Hysterosalpingogram (HSG)

Hysterosalpingogram (HSG)

What exactly is a hysterosalpingogram? What steps are involved? Does it involve any pain?

Hysterosalpingogram (HSG) is an X-ray study of the uterus that uses a special dye visible on X-rays. A series of X-ray images taken as the dye flows into the uterus and through the fallopian tubes helps doctors evaluate the size and shape of the uterine cavity and determine whether the fallopian tubes are open, and sometimes even if there are adhesions near the tubes.

HSG is best scheduled two to three days after the last day of menstrual flow. It is important to ensure that you are not pregnant at the time this study is performed, so if there is any doubt about whether you are pregnant, or if the flow is light, a pregnancy test should be performed beforehand. Many physicians will recommend a dose of antibiotics to reduce the risk of infection and a non-steroidal antiinflammatory agent such as ibuprofen (Advil) or naproxen (Aleve) to minimize cramping.

The doctor begins by inserting a speculum into the vagina. The cervix is wiped with an antiseptic, and a catheter (narrow tube) is inserted into the uterine cavity. There may be a mild cramp with this portion of the procedure. The speculum will be removed, and you will be repositioned on the X-ray table. Your physician or the radiologist will place tension on the uterus to straighten the bend and give a better picture of the uterine cavity. Next, the dye is injected into the uterus through the catheter. This is often associated with cramping. If you are relaxed and in the hands of a gentle physician, the cramping is usually mild. However, if the dye does not flow through the fallopian tubes, additional pressure may be necessary to see if the tubes are really blocked. This can cause more intense discomfort.

After the X-ray, you will be asked to remain lying down for another 5 - 10 minutes to allow the cramping to subside. Arrangements should be made with your physicians so that you know when you will be asked to return to discuss the results and determine the next step in your treatment plan. If you experience increasing pain, fever or heavy bleeding after the procedure, you should contact your physician.

My doctor wanted me to have a hysterosalpingogram, but when I arrived at the radiologist, I found I could not have the test done because I am allergic to iodine. Is there any other test that can be done to serve this purpose? He is starting me on Clomid.

Iodine allergies are a confusing issue. The first consideration must be the type of allergic reaction experienced in the past. With more severe reactions, I would definitely avoid using an iodine-based dye. The next consideration is based on the type of dye. There are ionic and non-ionic iodine dyes. Allergic reactions are almost unheard of with use of a non-ionic dye. For my patients with mild reactions in the past, I will premedicate with a steroid and Benadryl (an antihistamine) and use a non-ionic dye. I have not yet seen any patients have problems using this approach. Still, this does not remove all risk, and you should discuss the alternatives with your own physician.

Another test to consider might be saline sonography using a special material called Albuminex, which will allow the tubes to be visualized easier. The standard saline sonogram does not generally allow the tubes to be seen at all. Yet an another alternative test is laparoscopy. This outpatient surgical procedure involves placing a miniature viewing device and surgical instruments through tiny incisions in the abdominal wall while you are under anesthesia. A colored dye that does not contain iodine is injected through the cervix; the doctor then watches to see it spill out the ends of the fallopian tubes.

A recently developed office-based procedure, vaginal hydrolaparoscopy (VHL), is undergoing clinical studies. VHL enables your physician to evaluate your fallopian tubes by placing a needle-thin telescope through the top of the vagina into the abdomen after injecting local anesthesia. The space behind the uterus is filled with fluid, and the fallopian tubes and ovary float into view. The state of the tubes can be determined by injecting a colored dye (that doesn't contain iodine) through a tube placed into the cervix. The dye is seen exiting the end of the fallopian tube. The doctor can also look for adhesions or endometriosis.

In any case, your gynecologist should first consider whether it is likely that tubal damage or blockage is present. Review of your medical history for pelvic infections, previous pelvic surgery, painful intercourse or painful periods may indicate an increased risk of fallopian tube problems. A blood test for chlamydial antibody may show that you have had a previous chlamydia infection that may have damaged the tubes. If nothing in the laboratory results and review of your medical history suggests the presence of tubal blockage, the likelihood of damage is less than 5 percent, and further testing can be deferred.

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