Hysterosalpingography - HSG (Info for infertile couples)
What is Hysterosalpingography?
For a sperm to fertilize the egg, the female genital tract must be permeable throughout its length. Any defect that damages the permeability of this channel starting from the lower floor (cervix, uterus) to the upper floor of this apparatus causes infertility or ectopic pregnancy.
Hysterosalpingography (HSG) is a radiological examination (graphy) that focuses on the evaluation of the uterus and the Fallopian tubes in females. HSG can show abnormalities affecting the endometrial cavity (uterus cavity; the cavity where pregnancy will develop for 9 months) and various problems that the Fallopian tubes may have (blockages, narrowings or expansions (hydrosalpinx).
What defects in the uterus does HSG reveal?
Although in everyday jargon, HSG is known as the tube graphy, it initially studies the uterus (its cavity) since the contrast is first injected into the uterus and then passes into the tubes. Even the initial positions of the examination focus on the moment the cavity passes into the uterus. Among the problems that can affect the uterus and that can be seen during HSG we mention endometrial polyps, submucosal fibroids, synechiae (intrauterine adhesions), uterine and / or vaginal septa (curtains) (as well as other congenital and acquired abnormalities of the uterus).
What defects in the Fallopian tubes does HSG reveal?
Among the tube defects that HSG can reveal are total or partial blockages, hydrosalpinx (swelling of the tubes after blockage of their distal part), adhesions of the tubes with neighboring pelvic structures.
If the tubes are not blocked then the contrast will pass into the abdominal cavity. This is a positive sign of the tubes' permeability, but this does not always mean that the tubes work normally.
There are cases where HSG can show a blockage (especially at the exit site of the tubes from the uterus) and this blockage to be just a consequence of a spasm, so just something temporary and meaningless. Sometimes just accumulations of debris can also give the impression of a permanent tube blockage. To minimize these artifacts, it is advised that before the HSG procedure, the patient should take a premedication with antispasmodics. In many cases, it is not possible to differentiate a spasm from a permanent blockage.
When is HSG performed?
HSG is performed between day 6 – 10 of the menstrual cycle considering that day 1 is the day when menstruation comes.
When is HSG indicated?
HSG is indicated in cases of infertility!
What are the steps of the HSG procedure?
- Premedication 30 minutes before the procedure with antispasmodics and antiallergics (to minimize spasms and allergic reactions to the contrast).
- Gynecological position
- Cleaning the cervix with betadine solution to avoid infections.
- Placing the device
- Injection of the contrast dynamically and taking several positions in a row to gather all the necessary information about the uterus and tubes.
- Removing the instruments
How long does HSG take?
HSG lasts for 5-10 minutes.
Is it accompanied by pain?
In most cases, no. However, in some cases, it may cause discomfort similar to menstruation.
In the days following HSG…
The patient is advised to take antibiotics for 3 days to minimize the risk of infections.
What is the significance of HSG?
HSG is a diagnostic procedure that every woman seeking a pregnancy for more than 12 months should undergo.
Although the primary purpose of HSG is diagnostic, in rare cases, the pressure of the contrast can unblock some debris that blocked the tubes. This is why a number of women have achieved pregnancy after an HSG and without any other treatment.
Who performs HSG?
HSG is usually performed by gynecologists but can also be done by radiologists. Ideally, it should be performed by those gynecologists who treat infertility as it would be better for HSG to be done with as few shots (positions) as possible. Usually, doctors with little experience in this direction take many shots and this brings prolonged discomfort to the patient and unnecessary exposure to radiation.