Overview of Hysterosalpingogram
A Hysterosalpingogram, or HSG, is a type of medical test that helps doctors check the health of a woman’s uterus and fallopian tubes. This is done by injecting a special dye into the uterus, which then travels into the fallopian tubes and reaches the areas near the ovaries. Doctors then use technologies like fluoroscopy and x-ray to take pictures at different stages of the test in order to examine the uterus shape, whether or not the fallopian tubes are open (called tubal patency), and whether the dye spills out into the abdomen (peritoneal spillage). This allows them to have a better understanding of the structure of the uterus and the fallopian tubes.
This test is mainly used when investigating reasons for female infertility. In fact, issues relating to the structure of the uterus and the fallopian tubes can contribute to about 60% of infertility cases. This shows how significant these aspects can be when it comes to the ability to conceive.
Unlike other tests like a pelvic ultrasound, hysteroscopy, or MRI scans, the HSG is unique because it can specifically check the fallopian tubes and the structure of the uterus. This makes the HSG an important part of the process when other tests are also being used to find out why a woman is having trouble getting pregnant.
Advancements in modern medicine have made this test much safer and more comfortable for the patient. Modern dyes that are nonionic and iso-osmolar are now used, which make the process much easier for the patient. However, like all medical procedures, the HSG does have a few risks and it’s not suitable for everyone. Despite this, the HSG remains an essential part of understanding female infertility, and it’s crucial for healthcare providers to know how to interpret the results accurately and provide the best patient care.
Anatomy and Physiology of Hysterosalpingogram
During a procedure called an HSG (Hysterosalpingogram), doctors mostly look at two parts of the female reproductive system: the fallopian tubes and the inside of the uterus or womb, which is also called the “endometrial cavity”. Having healthy and open fallopian tubes is essential for a woman to become pregnant. These tubes are channels that egg cells travel down from the ovaries (where eggs are released) into the womb.
If a woman is having trouble getting pregnant, an HSG can help doctors see if the shape of the womb and fallopian tubes are normal, and whether there is something blocking the tubes. If a blockage or a structural problem like a birth defect is the cause of the infertility, then it is referred to as “tubal infertility”. Most commonly, these blockages are caused by sexually transmitted infections (STIs), particularly a bacteria called Neisseria gonorrhoeae. Other conditions such as endometriosis, previous surgeries, and certain types of infection can cause these blockages too. Interestingly, sometimes a false alarm of a blockage can be caused by a temporary spasm of the fallopian tube during the HSG procedure, which returns to normal afterwards.
The inside of the womb can also be damaged, leading to fertility problems. For instance, scar tissue can fill up the womb and stop doctors from seeing the fallopian tubes during an HSG. Birth defects can also disrupt the shape of the womb, possibly creating blockages in the fallopian tubes. These defects are quite rare, however, found in only about 5% of all HSG procedures.
There are also other possible causes of fertility problems that an HSG might spot. These include womb cancer, growths called polyps and fibroids, and scar tissue called “adhesions”. However, other methods such as an ultrasound are often better at spotting these problems. Therefore, doctors typically use ultrasound alongside HSG to get a comprehensive understanding of any fertility issues.
Why do People Need Hysterosalpingogram
An HSG, or hysterosalpingogram, is a type of test mainly used in women who are having trouble getting pregnant. This test allows doctors to see the inside of the uterus and the fallopian tubes, ensuring they are shaped properly and not blocked. The test is done to rule out issues in these areas as the cause of infertility. Other imaging tools, such as a pelvic ultrasound, might also be used to detect other potential issues related to infertility.
When a Person Should Avoid Hysterosalpingogram
HSG, or hysterosalpingogram, is a type of test that looks at a woman’s reproductive organs. But, this test cannot be performed under some conditions like if a woman is currently pregnant, has an infection in her pelvic area, or is experiencing heavy uterine bleeding. If the test is carried out in the early phase of a woman’s menstrual cycle, it may reduce the risk of disturbing a potential pregnancy. Attention is given to this mainly in cases where the woman is trying to have a baby.
However, there are times when HSG is safe even if a woman has had a pelvic inflammatory disease before. Though, there’s a small chance that the disease might flare up again after the procedure. Routine use of antibiotics to prevent this is usually not encouraged.
Allergies are another factor for consideration. If a woman is allergic to the contrast media, which often contains iodine, used in this test, it’s a no-go. Also, if a woman has a history of any thyroid disease, she should consult with an endocrinologist (a doctor that specializes in treating hormone-related conditions) before having HSG. It’s because the iodine in the contrast can affect thyroid hormone levels or worsen certain conditions like Grave’s disease.
Although it’s been suggested to give certain patients glucocorticoids (a type of hormone) before the procedure, current medical evidence doesn’t support this approach. For patients with iodine allergies, a contrast media that doesn’t contain iodine should be used instead.
Equipment used for Hysterosalpingogram
The tools that are usually needed for an HSG test, a type of X-ray used to examine the uterus and fallopian tubes, include a speculum, a special table designed for the procedure, a solution for cleaning the vagina and cervix, a long clamp-like instrument to hold the neck of the womb, and a tube-like tool to inject the dye. The type of tube used can vary; it could be a metal tube with a small rubber end, a plastic tube with a part that can be blown up like a balloon, or a thin tube with a shallow cap-like end.
Who is needed to perform Hysterosalpingogram?
An HSG, which stands for hysterosalpingogram, is typically done in a special room called a radiology suite by a professional known as a radiology technician. This person has special training to use machines that can see inside your body. But sometimes, a doctor who specializes in women’s health (an OB/GYN) may do the test in their office or a clinic. This test usually only needs one person to do it.
