Hysterosalpingograms

HSG Outpatient Procedure for Infertility

HSG is an outpatient procedure performed in the Radiology Department. A special iodine-containing dye is injected through the cervix. It flows into the uterine cavity and through the fallopian tubes. If the tubes are not blocked, the dye will spill out of the tubes into the abdomen indicating that the tubes are open. Several x-ray pictures are taken during the procedure to provide a permanent record of the condition of the tubes and the uterine cavity. The actual progress of the dye flowing through the tubes can be followed on a fluoroscopy monitor, which is like real-time TV. X-ray pictures are available in a few minutes and can be examined by the radiologist, the gynecologist, and the patient. HSG is performed within the first 7 days after the end of a normal menstrual period.

Why is hysterosalpingography (HSG) performed?

Your doctor may recommend an x-ray of the uterus and fallopian tubes if he or she suspects infertility. The HSG can be used in order to diagnose a blockage of one or both tubes that may prevent the fertilization of an egg by sperm. In addition, this procedure gives a picture outline of the uterus cavity and may help in detecting abnormalities of the uterus that could cause infertility, amenorrhea (absence of menstrual periods), or repeated miscarriages. Occasionally this procedure is ordered to diagnose causes of pelvic pain, which originate inside the uterus. It is sometimes done a few weeks or months after a tubal surgery in order to give information about the success of the surgery.

Is the procedure uncomfortable?

The HSG usually causes some minor cramping and discomfort, so you will be given a prescription for medication to take by mouth 30 minutes prior to the procedure. It is important that you ensure that a responsible adult will be able to provide transportation and observation following the procedure.

What can I expect during the procedure?

The patient undergoing an HSG will first lie flat on an x-ray table. A vaginal speculum will be inserted (much like is done in a Pap smear). The cervix is grasped with an instrument and a small probe is inserted into the cervical canal. After injection of the liquid contrast, the uterus may respond by having crampy contractions. Such cramps sometimes cause a spasm in the fallopian tube. In that case, you will be given a medication to relieve the spasm, which works in most cases.

What are the potential complications and side effects of hysterosalpingography?

During insertion of the instrument and injection of the dye, there may be cramping and discomfort which usually disappears after a few minutes. A small percent of patients may experience prolonged discomfort, especially when their fallopian tubes are blocked and the liquid contrast is unable to flow out of the uterus properly.

Rarely patients develop an infection of the lining of the uterus, fallopian tubes, or pelvis following the procedure. This is more common when the tubes have been damaged previously by infection or other causes. Infection of the tubes can lead to infertility, but the risk of infection is low.

Allergic reactions are possible after injection of the iodine-based contrast. Please notify your physician of any allergies you are aware of prior to the procedure. During the procedure a small amount of x-ray irradiation will be directed into the pelvic area and the ovaries. The minimal possibility of injury to an unfertilized or recently fertilized egg by the radiation does exist. For this reason every attempt is made to schedule the procedure prior to ovulation, since this is the time of month when your eggs are able to be fertilized.

What can I expect during the procedure?

The patient undergoing an HSG will first lie flat on an x-ray table. A vaginal speculum will be inserted (much like is done in a Pap smear). The cervix is grasped with an instrument and a small probe is inserted into the cervical canal. After injection of the liquid contrast, the uterus may respond by having crampy contractions. Such cramps sometimes cause a spasm in the fallopian tube. In that case, you will be given a medication to relieve the spasm, which works in most cases.

What can I expect after having a hysterosalpingography?

There may be some spotting or light vaginal bleeding for a few days following the procedure. If bleeding increases or persists, call your doctor. There may be moderate pain or cramping for several hours after the procedure. If the pain increases or persists overnight, call your doctor. Fever or persistent pain may be an early indication that an infection is developing. These symptoms should be reported to your doctor if they persist more than a few hours.