Hysterosalpingogram is a Greek word; Hystero meaning ‘uterus’, salpinx meaning ‘tube’, and gram meaning ‘drawing’. So an HSG essentially is an image of the uterus and the tubes. It is used to see if either or both fallopian tubes are open or blocked. It also can show if the cavity of the uterus (the womb) is of a normal size and shape. Healthy and patent tube/s are required for a pregnancy to occur naturally or with IUI.

A problem with the fallopian tubes or ‘Tubal Factor Infertility’, is one of the most common causes for infertility. Between 25 to 35 percent of female infertility is caused by tubal factors. Endometriosis, adhesions, or scarring because of previous pelvic infection, tuberculosis, or previous pelvic surgery can lead to tubal damage and blocked tube/s. Unhealthy damaged tubes also increase the risk of tubal ectopic pregnancy where the embryo implants and grows in the tube instead of the uterus.

What is the HSG procedure?

The HSG is usually scheduled between Day 7-9 of a woman’s period and is usually performed at the Radiologists office.

You have to lie down on the table with your legs flexed like for a pelvic exam. First, your position is adjusted so that the X-ray exposure is appropriate. A speculum is inserted into your vagina to be able to see the cervix (the mouth of the uterus) which is cleansed with an antiseptic solution. A small flexible catheter is inserted through the cervix and into the uterine cavity and the speculum is then removed and you are asked to lie flat on the table during the x-ray imaging. A small amount of dye is gently pushed through the catheter. The dye first fills up the uterine cavity, then starts filling the fallopian tubes and if the tubes are open, there is spillage of the dye at the end of the tubes. Fluoroscopy is a “live” x-ray that allows the Radiologist to watch as the dye is traveling through the tubes.

If the tube/s are blocked where they attach to the uterus (cornual end), then only the uterus will appear and the dye will not flow into the tubes.

If the tube is blocked some-way down its length, the dye will flow up till the blockage and then stop.

If the tube is blocked at its terminal (fimbrial) end, it may be distended and dilated in the proximal part and this will show up on the HSG as a Hydrosalpinx.

If there are adhesions in the pelvis surrounding the tubes, the dye may flow out of the tubes, but may appear loculated and not freely distributed.

A fibroid or polyp within the uterine cavity will appear like a filling defect where the dye was not able to flow.  Similarly, if the uterus is abnormally developed since birth, the shape of the cavity will not appear to be normal.

Are there any complications?

Complications are exceptionally rare. They include an allergic reaction to the dye, injury to the uterus, or pelvic infection.  Cramping and spotting for few days after the procedure are not uncommon.

Call your doctor if you have any of these symptoms:

–          Foul-smelling vaginal discharge

–          Vomiting

–          Fainting

–          Severe abdominal pain or cramping

–          Heavy vaginal bleeding

–          Fever or chills

How to Prepare for the HSG?

1. Where to get it done? Speak to your Fertility Specialist or your primary Gynaecologist regarding this. It is important to get this done at a reputed centre to minimise the risk of complications and to get clear images and reliable reporting.

2. Allergic reactions to the dye are rare, but can occur. Be sure to tell your doctor/Radiologist if you have ever had an adverse reaction to a contrast dye (as used with CT scan, IVP, etc).

3. Take an anti-inflammatory painkiller about an hour before the procedure. It is common to experience some mild to heavy cramping as the catheter is inserted, and pre-medicating with a painkiller can help minimize discomfort. You may want to take another dose later in the day, after the procedure.

4. Ask your doctor whether you should take antibiotics before/after the procedure. 

5. Carry a pad with you. A small amount of spotting and leakage of the dye is expected after the HSG.

6. Go with someone. Take your husband or a friend or relative with you to have someone around.

7. Consider taking the day off.  HSG is not a major procedure, but it usually is painful. Cramping and spotting may continue throughout the day and make you uncomfortable. There may be some nausea and dizziness. If you can, take the day off at work so you get a little time to recover.

Are there alternatives to HSG?

There are other procedures that can be carried out instead of the HSG.

Hysterolaparoscopy —This is a surgical procedure requiring general anesthesia and can give a detailed view of the inside of the uterus and also of the outside of the uterus, the tubes, ovaries, and other pelvic structures.

Sonosalpingography- This technique uses ultrasonography to confirm tubal patency by visualising turbulence near the fimbrial end when a mixture of air and saline is injected through a catheter placed within the uterus.