Hysterosalpingogram

  • A hysterosalpingogram, or HSG, is an x-ray test that determines whether the fallopian tubes are patent (open) and the uterine cavity is healthy(1).
  • HSG is an X-ray dye test assisting a doctor in detecting problems with the reproductive anatomy, which could be preventing a woman from becoming pregnant(2).
  • HSG should ideally be performed during the first half of the menstrual cycle (days 1 to 14) to minimize the possibility of pregnancy or menstruation during the procedure(3).

What Is a Hysterosalpingogram (HSG)?

A hysterosalpingogram (HSG) is an X-ray dye test used to diagnose reproductive issues(4). An X-ray machine captures images of the uterine cavity and fallopian tubes filled with a specific dye during an HSG. 

This procedure may assist a doctor in detecting problems with the reproductive anatomy that prevents an individual from becoming pregnant. Blocked fallopian tubes and an abnormally shaped uterus are two of these concerns(5).

An HSG determines whether the fallopian tubes are patent or open and the uterine cavity is healthy(6). 

HSG is a quick outpatient procedure that usually takes less than five minutes and is performed following the end of a menstrual period but before ovulation(7).

The initial ultrasound performed transvaginally detects gross structures such as fibroids and polyps(8). 

Hysterosalpingography is more sensitive for detecting fallopian tube anomalies. Following the initial ultrasound examination, clinicians may do a hysterosalpingogram or hysterosalpingosonogram(9). However, research suggests that a hysterosalpingogram is superior when pregnancy is the primary outcome.

Why Do an HSG: Uses and Benefits of the Procedure

Generally, an HSG may determine whether a tubal ligation or tubal reversal treatment successfully closed the fallopian tubes and prevented conception(10).

HSG is used to diagnose fallopian tube and uterine issues, such as(11).

  • Fallopian tube obstruction or constriction
  • Fallopian tube and uterine scarring 
  • Anomalies of the fallopian tubes and uterus in terms of shape and size
  • Uterine tumors(12).

A hysterosalpingogram may also have the following benefits:

  • An HSG may increase fertility. It is, however, debatable whether this surgery improves fertility(13). After a normal HSG, some studies demonstrate a slight boost in infertility that lasts about three months. 
  • An HSG detects scar tissue or abnormalities in the uterus or fallopian tubes, resulting in infertility and pregnancy issues(14).
  • An HSG helps ensure that the fallopian tubes have been blocked a few months after the tubal sterilization procedures(15).
  • An HSG can help determine the cause of infertility(16). The open fallopian tubes provide a clear channel for fertilization. These processes are hindered by blocked fallopian tubes.

How to Prepare for an HSG 

HSG should ideally be performed during the first half of the menstrual cycle (days 1 to 14), when chances are reduced that a woman is pregnant or menstruating during the procedure(17).

The obstetrician-gynecologist may offer an over-the-counter pain medication an hour before the procedure or administer antibiotics to prevent infection(18).

The HSG Procedure

During HSG, the uterus and fallopian tubes are contrasted using a dye-infused fluid to see structures and tissue(19). 

The dye highlights the inside of the uterus and fallopian tubes‘ interior dimensions and shape. Additionally, the dye may move through the body’s components.

  1. The patient or individual lies down with the feet in a position similar to when having a pelvic exam. The vagina is inserted with a speculum device that separates the vaginal walls, allowing for visualization and cleaning of the cervix.
  2. Local anesthesia may be injected into the cervix’s terminus for pain relief.
    It is possible to experience a tiny pinch during the administration of anesthesia.
  3. The dye solution will slowly be pumped into the uterus while the radiology technician operates the fluoroscopy machine over the pelvic area.
    The dye may be injected using one of two approaches. One technique involves grasping the cervix with a cannula to secure it.
    The other procedure involves inserting a tiny plastic tube with an inflatable balloon at the end. Once inside the body, the balloon inflates, holding the tube in place for the dye injection(20).
  4. X-ray images are collected as the uterus and tubes are filled with fluid. If there is no obstruction, the liquid will slowly leak out of the tubes’ far ends, and the body absorbs this once it flows out.
  5. After obtaining sufficient X-ray images, the cannula or plastic tube containing the balloon from the body will be removed(21).

