In case of any abnormalities, you may have to wait for 30 minutes or so to obtain delayed images, which can provide clues about any abnormalities.
- The doctor may ask you to change positions to get a profile view.
- Once the images are taken, the catheter will be removed.
- To check for any scarring of the ovaries, an x-ray will be taken the next day of the procedure.
A minimal radiation dose is used during this procedure to ensure that the patient is exposed to milder x-rays. If a potential abnormality is identified then treatment begins and follow-up examinations will be recommended to know how you are responding to the treatment.
What Will You Experience During And After The Procedure?
Women who undergo hysterosalpingography can experience minor discomforts. You may notice the following symptoms:
- Slight vaginal bleeding
- Feeling dizzy or faint
- Abdominal pain
Note: Make sure not to use tampons or douche and avoid sexual intercourse for two days post the examination (3).
When To Call The Doctor?
HSG is a minimally invasive method with few risks. However, some women may experience an allergic reaction to the contrast material used during the procedure, or pelvic infection, or an injury to the uterus. Call the doctor if you have any of the following symptoms (2):
- Severe abdominal pain or cramping
- Foul-smelling vaginal discharge
- Fever or chills
- Heavy vaginal bleeding
- Itching, rash, or hives (4)
- Difficulty in breathing or swallowing
What Are The Benefits?
The benefits of HSG are as follows:
- This procedure is less invasive, without any complications.
- It is a short procedure and takes 30-45 minutes (5).
- Helps diagnose uterine abnormalities and infertility causes.
- It can sometimes help open the blocked fallopian tubes.
- The procedure has no side effects.
What Are The Limitations Of Hysterosalpingography?
The procedure also has a few limitations (1):
- It cannot detect the abnormalities of uterine wall, ovaries, and pelvic structure.
- It cannot identify all causes of infertility, such as the fertilized egg’s inability to attach itself to the uterine wall or abnormal sperm count.
Are There Any Alternatives To HSG?
Yes. Alternatives to HSG include:
- Laparoscopy – It is a surgical procedure done by administering general anesthesia.
- Hysteroscopy – It gives a detailed view of the inside of the uterus but cannot detect any blockage in the fallopian tubes.
- Sonohysterography – It uses ultrasound to view the inside of the uterus but does not detect any abnormalities in the fallopian tube.
Hysterosalpingography can examine uterine abnormalities, such as fallopian tube blockages, adhesions, and fibroids. However, doctors may not perform this if you have pelvic infections or sexually transmitted diseases. The procedure creates a video image of the insides of the uterus, which a radiologist can interpret. You may experience some discomforts, such as cramps, vaginal bleeding, or abdominal pain post the procedure. It is helpful to contact your doctor in these cases or if you notice vomiting, fever, itching, or rashes.
2. FAQs on Hysterosalpingography; ACOG (2011)
3. Hysterosalpingogram; Reproductive Health Department, Vacaville
4. B Siegal; Hysterosalpingography; Winchester Hospital
5. Hysterosalpingogram; Grand Lake Health System