UNDERSTANDING DIAGNOSTIC PROCEDURES IN A FERTILITY CLINIC: HYSTEROSALPINGOGRAM (HSG) (Part 1)

When a woman is trying to conceive, many parts of the body would have to work right for this to happen. The ovaries need to produce an egg every month by a process called ovulation, the womb has to be in good shape and receptive for a baby, and the fallopian tubes has to be opened. If the fallopian tubes are blocked, sperm won’t be able to reach the egg or the fertilized egg won’t be able to get into the uterus(womb). Blocked tubes can happen for different reasons, but your doctor will diagnose it with a test called HYSTEROSALPINGOGRAM also called Uterosalpingography.

What is Hysterosalpingogram (HSG)?

A Hysterosalpingogram is a unique type of x-ray that is used to evaluate the fertility of a woman by examining her fallopian tubes and womb. This procedure is usually carried out few days after a woman’s menstrual period but before ovulation (so as to prevent risk of carrying out this procedure while been pregnant), it is mostly done between day 8 and day 10 and in some cases day 12 of the menstrual cycle.

How to prepare for HSG

The HSG is performed while you are awake and conscious. It doesn’t usually involve general anesthesia. You also won’t need to fast the day or night before the procedure.

On the day of the procedure, your doctor might suggest taking a painkiller like ibuprofen or muscle relaxants an hour before your HSG is scheduled to occur. This can help with the discomfort of the test. Also, some doctors prescribe antibiotics to be used after the test to reduce the risk of infection.

HSG Procedure Description

This procedure is carried out in a fertility clinic or a radiographylaboratory. You’ll start by lying down on a table under an X-ray imager called a fluoroscope. A speculum is inserted into your vagina to keep it open, and then the neck of the womb (cervix) is cleaned with a cleansing solution. The cervix may also be swabbed with a local anesthetic to reduce any discomfort in some centers. A thin tube called a cannula is inserted into thecervix and gently fills the womb with liquid that contains iodine(also known as medical dye). The liquid is flushed through the tubes with repeated images of the uterus and fallopian tubes on the X-rays so that the doctor can see if the tubes are blocked and what parts of the tube are blocked.

The speculum is removed and images are taken with the fluoroscope X-ray. The contrasting liquid will show the outline of your uterus and fallopian tubes and how the fluid moves through them. In some cases, the doctor may ask you to move around so that side views may be captured.

Once the HSG is completed, the instruments will be removed. You will be able to get dressed and leave the procedure room. You may experience some mild cramping in the first hour after the HSG. Some have vaginal spotting for a few days after the procedure. Dizziness and stomach discomfort are possible in some few patients too.

The physician/ doctor will discuss the preliminary findings with you after the HSG procedure. Also, your doctor may tell you to abstain from sexual intercourse for a few days post-procedure to prevent infections.

HSG procedure risks

HSG is mostly safe, but all procedures have to an extent a minimal risks. One may encounter problems if one has an allergic reaction to the medical dye in the fluid. Pelvic infection or injury to your uterus is also a rare possibility.

One needs to call/ visit the doctor immediately if any of the following symptoms occur after the procedure: foul smelling vaginal discharge, fainting, severe pain or cramping in lower abdomen, vomiting, heavy vaginal bleeding and fever.

Exposure to radiation during HSG is small and these doses are not yet known to injure ovaries, uterus, or eggs (this includes the egg(s) that may be developing for ovulation during themenstrual cycle in which the procedure was done).

Possibility of pregnancy after an HSG procedure?

Pregnancy after an HSG may be more likely to occur in women with no additional pathology this however depends largely on the cause of the patient’s infertility. An HSG procedure can be carried out with a water-based or an oil-based contrast medium (This dye/medium enables the radiographer to see the uterus shape and fallopian tubes on the x-ray). Studies show that there was an increase in pregnancy rates with oil-based contrast when compared to water-based contrast. If you hope to get the pregnancy boost, an oil-based contrast for HSG is your best bet. This improvement in pregnancy lasted for up to three months post HSG procedure. Some women claim that they got pregnant after a month or two of undergoing HSG procedure…………………………………………………..To be continued next week