A hysterosalpingogram (hystero = uterus; salpingo = fallopian tubes; gram = X-ray) or HSG is a simple procedure where X-rays are used to evaluate the uterus and the fallopian tubes.
A HSG is a routine test done as part of an infertility work-up. It is to be done in the first half of the cycle so that we can be sure that the patient is not pregnant. In experienced hands, a HSG is quick, efficient and can be painless.
In this post, I explain why we might use HSG, how we administer it, what we can learn from it, and what its limitations are when it comes to helping us find out why you're having trouble getting pregnant..
Indications for HSG include:
Evaluation of the uterine cavity for polyps, malformations or scar tissue;
Evaluation of the fallopian tubes for patency and abnormalities such as hydrosalpinx.
The inner lining of the fallopian tubes can also be evaluated. The presence of folds (rugae) in the tubes is a sign of a healthy tube.
To diagnose salpingitis isthmica nodosa (SIN); which is a condition associated with tubal blockage and increases the risk of a tubal pregnancy
Location of a foreign body in the uterus (lost IUD)
Confirmation of tubal blockage after a hysteroscopic tubal occlusion procedure (ESSURE)
How is a hysterosalpingogram performed?
The patient lies on her back with her legs in stirrups. A pelvic exam is often performed. A vaginal speculum is inserted to expose the cervix, which is then held with an instrument (single-toothed vulsellum). A local anesthetic can be given around the cervix (paracervical block). A plastic canulla is inserted through the cervix into the uterine cavity where its balloon is inflated to hold it in place. A radio-opaque dye is then (gently) injected into the uterus through the canulla. As the dye is being injected, serial X-ray pictures are taken. These can later be viewed in great detail. Once the procedure is completed, the vaginal instruments are removed. The entire process takes only a few minutes.
Does it hurt?
Patients may experience some cramping as the dye is being injected. This can be worse if the tubes are blocked and there is resistance to the dye flowing through. We encourage our patients to take ibuprofen 800 mg a few minutes prior to the procedure.
What are the complications of HSG?
A HSG is a very safe procedure and has been done for many decades. There are always risks with every procedure. Some of the very rare complications associated with HSG include:
Some patients may feel faint after the procedure (vasovagal attack). This is uncommon and the feeling passes off in a few minutes.
Pelvic infection. Any vaginal procedure is associated with the risk of infection. The risk is so small that we no longer routinely give an antibiotic after a HSG. Some patients, however, e.g. diabetics or those with hydrosalpinx, may benefit from antibiotics.
The exposure to X-rays is minimal and there is no increased risk to the patient.
What if my tubes are blocked?
It is now possible to use special catheters (selective salpingography and wire guides) to open up blocked tubes at the time of diagnosis. We specialize in this "tubal catheterization" procedure and I will write a blog about it in the near future.
What are the limitations of a HSG?
A HSG only gives information about the inside of the uterine cavity. You could have fibroids in the uterine wall and these will not be seen on HSG. Also, it is not possible to visualize the ovaries on HSG. At InVia Fertility Specialists, we use a combination of HSG and ultrasound to complete a thorough investigation of the pelvic structures.
An additional advantage of HSG is that it can increase the chance of a spontaneous pregnancy! Just the “flushing open” of the tubes may enhance your fertility!
Dr. Karande is Board Certified in the specialty of Obstetrics and Gynecology as well as the subspecialty of Reproductive Endocrinology and Infertility. He is a Fellow of the American College of Obstetricians and Gynecologists and Member of the American Society for Reproductive Medicine.