Expectations During and After an HSG

During the Procedure

  • The duration of the procedure varies. However, it typically lasts around 45 minutes(22).
  • Cathode insertion and contrast material infusion may cause discomfort.
  • Some patients experience cramping similar to menstrual cramps. 

After the Procedure

  • The patient or individual can already resume normal activities following the procedure.
  • Vaginal spotting and pelvic cramps are possible on the first day following the procedure. Tampons are not recommendable in case of vaginal bleeding.
  • Pain relievers like Tylenol or ibuprofen may be given after the procedure. On the other hand, antibiotics may be recommended in some circumstances following the surgery.
  • If the patient or individual experiences severe pain, fever, or excessive bleeding following the exam, they should contact a healthcare professional immediately(23).

HSG Results Interpretation

The doctor can review the films immediately following the test(24). Typically, this enables a physician to provide an early impression of how the films will seem. 

Occasionally, a radiologist takes a day or two to thoroughly evaluate the films and provide a written gynecology report for the obstetrician.

The HSG test results may assist physicians in determining whether there is a blockage in the fallopian tube or uterus, which may make it more difficult for sperm to reach and fertilize an egg(25).

Additionally, it enables an OB/GYN to examine the shape of the uterus, which affects fertility. 

The following summarizes the significance of the various test results:

Results of a Normal HSG Test

If the liquid dye flows freely through the fallopian tubes and pours out, the HSG test findings are normal. This result indicates that there are no obstructions(26).

HSG Test Findings That Are Abnormal

If the liquid dye hits a blockage in one of the fallopian tubes or the uterus, the HSG test findings are abnormal. In some circumstances, surgery may be necessary to remove the obstruction and increase the likelihood of conceiving(27).

In some circumstances, mainly when a blockage has resulted in fallopian tube damage or scarring, a health care professional may consider attempting conception via in vitro fertilization (IVF).

Equipment Used in HSG

The two primary devices used to inject media into the intrauterine area are an acorn cannula and a balloon tip catheter(28).

A single-tooth or double-tooth tenaculum and Haeger, Hank, or Pratt cervical dilators are used due to the necessity of entering the endocervix.

Local anesthetics such as lidocaine with epinephrine may be administered into the paracervical space or cervical stroma, depending on the provider’s preference to lessen traumatic bleeding and pain.

A radio-opaque dye delivered through the endocervix using a cannula is the most frequently utilized media. Iodine is present in all media, with a contemporary preference for water-soluble medium. 

Traditionally, oil-based media were utilized since it was considered more capable of returning to the conception-competent state faster. However, the use of oil-based media raises the chance of developing granuloma(29). 

Granulomas are small lumps that form in areas with inflammation or infection.

Risks of an HSG Test

HSG is considered a safe procedure(30). However, several documented problems, some of which are severe, occur less than 1% of the time.

  • Infection. The most frequently seen adverse complication of HSG is pelvic infection. This effect is more common in women who have previously experienced tubal illness, such as a past infection of chlamydia (a common STD). 

Within 1-2 days of the HSG, a woman should contact her specialist if she develops growing pain or a fever.

  • Fainting. The woman may experience dizziness during or shortly after the surgery on rare occasions.
  • Radiation Exposure. The radiation dose associated with an HSG is exceptionally minimal. This exposure has not been harmful, even if a woman becomes pregnant later that month. If pregnancy is suspected, then HSG should be avoided.
  • Iodine Allergy. In sporadic cases, a woman may develop an allergy to the iodine contrast material used in HSG. If a woman is allergic to iodine, intravenous contrast dyes, or seafood, she should inform her doctor. HSG should be performed without using an iodine-containing contrast solution for women with allergic reaction to iodine. 
  • Spotting. Spotting may occur for 1-2 days following HSG. Unless otherwise instructed, she should tell her doctor if a woman develops significant bleeding following HSG.

FAQs

1. Is the HSG test painful?

There are concerns about discomfort in the process, which differs from one person to person(31). Some may have mild to moderately painful cramps, while others feel nothing. Only a small percentage of women report significant cramps during the surgery.

