Why HSG (Hysterosalpingogram) is done?
Hysterosalpingogram ( HSG) is a type of X-Ray of abdomen to know the condition of the fallopian tubes. If the fallopian tubes are blocked then the couple may have difficult in conceiving, it is required to check whether tubes are open or not in cases of infertility. It’s also used to investigate miscarriages resulting from abnormalities within the uterus such as tumour masses, adhesions and uterine fibroids.
What is a Hysterosalpingogram (HSG)?
HSG is a diagnostic X-Ray procedure that usually takes around 15 minutes to perform. It is usually done before ovulation around 10 -12 days after menstruation. This is done on an outpatient basis.
How the patient is prepared for the HSG test?
The doctor usually obtains history regarding pregnancy and any allergies as HSG should not be done on a pregnant woman. Any kind of allergies should be noted as the dye used in this procedure may cause severe reactions in such people. This procedure should not be performed in inflammatory conditions like a chronic pelvic infection or an untreated sexually transmitted disease. Since the dye used may damage the developing fetus doctors advise taking contraceptive pills in the cycle when the fallopian tube test is done in order to prevent pregnancy. The patient is also given antibiotics to prevent infection and also at times a pain killer to reduce the discomfort during the procedure.
How is a Hysterosalpingogram done?
Hysterosalpingography uses a real-time form of x-ray called fluoroscopy to examine the uterus and fallopian tubes
A woman is positioned under a fluoroscope (an x-ray imager that can take pictures during the study) on a table. The doctor then examines the patient’s uterus and places a speculum in her vagina. Her cervix is cleaned, and a cannula is placed into the opening of the cervix. A liquid containing iodine (a fluid that can be seen by x-ray) is slowly pushed through the cannula. The contrast is seen as white on the image and can show the contour of the uterus as the liquid travels from the cannula, into the uterus, and through the fallopian tubes. If the tubes are blocked the dye doesn’t pass through and may cause swelling of the tubes called hydrosalpinx.
After the HSG, a woman can immediately return to normal activities but refrain from intercourse for a few days.
An HSG usually causes mild or moderate cramping pain for about an hour. However, some women may experience cramps for several hours. These symptoms can be greatly reduced by taking medications used for menstrual cramps like pain killers before the procedure or when they occur. But every woman before the test is worried about the test and asks if the fallopian tube test is painful.
Pain during the HSG test is variable. Some women may experience mild cramping. Some don’t feel much of anything. Very few report severe pain and cramping. Moreover, fear of pain is seen in almost every woman undergoing the tube test. Women having previous infections of the pelvis or blocked tubes experience more pain.
Does the HSG Test increase the chance of pregnancy?
At times women undergoing this test may have blocked tubes. If the block is flimsy or a recent one there is a chance that it may open after the HSG test. In these cases, the patient may fall pregnant after the fallopian tube test. Antibiotics given before the tube test may help the healing of infected tissue.
Can HSG test open blocked tubes?
Blocked tubes are less likely to get opened after the test. But at times thin tissue blocking may get removed by flushing of dye into the tube. At times tubes get into spasm after introducing the dye. This may give a picture of the blockage of both tubes. But after an hour or so these tubes relax and come to normal function.
What are the risks of HSG?
HSG is considered a relatively safe procedure. However, some complications mild or serious can happen in less than 1% of the time. There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk. The effective radiation dose for this procedure varies. Special care is taken during x-ray examinations to use the lowest radiation dose possible while producing the best images for evaluation.
In the event of a chronic inflammatory condition, pelvic infection, or untreated sexually transmitted disease, be certain to notify the physician or technologist before the procedure to avoid worsening of infection.
Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. Some of the HSG test side effects are:
- The most common serious problem with HSG is pelvic infection. This usually occurs when a woman has had a previous tubal disease (such as a past infection of chlamydia). In rare cases, the infection can damage the fallopian tubes or make it necessary to remove them. A woman should call her doctor if she experiences increasing pain or a fever within 1-2 days of the HSG.
- Fainting – Rarely, some women may get light-headed during or shortly after the procedure and faint due to a vasovagal attack.
- Iodine Allergy – Rarely, a woman may have an allergy to the iodine contrast used in HSG. A woman should inform her doctor if she is allergic to iodine, intravenous contrast dyes, or seafood. Women who are allergic to iodine should have the HSG procedure performed without an iodine-containing contrast solution. If a woman experiences a rash, itching, or swelling after the procedure, she should contact her doctor.
- Spotting – Spotting sometimes occurs for 1-2 days after HSG. Unless instructed otherwise, a woman should notify her doctor if she experiences heavy bleeding after HSG.
What are the limitations of the HSG test?
Hysterosalpingography only sees the inside of the uterus and fallopian tubes. Abnormalities of the ovaries, wall of the uterus, and other pelvic structures may be evaluated with MRI or ultrasound. Alternatively, a surgical procedure to directly view the tubes (laparoscopy) can be done which is more accurate for the fallopian tube test. In addition, laparoscopy is better to diagnose PCOS in women with hormone imbalances and insulin resistance. Consequently, these women can achieve pregnancy by following weight reduction tips. Following a healthy diet with fewer carbohydrates, lean proteins, and avoiding trans fat helps PCOS women. High blood pressure, heart diseases, high blood sugar levels are some of the health conditions associated with PCOD.
What is the next step if tubes are found to be blocked on Hysterosalpingography?
Patients may undergo revaluation of tubes with laparoscopy or may be suggested to go for IVF. In vitro fertilization (IVF) is a procedure that can bypass the function of the tubes and can achieve pregnancy in cases with the blocked fallopian tubes.
Any alternative to HSG Test?
Many women are scared of this test as it causes pain and also exposes to radiation. Often they search for an alternative test to evaluate the fallopian tubes. Laparoscopy is the best test to check the fallopian tubes. It can evaluate the condition of the ovaries, uterus, and pelvis along with the tubes. It gives a real-time view of all the pelvic organs. Although it is a costly test and requires anesthesia it is considered the gold standard test for tubal function.