One of the most important procedures to diagnose the causes of female infertility is Hysterosalpingography (HSG), also known as hysterography, uterosalpingography, uterotubography, or simply HSG. This test aims to assess the shape of the uterus and the permeability of the patient’s fallopian tubes.
The radiologist administers an iodinated contrast medium into the cervix using a catheter. Utilising X-ray images, the expert will then examine how the fluid passes through the cervix, uterus and fallopian tubes. This test aims to discover abnormalities in the uterus as well as the fallopian tubes that may explain why the patient cannot become pregnant in natural ways, even after months of trying.
Hysterosalpingography – What is it?
During a hysterosalpingography, as already mentioned, the shape of the uterine cavity and the patency of the fallopian tubes are being assessed using X-ray images. These images can reveal abnormalities that may be present inside the uterus such as septa, bicornuate uterus or unicornuate, myomas or polyps that hinder the implantation of the embryo or even cause a miscarriage. Furthermore, adhesions or scars present in the uterus that may also interfere with the ability of the embryo to implant can also be assessed.
One of the main purposes of hysterosalpingography is to demonstrate the tubal patency. For the egg and sperm to be able to meet and fertilise in the fallopian tubes, they must be open. The fertilisation between egg and sperm cannot occur or will be considerably more difficult if either one or both of the fallopian tubes are blocked.
Another very important information that this test provides us with are indications as to which treatment is most likely to be successful for the patient. An in vitro fertilisation treatment is usually necessary if the fallopian tubes are blocked. If both fallopian tubes are open, allowing the egg and sperm to meet, fertilise and travel to the uterus to implant, artificial insemination can be carried out. In the case of obstructed fallopian tubes, it is not recommended to perform artificial insemination due to the low chances of success.
At IVF-Spain Madrid our fertility experts, together with our team , will choose the best treatment for you by evaluating every possibility available to achieve a successful pregnancy.
How is hysterosalpingography carried out?
Capturing X-ray images, the radiologist is able to examine how the contrast medium fills the uterus and fallopian tubes, drawing their shape and giving us an idea of their state.
After the contrast medium is introduced through the cervix into the uterus using a catheter, the uterus will appear white on the X-ray. If the fallopian tubes are permeable, the fluid is released into the abdomen which will be visible on the X-ray images. If the fluid is not released into the abdomen the fallopian tubes may be blocked or other structural abnormalities within the uterus may cause the blockage.
In these X-ray images, it is also visible if the fallopian tubes are swollen or dilated. This swelling or dilation is caused by an accumulation of fluid, as it happens in the case of hydrosalpinx, which occurs when the patient has suffered a tubal infection or had abdominal surgery.
Patent tube vs blocked tube
How uncomfortable is this test?
The reality is, yes, this test is somewhat uncomfortable for patients. To reduce the discomfort of the procedure and speed up your recovery, you may take a sedative or muscle relaxant.
But there is also the good news that an improved version of hysterosalpingosonography, called hysterosalpingosonography (HSSG) already exists. The advantages of this test are that it avoids the use of x-rays, as it is performed using ultrasound, it’s less uncomfortable and it provides the same results as HSG. Here, the uterine cavity and fallopian tubes are assessed using transvaginal ultrasound by following the form of the endometrium.
How to prepare for hysterosalpingography
Hysterosalpingography is a simple and quick procedure that only takes about 25-30 minutes, although depending on the patient it may take a bit longer. During this test, which is performed in an x-ray room, the patient lies on an obstetric table under the x-ray machine with her legs placed in stirrups as if she were having a visit at her gynaecologist. Anaesthesia is not required, although a series of instructions for proper preparation should be followed:
- The use of a laxative to clean the intestines and facilitate the image capture may be recommended by the fertility expert.
- To ensure that the patient is not pregnant, the procedure is performed a few days after the end of her period. X-rays could be harmful to the embryo.
- You may take a sedative or muscle relaxant to reduce the discomfort of the procedure if they were prescribed to you by a doctor.
- You may feel slight discomfort during the recovery process similar to menstruation. To help you feel better, you may take an anti-inflammatory drug.
- Light bleeding or brownish discharge in the days following the test are normal.
The difference lies in a good diagnosis
To obtain a complete overview of all the factors that may influence female and male fertility, we carry out extensive and personalised examinations at all of our fertility clinics.
We study each case in depth, assessing different aspects, from the quality of the embryo chosen for transfer to the receptivity of the patient’s endometrium. We don’t want to add to the emotional and financial burden the patient experiences. This is why we focus on genetics and immunology, two very important aspects in identifying why implantation failures or recurrent miscarriages occur.
This approach to reproductive medicine allows us to optimise treatment to obtain the best chance of success and create life in as few attempts as possible.