2. When is HSG not necessary?

HSG may not be performed if the woman is pregnant, afflicted with a pelvic infection, and is bleeding from the uterus at the time of the surgery(32).

3. Who performs a hysterosalpingogram?

An HSG can be performed by a gynecologist, a radiologist, or a reproductive endocrinologist(33). A radiologist will then evaluate the X-ray images and write a report informing the physician of the findings.

4. What do the HSG results mean?

The healthcare professional will disclose the results and recommend future measures(34). If the HSG demonstrates obstruction, the provider may offer treatments such as laparoscopy (a procedure used to check the organs in the abdomen) to help diagnose and treat the condition. 

Alternatively, a doctor may recommend fertility therapies that do not necessitate clean fallopian tubes, such as in vitro fertilization (IVF).

5. When should one call their doctor?

Patients or individuals should notify the medical provider when fever, chills, vomiting, fainting, heavy vaginal bleeding, foul-smelling or unusual vaginal discharge, or severe stomach cramps are experienced(35).

6. What are the side effects of an HSG?

Undergoing a hysterosalpingography test is not a very pleasant experience and may cause some discomfort(36). However, quick recovery is expected, and getting back to normal activities the next day is possible.

Some women experience cramping for approximately two days following the test However, this is not worrisome. Spotting may also last for three days after the procedure(37).

  1. Hysterosalpingogram (HSG) https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/hysterosalpingogram-hsg/
  2. Hysterosalpingogram https://my.clevelandclinic.org/health/diagnostics/22254-hysterosalpingogram
  3. Ibid
  4. Ibid
  5. Ibid
  6. Hysterosalpingogram (HSG) https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/hysterosalpingogram-hsg/
  7. Ibid
  8. The role of transvaginal ultrasound in the management of abnormal uterine bleedin
    https://gynecolsurg.springeropen.com/articles/10.1007/s10397-004-0012-5
  9. Hysterosalpingogram https://www.ncbi.nlm.nih.gov/books/NBK572146/
  10. Hysterosalpingography (HSG) https://www.acog.org/womens-health/faqs/hysterosalpingography
  11. Ibid.
  12. Hysterosalpingography
    https://www.northlakeobgyn.com/hysterosalpingography.php
  13. Hysterosalpingogram (HSG) https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/hysterosalpingogram-hsg/
  14. Hysterosalpingography (HSG) https://www.acog.org/womens-health/faqs/hysterosalpingography
  15. Ibid
  16. Hysterosalpingogram https://my.clevelandclinic.org/health/diagnostics/22254-hysterosalpingogram
  17. Ibid. 
  18. Ibid. 
  19. Hysterosalpingography (HSG) https://www.acog.org/womens-health/faqs/hysterosalpingography
  20. Hysterosalpingogram https://my.clevelandclinic.org/health/diagnostics/22254-hysterosalpingogram
  21. Hysterosalpingography (HSG) https://www.acog.org/womens-health/faqs/hysterosalpingography
  22. How to Prepare for a Hysterosalpingogram (HSG) Procedure https://radiology.ucsf.edu/patient-care/prepare/hysterosalpingogram
  23. Ibid.
  24. Ibid.
  25. Here’s Why You Might Get a Hysterosalpingogram (HSG) Test https://www.whattoexpect.com/getting-pregnant/fertility-tests-and-treatments/hsg-test
  26. Ibid.
  27. Ibid.
  28. Hysterosalpingogram https://www.ncbi.nlm.nih.gov/books/NBK572146/
  29. Ibid.
  30. Hysterosalpingogram (HSG) https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/hysterosalpingogram-hsg/
  31. Hysterosalpingogram https://my.clevelandclinic.org/health/diagnostics/22254-hysterosalpingogram
  32. Hysterosalpingography (HSG) https://www.acog.org/womens-health/faqs/hysterosalpingography
  33. Hysterosalpingogram https://my.clevelandclinic.org/health/diagnostics/22254-hysterosalpingogram
  34. Ibid.
  35. Hysterosalpingography (HSG Test) – Preparation, Procedure, Side Effects https://www.healthcheckup.com/tests/hysterosalpingography-hsg-test-preparation-procedure/
  36. Ibid
  37. Ibid  
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