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Hysterosalpingography (HSG) is a diagnostic imaging study commonly used to assess the patency of the fallopian tubes and the shape of the uterine cavity.
Hysterosalpingography is a radiologic procedure that involves the injection of a contrast medium into the uterine cavity and fallopian tubes. This is typically done under fluoroscopic guidance. The contrast medium helps visualize the internal structures of the uterus and fallopian tubes on X-ray images, providing valuable information about their anatomy and function. This is done with a water-soluble contrast solution. For an oil-based contrast with poppy seed oil please read here regarding Lipiodol Oil.
It is important that you are not actively trying to get pregnant the month of the HSG study so that there is no risk to an early pregnancy with this test as there is x-ray imaging.1
Indications for Hysterosalpingography HSG Study
One of the primary indications for HSG is the assessment of infertility. It helps identify abnormalities in the uterine cavity, such as polyps or fibroids, and provides information about the patency of the fallopian tubes. Tubal obstruction is a significant factor in female infertility, and HSG can reveal whether the tubes are open or blocked. If the tubes are blocked pregnancy is not possible, these tubes would need to be opened first by a procedure called FTR. Read more here regarding the FTR procedure.
HSG is also valuable in evaluating congenital uterine anomalies, such as a bicornuate or septate uterus. These anomalies can affect fertility and increase the risk of pregnancy complications, and HSG provides crucial information for appropriate management.2
HSG Test: What to Expect
• Positioning: You will lie down on your back on an x-ray table, like a pelvic exam.
• Instrument placement: A speculum is placed into the vagina, like a PAP smear test. A thin catheter is inserted into the cervix opening.
• Contrast: A water soluble dye is injected through the catheter into the uterus. The dye helps visualize the shape and structure of the uterus and fallopian tubes on X-ray images.
• X-ray Imaging: X-ray images are taken in real-time as the contrast dye fills the uterine cavity and then flows into the fallopian tubes. The images provide information about the presence of any abnormalities, such as uterine polyps, fibroids, or blockages in the fallopian tubes
• Evaluation: Our doctor will then evaluate the images and give you the results immediately after the test is completed. You will be provided the images and report to take with you to your fertility specialist.
• Post-procedure: After the procedure, the catheter is removed and you will apply a pad and get dressed.
HSG Study Interpretation
Normal HSG Findings
In a normal HSG, the contrast medium fills the uterine cavity and then spills out of the fallopian tubes into the pelvic cavity. This suggests that the tubes are patent, allowing the free flow of contrast medium. If both tubes are open then pregnancy should be able to proceed, if you are unsuccessful at pregnancy with open tubes, you can consider fallopian tube flushing procedure.
Abnormal HSG Findings
Abnormal findings in HSG may include uterine abnormalities like polyps or fibroids, as well as tubal abnormalities such as blockages or hydrosalpinx (fluid-filled fallopian tubes). These findings can provide insights into the underlying causes of infertility.3 For blocked tubes it is important to see where the tubes are blocked, which can determine how successful the FTR procedure can be at re-opening the tubes.
HSG and Female Fertility Assessment
Assessing Fallopian Tubal Patency
One of the crucial roles of HSG is the assessment of tubal patency. Tubal blockages are a common cause of female infertility, and HSG provides a direct and real-time evaluation of the fallopian tubes. The information obtained from HSG can guide further fertility investigations and treatment options, such as the FTR procedure for opening blocked tubes.
Infertility Treatment Planning
The findings from HSG play a significant role in determining the appropriate course of action for couples experiencing infertility. If tubal blockages are identified, assisted reproductive technologies (ART) such as an FTR procedure or in vitro fertilization (IVF) may be recommended as an alternative method for achieving pregnancy.4
HSG Limitations and Considerations
HSG False Positives and Negatives
Hysterosalpingography, while valuable, is not infallible. False positives and negatives can occur. For example, tubal spasm during the procedure may result in a false impression of blockage. Additionally, the sensitivity of HSG can be influenced by the experience of the radiologist performing the procedure. Make sure to have your HSG study performed by an experience diagnostic radiologist such as our doctor that not only performs HSGs but also treats the abnormal tubes with the FTR procedure.
HSG Patient Discomfort
The procedure can cause discomfort for some women, particularly during the injection of the contrast medium. Experiencing some cramping or pressure is normal.5
Hysterosalpingography HSG Study Cost
The HSG study should be performed by a Board-Certified Diagnostic Radiologist that specializes in women’s imaging to get the most accurate results. Additionally, the x-ray machine used should be up to date with the ability to zoom and window properly on the fallopian tubes for accurate evaluation. At our office the cost of the HSG study is $950 and this is inclusive of everything including the pregnancy test on the day. This procedure is only done by our physician who also treats blocked and abnormal tubes and not by an assistant or non-physician provider like other offices. After the procedure you do not need to wait for a report to be sent to your doctor, our physician will review the results and images with you immediately after the study is completed. You will be sent a final report to take with you to your fertility specialist.
Hysterosalpingography is a valuable diagnostic tool in the assessment of female fertility. It provides real-time imaging of the uterine cavity and fallopian tubes, offering insights into potential causes of infertility. While it has some limitations, its role in guiding treatment decisions and contributing to the understanding of reproductive health is undeniable.
As with any medical procedure, the decision to undergo HSG should involve a discussion between the patient and healthcare provider, considering the individual's medical history, fertility goals, and any potential alternatives or complementary tests. Advances in imaging technology continue to refine the accuracy and reliability of HSG, contributing to improved fertility care for couples worldwide.
HSG Study Preparation
To prepare for an HSG study you will be prescribed an antibiotic that you will take for 5 days total. You will need to start the antibiotic two days prior to the procedure to prevent any infection. Dress in comfortable clothes on the day of the procedure as you will change into a gown. There may be some cramping during the test, so it is recommended that you take an Ibuprofen or Tylenol one hour prior to the test. There is no downtime, but you can expect some spotting and cramping afterwards. Make sure to bring a pad to apply after the procedure as some of the contrast fluid will leak out the first day and you will have some spotting for a few days.
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- Swart P, Mol BW, van der Veen F, van Beurden M, Redekop WK, Bossuyt PM. The accuracy of hysterosalpingography in the diagnosis of tubal pathology: a meta-analysis. Fertil Steril. 1995;64(3):486-491.
- Mol BW, Collins JA, Wiegerinck MA, et al. The role of hysterosalpingography in the diagnosis of tubal pathology: the predictive value for in vitro fertilization of tubal patency tests. Hum Reprod. 1998;13(5):1266-1271.
- Mol BW, Swart P, Bossuyt PM, van Beurden M, van Der Veen F. Reproducibility of the interpretation of hysterosalpingography in the diagnosis of tubal pathology. Fertil Steril. 1996;66(6):1056-1060.
- Mol BW, Ankum WM, Bossuyt PM, Van der Veen F. Contraceptive induced amenorrhoea leads to decreased sensitivity of hysterosalpingography in the diagnosis of tubal pathology. BJOG. 1996;103(3):195-198.
- Ried K, Englehardt PF. Hysterosalpingo-contrast-sonography (HyCoSy) with SH U 454 (Echovist) in comparison with conventional hysterosalpingography with regard to patient preference. Hum Reprod. 1997;12(11):2444-2448.
The above information explains what is involved and the possible risks. It is not meant to be a substitute for informed discussion between you and your doctor, but can act as a starting point for such a discussion.