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Hysterosalpingogram
Also Known as
'Tubogram' or 'Hysterosalpingography'
Description
An hysterosalpingogram (HSG) is an X-ray test performed to evaluate the
inside of the uterus and fallopian tubes by injecting radiologic dye into
the uterine cervix through the vagina.
Normally, injected dye will fill the uterus, pass through the fallopian
tubes and spill out into the peritoneal cavity. Fallopian tube
abnormalities and infertility due to adhesion in the uterine cavity
(e.g. tubal blockages, fibroid tumors, polyps, scar tissue, or an
abnormal shape to the cavity) can be diagnosed with an HSG.
Usually an HSG is taken 2-5 days after menstruation has ended, and before
ovulation, to ensure the patient is not pregnant during the procedure.
Limited research suggests that fertility increases after X-rays are taken
with an oil contrast, the hypothesis being that after administration,
adhesions fall off, function of the uterine cavity improves, mucous is
removed, and the ability of the smooth muscle improves. This suggests that
the HSG may have treatment applications; but most HSGs are performed only
for diagnostic purposes because its therapeutic effect is still controversial.
Indications of HSG
- Infertility
- To detect a blocked fallopian tube.
- To detect uterine abnormalities, such as uterine anomalies, endometrial
polyps, fibroids, intrauterine adhesions, genital tuberculosis.
- To evaluate the results of tubal surgeries, such as a tubal ligation or
reversal operation.
How to prepare for HSG
- An HSG is usually scheduled within 2-5 days after the period ends
(day 7-10 of the menstrual cycle) and before ovulation (day 14 of the cycle)
to avoid exposing the uterus to radiation and X-ray dye, if the woman is
pregnant. Tell your doctor if you might be pregnant.
- If you have had a pelvic inflammatory disease or sexually transmitted
disease (gonorrhea, chlamydia, etc.), you are at a higher risk of developing
complications after the HSG. Tell your doctor if you suspect pelvic infection,
as you may need to take antibiotics before the test.
- Tell your doctor before the test if you:
- are allergic to X-ray dye (iodine), any medications
or foods.
- are asthmatic.
- are taking any medications.
- have any bleeding disorders.
How it is done
You will be asked to disrobe below the waist and lie on an exam table
under a fluoroscopy (real-time X-ray machine with a video monitor).
The gynecologist or radiologist will insert a speculum in the vagina,
place a tube into the opening of the cervix, then gently inject a small
amount of X-ray dye into the uterus while watching the fluoroscopy
monitor. Contrast material will fill the uterus and fallopian tubes and
finally spill out into the pelvic cavity around the uterus and tubes.
Several X-ray pictures will be taken during the procedure.
This procedure may cause mild to moderate cramping, similar to
menstrual cramping. Tell your doctor if you experience cramping for more
than several hours after an HSG.
Risks and complications of an HSG
- Infection is the most common complication of an HSG, but it is rare
and found in less than 1% of all cases. It usually occurs in patients with
a history of pelvic infection. If you have fever or abdominal pain within
a day or two after the HSG, contact your doctor immediately.
- Allergic reaction to iodine dye may cause skin rash, itching, shortness
of breath, or swelling in the throat or in other parts of the body.
- Fainting.
- The patient may experience a small amount of vaginal bleeding a few
days after an HSG.
- The amount of radiation from HSG is too small to do any harm.
However, if you suspect
that you are pregnant, you should not take the test.
- Damage to the uterus or fallopian tubes.
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