Preparing for Hysterosalpingogram
Having a hysterosalpingogram (HSG), a special X-ray of the womb and fallopian tubes, should ideally take place during the earlier part of your monthly menstrual cycle, specifically between days 1 to 14. This timing lowers the risk of performing the procedure during an unexpected pregnancy.
To make sure you’re comfortable during the procedure, health care providers may suggest the use of pain-relieving medications and local anesthesia placed around the cervix, which is the lower part of the womb. An hour before the HSG, you might be asked to take an over-the-counter anti-inflammatory pain reliever like naproxen, ibuprofen, or indomethacin. However, research hasn’t necessarily found that these medications significantly reduce pain.
In certain situations, such as if you’ve had pelvic inflammatory disease or a previous infection, your doctor might prescribe antibiotics to prevent any possible infections from the procedure. Additionally, a medication called hyoscine-N-butyl bromide, which helps reduce muscle spasms, might be given to lessen pain during and after the procedure, as well as to decrease spasming in part of the fallopian tube. But, studies don’t show strong evidence that this medication is always beneficial, so it’s not usually given to everyone.
Finally, most people are able to go home by themselves after the procedure. Nonetheless, based on how you feel, you may want to arrange for someone to accompany you or pick you up after the procedure.
How is Hysterosalpingogram performed
A hysterosalpingogram (HSG) is a special type of X-ray used to evaluate a woman’s uterus and fallopian tubes. Here is how it’s done:
The patient lie down on an examination table and a device called a speculum is carefully inserted into the vagina, allowing the doctor to see the cervix. The cervix and the inside of the vagina are then cleaned with a special solution. Numbing medicine is injected into the area around the cervix for patient’s comfort.
A device with a rubber tip is then gently passed through the cervix, which is the entrance into uterus. This device creates a seal to prevent leakage of a special dye that will be used for the X-rays. Before this device is put in, the dye is put through it to avoid any air that might interfere with the X-ray images.
The doctor uses a special instrument, a tenaculum, to move the uterus to get a better view with the X-rays. A preliminary X-ray of the pelvis is taken before the dye is put in. The dye is slowly introduced to fill the uterus and pelvic X-rays are taken to observe how the dye spreads from the uterus into the fallopian tubes, and if it reaches the ends near the ovaries, which have a fringe-like appearance (fimbriated).
Different images are obtained including: early filling of the uterus with contrast to check for any defects, complete filling of the uterus to see the shape, dye flowing through the fallopian tubes, and if dye spills into the abdominal cavity. The number of images taken differs depending on the hospital or clinic’s policies.
The HSG mainly captures the flow of dye and shows the areas the dye has reached. If one or both fallopian tubes do not show dye flow, medication can be given to relax the tubes, because sometimes they can spasm and seem blocked when they are not. The dye used is a special kind that can be seen on X-rays (radio-opaque). It’s bright on imaging and can easily show the pathway. Failure to see the expected flow of contrast from either fallopian tube into the abdominal cavity signals a blockage.
The type of dye used tends to change over time. In the past, the dye used caused more side effects and was less tolerable for patients. Newer forms of the dye are now closer in concentration to body fluids (iso-osmolar), which has improved safety and comfort. Despite this, there is no agreement on which type of dye is the best to use for an HSG procedure.
Possible Complications of Hysterosalpingogram
Severe complications after having an HSG, which is a type of x-ray used to view the inside of the uterus and fallopian tubes, are quite uncommon. Some people may experience stomach cramping and bleeding from the vagina for a few days after the test. Other less common complications can include allergetic reactions to the dye that’s used during the test, an infection in the pelvis, or injury to the uterus or cervix (which are parts of the female reproductive system).
In rare cases, a person may feel faint or pass out because the cervix (the lower part of the uterus) is being touched during the test. It’s important to contact the doctor or the OB/GYN (a doctor specialized in women’s health and pregnancy) right away if there are any signs of problems after the test. These can include a bad-smelling discharge, severe stomach pain, heavy bleeding from the vagina, a fever or chills, or feeling like passing out.
In one unusual case, leftover tissue from a previous pregnancy was found during an HSG. This caused the dye used during the test to enter the bloodstream, which led to a problem of too much fluid in the body during a later procedure.
What Else Should I Know About Hysterosalpingogram?
A Hysterosalpingogram (HSG) is an important test in the diagnosis of female infertility. It is a type of test that is often used hand in hand with other tests such as pelvic ultrasound (a painless procedure that uses sound waves to capture images inside your body), hysteroscopy (an examination of the uterus), magnetic resonance imaging (MRI – an imaging technique that uses magnetic fields and radio waves to capture detailed images of internal organ), and laparoscopy with chromotubation (a surgical procedure to view the inside of the abdomen and pelvis, used to evaluate and treat a condition). The laparoscopy with chromotubation is especially helpful as it commonly helps to highlight and treat both tubal (relating to the fallopian tubes) issues as well as non-tubal problems including scar tissue and endometriosis (a disorder where tissue that normally lines the uterus grows outside of the uterus). The HSG is particularly useful in identifying issues with the fallopian tubes and inside of the uterus, like scar tissue and growths.
While each test gives valuable information in assessing female infertility, no one test provides a complete picture. Therefore, a combination of transvaginal ultrasounds (a type of ultrasound performed by inserting the ultrasound probe into the vagina), HSG, and hysteroscopy is often recommended to thoroughly evaluate patients with infertility.