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

1. Infertility
2. To detect a blocked fallopian tube.
3. To detect uterine abnormalities, such as uterine anomalies, endometrial polyps, fibroids, intrauterine adhesions, genital tuberculosis.
4. 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.