Hysterosalpingogram (HSG)

The hysterosalpingogram (HSG) is an x-ray test that lets your physician examine the inside walls of your uterus and fallopian tubes. We routinely perform an HSG for three primary reasons:

  • To see if a patient’s fallopian tubes are open
  • To assess whether the uterus has a normal shape
  • To confirm that the uterine cavity is not affected by fibroids, polyps, or scar tissue

We may also use a sonohysterogram to detect abnormalities inside the uterus; however, sonohysterograms are not helpful in detecting blocked fallopian tubes.

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How it works

The HSG requires the assistance of a type of x-ray called a fluoroscopy, or “live x-ray.” At Shady Grove Fertility’s Rockville and Towson offices, we dedicate a special x-ray room to these procedures. An experienced midlevel provider—certified physician assistant (PA-C) or certified registered nurse practitioner (CRNP)—or a physician will perform the procedure.

Preparing for the HSG

Your physician or nurse will advise you to take ibuprofen or a similar over-the-counter nonsteroidal anti-inflammatory drug (NSAID) 1 hour prior to the procedure to reduce the discomfort from possible cramping. Your nurse will also advise you to arrive 30 minutes prior to the test to review informed consent paperwork and provide a urine sample. The actual HSG procedure generally takes approximately 10 minutes.

The HSG procedure

During the procedure, the provider will place a speculum into your vagina in the same manner as if you were undergoing a Pap smear. He or she will cleanse the cervix with an antiseptic solution before placing a small, flexible catheter approximately 1 inch into the cervical canal, where it rests against the cervix. The clinician will pass a small amount of dye through the catheter, filling the uterine cavity and then filling the fallopian tubes. The tubes are considered open when the dye “spills” at the ends of the tubes (this is visible on the fluoroscopy). If your tubes are open, they should be able to “pick up” your ovulated egg. This part of the process generally takes less than 1 minute.

To examine the uterus, the clinician gently infuses the dye into the uterine cavity, and while some cramping may occur, it is usually less than menstrual cramping. If the dye cannot pass through the tube, a blockage is present.

After the HSG

While many women have no pain after the HSG, some may feel crampy or achy after the procedure, so it’s a good idea to have someone else drive you home. Some patients will also experience spotting a few days following the HSG—this is completely normal.

The results

The clinician performing your procedure will review your images with you immediately and will provide you with your preliminary results. He or she will send the images to your electronic medical record so your physician may review them in a timely manner.

In the event that the clinician discovers a tubal blockage, your physician will provide potential treatment options. If scar tissue in or around the fallopian tubes is causing the problem, a physician can often surgically remove it. If your fallopian tubes are damaged, your doctor may be able to repair them with surgery, depending on the type and extent of the damage. If your tubal disease is severe, however, in vitro fertilization (IVF) that bypasses your fallopian tubes may be a valuable treatment to consider.

FAQ

Complications are exceptionally rare. As a precautionary measure, we ask patients who are considered at an increased risk for infection—those with prior history of pelvic inflammatory disease (PID) or known dilated tubes—to start an antibiotic prior to the procedure to reduce this risk. We also instruct patients not to have intercourse or use tampons for 24 hours. A potentially serious, but very rare, complication can result if you are allergic to the contrast dye. If you have had any allergic reaction to prior contrast dye (as used with a computerized tomography [CT] scan or intravenous pyelogram [IVP]), you need to notify your physician so that he or she can prescribe medications to reduce your risk for a reaction.

Some women feel slight cramping, especially when the clinician injects the dye. Women who have a blocked fallopian tube may feel more intense pain. Over-the-counter pain medicines such as ibuprofen can help relieve this pain or discomfort.

We instruct patients to refrain from intercourse for 24 hours to reduce the risk for an infection. However, we do not discourage attempting pregnancy this month. The purpose of the urine sample that you provide before your HSG is to ensure that you are not pregnant at the time of the procedure.

At Shady Grove Fertility, we take special care during the HSG to use the lowest radiation dose possible while capturing the best images for evaluation. Radiation exposure from these small doses is not known to injure ovarian tissue and there have been no demonstrated ill effects from this radiation, even if conception occurs in the same month.

We recommend you schedule the test after your period ends but before you expect to ovulate, usually between days 5 to 12 of your menstrual cycle. To figure out the days of your cycle, count day 1 as the day your period begins.

The alternative to an HSG is called chromotubation, which is a laparoscopic procedure that involves surgery and general anesthesia. During the surgery, the practitioner will infuse the dye into the uterine cavity through a catheter and watch the dye as it travels through your fallopian tubes and “spills” out into the pelvic cavity, confirming that the tube(s) is open. This procedure involves abdominal incisions and increased discomfort, surgical risks, and costs, and is not usually suggested as a first-line test to evaluate the patency of the tubes. The HSG has the advantage, not only of being a lower-risk, lower-cost procedure, but because it will enable your physician to also evaluate the uterine cavity for abnormal shape or filling defects such as myomas, polyps, or adhesions. A laparoscopy cannot evaluate the inside of the uterus.

While SGF physicians routinely make treatment decisions based on HSGs performed at outside facilities, the information is sometimes inconclusive or does not provide all of the information we need to make the best recommendations for your treatment. At Shady Grove Fertility, all of the infertility specialists who perform HSGs have been specially trained regarding pelvic sensitivities, the appropriate HSG technique, and interpretation of results. However, the choice to have your HSG performed at SGF versus another facility is ultimately yours to make.

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