Hysterosalpingography

Hysterosalpingography is a procedure where x rays are taken of a woman's reproductive tract after a dye is injected. Hystero means uterus and salpingo means tubes, so hysterosalpingography literally means to take pictures of the uterus and fallopian tubes. This procedure may also be called hysterography (or HSG).

Purpose

Hysterosalpingography is used to determine if the fallopian tubes are open, or if there are any apparent abnormalities or defects in the uterus. It can be used to detect tumors, scar tissue, or tears in the lining of the uterus. This procedure is often used to help diagnose infertility in women. The fallopian tubes are the location where an egg from the ovary joins with sperm to produce a fertilized ovum. If the fallopian tubes are blocked or deformed, the egg may not be able to descend or the sperm may be blocked from moving up to meet the egg. Up to 30% of all cases of infertility are due to damaged or blocked fallopian tubes.

Precautions

This procedure should not be done on women who suspect they might be pregnant or who may have a pelvic infection. Women who have had an allergic reaction to dye used in previous x-ray procedures should inform their doctor.

Description

As with other types of pelvic examinations, the woman will lie on her back on an examination table with her legs sometimes raised in stirrups. The x-ray equipment is placed above the abdomen.

A speculum is inserted into the vagina and a catheter (a thin tube) is inserted into the uterus through the cervix (the opening to the uterus). A small balloon in the catheter is inflated to hold it in place. A liquid water-based or oil-based dye is then injected through the catheter into the uterus. This process can cause cramping, pain, and uterine spasms.

As the dye spreads through the reproductive tract, the doctor may watch for blockages or abnormalities on an x-ray monitor. Several x rays will also be taken. The procedure takes approximately 15–30 minutes. The x rays will be developed while the patient waits, but the final reading and interpretation of the x rays by a radiologist (a doctor who specializes in x rays) may not be available for a few days.

Interestingly, sometimes the hysterosalpingography procedure itself can be considered a treatment. The dye used can sometimes open up small blockages in the fallopian tubes. The need for additional test procedures or surgical treatments to deal with infertility should be discussed with the doctor.

A hysterosalpingogram of the abdomen of a woman whose fallopian tubes are blocked. The fallopian tube (right on image) is blocked near the uterus, the triangular shape at center. The other fallopian tube is obstructed at a point further from the uterus where dilatation has occurred. (Photo Researchers, Inc. Reproduced by permission.)

Preparation

This procedure is generally done in the x-ray department of a hospital or large clinic. General anesthesia is not needed. A pain reliever may be taken prior to the procedure to lessen the severity of cramping.

Aftercare

While no special aftercare is required after a hysterosalpingography, the woman may be observed for some period after the procedure to ensure that she does not have any allergic reactions to the dye. A sanitary napkin may be worn after the procedure to absorb dye that will flow out through the vaginal opening. If a blockage is seen in a tube, the patient may be given an antibiotic. A woman should notify her doctor if she experiences excessive bleeding, extensive pelvic pain, fever, or an unpleasant vaginal odor after the procedure. These symptoms may indicate a pelvic infection. Counseling may be necessary to interpret the results of the x rays, and to discuss any additional procedures to treat tubal blockages or uterine abnormalities found.

Risks

Cramps during the procedure are common. Complications associated with hysterosalpingography include abdominal pain, pelvic infection, and allergic reactions.

It is also possible that abnormalities of the fallopian tubes and uterus will not be detected by this procedure.

Normal results

A normal hysterosalpingography will show a healthy, normally shaped uterus and unblocked fallopian tubes.

Abnormal results

Blockage of one or both of the fallopian tubes or abnormalities of the uterus may be detected.