Hysterosalpingogram - Uses, Procedure, Benefits, and Risks

Introduction:

The incidence of infertility is rising steadily worldwide. Infertility and subfertility are common problems affecting both men and women equally. Various factors contribute to the cause of infertility, such as lifestyle diseases, changing lifestyle habits, advancing age, and work-related stress. However, certain anatomical and structural abnormalities may also result in infertility. For example, in women, abnormal uteruses and fallopian tubes contribute significantly to increasing infertility. To study the uterus and fallopian tube, hysterosalpingography (HSG), otherwise called Uterosalpingography, is performed.

What Is a Hysterosalpingogram?

A hysterosalpingogram is a radiological diagnostic procedure that is used to evaluate the internal structure of the fallopian tubes. It is a specialized technique wherein a contrast dye is injected into the uterus and X-rays are taken. HSG is primarily indicated for women who have been suffering from long-term fertility issues.

There are many reasons for female infertility, one of which is blocked fallopian tubes. Tubal blockages would hinder the fertilization of the egg by the sperm. It will also not allow the fertilized egg to pass into the uterus. For a successful embryo implantation, the uterus should be in normal shape and size, devoid of any pathologies.

To determine tubal patency and assess the uterine cavity, HSG is most commonly advised by doctors. It is also advised as a prerequisite test before fertility treatments such as IUI or IVF (in-vitro fertilization).

When Is the Ideal Time to do HSG?

The test can be taken between 7 - 10 days after the beginning of the menstrual cycle because there will be no chance of pregnancy. A course of antibiotics and painkillers may be given before the procedure to reduce the incidence of infection and pain during the procedure.

What Are the Uses of Hysterosalpingograms?

Hysterosalpingograms are usually indicated to check the health of the uterus and fallopian tubes and any associated abnormalities.

The indications of a hysterosalpingogram are as follows:

• HSG is commonly used to evaluate infertility or subfertility issues.

• It is used to identify the cause of repeated spontaneous miscarriages.

• It is used to evaluate tubal patency (partial or complete blockage of fallopian tubes).

• In certain cases, the pressure of the injected dye material can also help reverse the tubal block.

• HSG is also done to ensure a successful tubal ligation.

• Uterine abnormalities such as polyps, fibroids, scarring, and other congenital abnormalities can also be detected using HSG.

What Is the Difference Between Hysterosalpingogram and Hysterosonogram?

• A hysterosonogram is an ultrasound imaging procedure used to evaluate the lining of the uterus. Hence, a hysterosonogram is chiefly indicated to detect any abnormalities associated with the uterus. Unfortunately, it is not successful in imaging the fallopian tubes. In contrast, a hysterosalpingogram is an excellent diagnostic tool for evaluating the uterus and fallopian tubes.

• A hysterosonogram is conducted with the help of ultrasound, whereas a hysterosalpingogram is done using X-rays.

• A hysterosonogram uses saline water as a contrast medium, whereas an iodinated contrast material is used in a hysterosalpingogram.

• A hysterosonogram is not efficient in evaluating fallopian tube pathologies, whereas a hysterosalpingogram is a gold standard in diagnosing tubal blockages and reversing their blockage.

• The advantage of a hysterosonogram is that no radiation is used in ultrasound; hence, it is very safe, whereas a hysterosalpingogram risks some radiation exposure.

What Are the Preparations to Be Done Before the Hysterosalpingogram Procedure?

The preparations are as follows:

• Patients are advised to do this test between their menstrual cycle's 5th to 10th days.

• Analgesics and antibiotics will be prescribed, and patients will be advised to start them before the procedure.

• There are no dietary restrictions.

• Patients will be advised to wear loose, comfortable clothing.

• Jewelry and accessories in the pelvic area will have to be removed.

• Patients should inform the doctor of any history of allergies.

• This procedure should be avoided if patients have any pelvic infections, uterine bleeding, or are pregnant.

• Patients may be advised to carry a sanitary napkin since mild spotting may occur after the procedure.

How Is Hysterosalpingogram Done?

A hysterosalpingogram is done in the following ways:

• HSG is usually done as an outpatient procedure. The entire procedure may take anywhere between 30 and 45 minutes.

• The patient will be asked to lie on the examination table in a position similar to a pelvic examination. A speculum will be inserted into the vagina so that the cervix can be seen.

• The cervix is cleaned. A thin tube called a cannula is inserted through the cervix into the uterus.

• The contrast material would then be injected through the cannula into the uterus. The uterine cavity is filled with the contrast material.

• A clear contour of the uterus and fallopian tube would be visible. If the fallopian tubes are open, the dye will spill into the pelvic cavity, where the body absorbs them.

• No dye spill would indicate blocked fallopian tubes.

• The doctor would then take the X-ray images, where the contrast material would appear white.

• The patient may be asked to turn to either side for a better view.

• Minor discomfort and cramps are common when the dye is injected into the uterus.

• The cannula and speculum will be removed after the procedure.

• The patient will be assisted to the waiting room.

What Are the Post Procedure Instructions to Be Followed by the Patients?

The following are some of the post-procedure instructions:

• HSG is an outpatient procedure; hence, patients may resume their normal activity.

• Vaginal discharge, bleeding, spotting, and cramps are common.

• The patient will be advised to take painkillers and antibiotics.

• The use of tampons should be avoided.

• One must refrain from intercourse for a few days as it increases the chances of any infection.

What Are the Benefits of Doing Hysterosalpingograms?

The following are some of the benefits:

• It is a minimally invasive procedure.

• It is relatively safe, with no major complications.

• The pressure of the injected dye can open a blocked tube.

• The radiation exposure is very minimal.

Apart from these benefits, they are also used to investigate congenital deformities like

• Uterine fibroids.

• Uterine Polyps.

• Tumors.

• Adhesions.

• Abnormality in the shape of the uterus.

These abnormalities, if not found, result in repeated miscarriages.

What Are the Risks Associated With this Procedure?

Complications associated with HSG are very rare; however, the following risks are a possibility and cannot be excluded:

• Pelvic infection.

• Allergic reaction to the dye.

• Uterine perforation may occur, but it is extremely uncommon.

• False positivity is another drawback with HSG. Tubal spasms can occur due to discomfort and cramps, resulting in tubal occlusion during the procedure.

What Could be the Contraindications?

HSG is not done if the individual is

• Pregnant.

• History of Pelvic Infection.

• Uterine bleeding.

Is the Procedure Painful?

Though a minimally invasive procedure, post-operative pain is inevitable. Mild cramping and uterine bleeding are normal. If experiencing unbearable pain, consult the healthcare provider.

What are the Other Alternatives to HSG?

Other methods that can offer some of the comparable information as HSG include:

• Laparoscopy: General anesthesia is necessary for this surgical procedure.

• Hysteroscopy: This procedure can provide an in-depth look at the uterus' within. However, it is unable to indicate if the fallopian tubes are obstructed.

• Sonohysterography: This method visualizes the uterus using an ultrasound examination. It provides no information about the fallopian tubes, similar to hysteroscopy.

• Sonohysterosalpingography: This process makes use of ultrasound and a saline solution. The saline enters the uterus through the cervix. The uterine lining is then seen via ultrasound, which is also used to monitor the saline flow into the fallopian tubes.

Conclusion:

Infertility is a common cause of concern among many couples. Studies have shown a rise in the number of female infertility cases. A proper diagnosis and subsequent treatment can help these patients overcome infertility. HSG is the most common first-line test advised by doctors to assess female infertility issues. It is a cost-effective and relatively safe test that can be carried out as an outpatient procedure. The results are promising, helping the patients and doctors decide the next line of treatment.