Overview of Hysterosalpingogram
A hysterosalpingogram, often abbreviated as HSG, is a kind of x-ray test that gives doctors a look inside a woman’s uterus and fallopian tubes. The procedure works by injecting a special dye into the uterus. This dye travels through the fallopian tubes and eventually reaches the ovaries. Doctors take x-ray images throughout the procedure to see how the dye moves and fills the uterus and tubes. This helps in evaluating the shape of the uterus and the openness or “patency” of the fallopian tubes. The test can also reveal if the dye has spilled into the abdominal cavity, another important factor in determining fertility issues.
The HSG test is primarily used for investigating fertility problems in women. It is known that issues with the structure of the uterus or fallopian tubes can contribute to infertility. In fact, such problems can be responsible for up to 60% of fertility cases.
What sets the HSG test apart is its ability to evaluate the structure of the endometrial cavity (the hollow space in the uterus) and the openness of the fallopian tubes. Although other tests like pelvic ultrasound, hysteroscopy, or MRI can also be used to look at the reproductive organs, the HSG test can provide additional valuable information about the causes of infertility.
Over the years, advances in the kind of dye used in the procedure have made the HSG test safer and more comfortable for patients. However, the test is not suitable for everyone and, in some cases, can lead to complications. Despite this, the HSG test remains a critical tool for diagnosing female fertility issues. Doctors must understand how to include it as part of an infertility evaluation to ensure that patients receive the best care and that the results are interpreted correctly.
Anatomy and Physiology of Hysterosalpingogram
The hysterosalpingogram (HSG) is a test that looks at two main parts of a woman’s reproductive system—the fallopian tubes and the endometrial cavity, which is the inside space of the uterus. Normally, the fallopian tubes are open at both ends and connect to the uterus. During a woman’s menstrual cycle, eggs from the ovaries move through these open tubes into the uterus. The fallopian tubes can usually be divided into three main parts, and they are located on both sides of the uterus.
Doctors use the HSG to see if the endometrial cavity and fallopian tubes are normal in shape and not blocked. This can help them find out if problems with the fallopian tubes or uterus may be causing a woman’s infertility, which is trouble getting pregnant.
“Tubal infertility” is a condition where problems with the fallopian tubes cause infertility. This can be from conditions you are born with or ones that cause damage to the tubes. The most common reason the tubes get blocked is due to sexually transmitted infections. Neisseria gonorrhoeae, a type of bacteria, is linked with about 90% of these types of infertility cases. Other causes of blockage in the fallopian tubes can include endometriosis, scarring from surgeries, or after medical treatment for pregnancies that happen outside of the uterus.
Important to note, sometimes the HSG can incorrectly show a blockage in the tubes from “spasms”, which are just temporary tightenings of the muscles in the tube.
Problems with the uterus can also lead to fertility issues. Sometimes, the inside of the uterus can become damaged and turn into scar tissues, which make it hard to see if the tubes are open with an HSG. There are also certain conditions that some women are born with that can change the shape of the uterus or block the tubes. This can often be detected when an HSG is performed. About 5% of all HSG tests uncover these types of abnormalities.
The HSG can also help spot other diseases that obstruct the uterus, such as uterine cancer, polyps, fibroids, and adhesions. However, other imaging tests are often better at showing these conditions. That’s why doctors usually recommend doing a pelvic ultrasound at the same time as an HSG when trying to find the cause of a woman’s infertility.
Why do People Need Hysterosalpingogram
An HSG, short for Hysterosalpingogram, is mainly used for people having trouble getting pregnant. This test checks if the inner part of the womb (endometrial cavity) and the tubes connecting the ovaries to the womb (fallopian tubes) are open and shaped normally. This helps rule out blockages in the tubes or abnormalities in the structure of the womb as reasons for infertility. Other imaging tests, like pelvic ultrasounds, might be used to find other health issues.
When a Person Should Avoid Hysterosalpingogram
Some conditions could prevent you from having a hysterosalpingogram (HSG), a type of X-ray used to look at the inside of the fallopian tubes and uterus. These conditions include being pregnant, having a pelvic infection, or experiencing heavy uterine bleeding.
The test is best done during the early follicular phase of your menstrual cycle when your uterus lining is thin, making it easier to view the X-rays. This timing can prevent the test from interrupting a possible pregnancy. But, since HSG is usually done when trying to understand infertility, overlapping with a viable pregnancy is less likely. Still, a pregnancy test is done before the HSG to make sure you’re not pregnant.
If you’ve had a pelvic inflammatory disease, it doesn’t mean you can’t have an HSG. Yet, there’s a small risk (1.4% to 3.4%) of getting an infection after the procedure. While antibiotics are sometimes given to stop infections, they are not a standard procedure for everyone.
An allergy to iodine, often used in the contrast material for the test, can also prevent you from having an HSG. If you have this allergy, you should let your doctor know. Also, if you have a thyroid disease, you should discuss this test with your endocrinologist. This is because iodine can reduce thyroid hormone levels or worsen a condition called thyrotoxicosis if you have a history of Grave’s disease. Some doctors might suggest giving certain patients glucocorticoids before the HSG, but not all doctors agree with this approach. If you do have an iodine allergy, a contrast material that doesn’t contain iodine will be used.
Equipment used for Hysterosalpingogram
During a hysterosalpingogram (HSG) procedure—a type of X-ray used to examine the uterus and fallopian tubes—several tools are needed. These include a speculum, which is a device that helps doctors see inside your body. In this case, it’s used to help view your vagina and cervix. You’ll lie on a special X-ray table known as a fluoroscopic table. Your doctor will also use a solution called betadine to clean your vagina and cervix to prevent infection.
To keep the cervix—which is the lower part of the uterus, connecting it to the vagina—steady during the procedure, your doctor will use a long tool called a tenaculum. The cannula, a tube for delivering dye into the uterus and fallopian tubes, is a crucial part of this procedure. Depending on the specific situation and needs, your doctor may use a metal cannula, a plastic catheter with an inflatable balloon, or a thin cather with a shallow acorn tip. This dye helps highlight any issues when the X-ray images are taken.
Who is needed to perform Hysterosalpingogram?
An HSG, or hysterosalpingogram, is often done in a place for taking x-rays by a trained person called a radiology technician. This is an exam used to check a woman’s fallopian tubes and uterus. But sometimes, a special doctor who cares for women’s health, an OB/GYN, might do the exam in their office or a health clinic. Most of the time, only one person is needed to do this exam.
Preparing for Hysterosalpingogram
A hysterosalpingogram (HSG), a test used to examine the uterus and fallopian tubes, is generally planned for the first two weeks of a woman’s menstrual cycle. This timing is chosen to decrease the risk of performing the test during times when the woman might be pregnant.
To help manage discomfort during the test, doctors may advise taking over-the-counter pain relievers – such as naproxen, ibuprofen, or indomethacin – about an hour before the test. Still, research hasn’t consistently shown these medications to significantly decrease pain.
Antibiotics are not typically given before the HSG test. However, a doctor might prescribe them for individuals with a history of pelvic inflammatory disease or a past infection. Another medication called hyoscine-N-butyl bromide, which relieves muscle spasms, could potentially decrease pain and spasms in the fallopian tubes during and after the test, but it isn’t usually recommended due to limited scientific evidence supporting its benefits.
Most people can usually go home by themselves after an HSG test. Still, depending on how they feel after the test and their personal preference, they should consider arranging for someone to accompany them.
How is Hysterosalpingogram performed
The Hysterosalpingogram (HSG) technique is a medical procedure used to examine the inside of the uterus and fallopian tubes. The fallopian tubes are pathways connecting the ovaries (where eggs are produced) to the uterus (where a baby grows). This procedure uses an X-Ray imaging technique. Let’s break it down to understand the steps better:
You’ll lie on an examination table in a position known as the dorsal lithotomy position – this means you’ll be lying on your back with your legs bent and slightly apart. A speculum (a medical tool that helps to widen the vagina) is then inserted to allow the medical professional to see the cervix, which is the lower part of the uterus. This area will be cleaned with a specialized solution to prepare it for the next steps.
A local anaesthetic is then injected into the tissue around the cervix to reduce pain or discomfort. A device called a cannula, which can be made of metal or plastic, will then be inserted into the cervix. The cannula has a specialized tip that ensures a tight seal to prevent leakage of the fluid being used for the test.
The uterus’s position might be adjusted using a tool called a tenaculum to get clear X-Ray images. A special dye, known as contrast, is then injected slowly into the cannula to fill the uterine cavity. This contrast helps to produce clear images of the uterus and fallopian tubes on the X-Ray.
Initial X-Ray images, known as scout radiographs or pelvic X-Rays, are taken to provide a baseline for comparison with later images. Then, more contrast is injected slowly, and additional X-Rays are taken to capture the path of the contrast as it flows through the uterus, into the fallopian tubes, and eventually reaches the ovary’s area. This procedure helps to detect any blockages or abnormalities in the uterus or fallopian tubes.
The contrast used in this procedure is made of a special dye, which appears very bright in the images, allowing for easy visualization of its path. If the contrast does not seem to flow from either of the fallopian tubes into the peritoneal cavity, it could mean there is a blockage.
It’s important to note that the exact type of contrast used can vary, and what’s best can depend on individual patient factors. The type of contrast used has changed over the years to improve safety and comfort for patients.
The radiologist or doctor will then interpret the images and discuss the findings with you. The entire HSG procedure aims to assess your reproductive health, specifically the condition of your uterus and fallopian tubes, which are vital for conceiving a child.
Possible Complications of Hysterosalpingogram
Serious problems after an HSG (a type of X-ray used to examine the female reproductive organs) are not common. However, some people might experience belly cramping and bleeding from the vagina for a few days. There might also be unusual reactions to the dye used, an infection in the pelvic area, or harm to the womb or cervix.
In rare cases, a person might faint because the cervix is being moved during the procedure. If they experience any bad-smelling discharge, severe belly pain, heavy vaginal bleeding, fever or chills, or fainting, they should reach out to their OB/GYN doctor immediately. There was one case where a patient’s leftover pregnancy tissue was found during the HSG, and this led to a build-up of fluid during later procedures.
What Else Should I Know About Hysterosalpingogram?
When a woman is having difficulty becoming pregnant, doctors use a variety of methods and tests to find out what might be causing the problem. One of the key tests is called a Hysterosalpingogram (HSG). This test helps to check on potential issues with the uterus, such as abnormal growths, and with the fallopian tubes, such as blockages.
However, HSG is just one part of the puzzle, and there are other tests and tools used alongside it. These can include a pelvic ultrasound, which uses sound waves to create a picture of the ovaries and uterus, and a hysteroscopy, which allows doctors to look directly inside the uterus. Magnetic Resonance Imaging (MRI) and laparoscopy, a minimally invasive surgery, can also be used to look for things like adhesions (scar tissues) and endometriosis, where tissue that normally lines the inside of your uterus grows outside your uterus. Sometimes, the laparoscopy procedure can even be used to treat some of the issues it finds.
No single test is able to tell the whole story for a woman experiencing infertility, so doctors often use a combination of these tools and methods. The goal is to get as much information as possible to help determine the most effective treatment plan.
