Importance of Hysterosalpingography Test (HSG) in Infertility

An HSG or hysterosalpingogram is an X-ray procedure used to examine the uterus (womb) and fallopian tubes. This test can tell if the fallopian tubes are open, and the inside of the uterus is healthy or not [1]. Having a blocked fallopian or any growth like fibroid, poly, or scarring in your uterus can reduce your chances for pregnancy. Once released, the egg travels through the fallopian tube and meets the sperm to get fertilized. If your fallopian tubes are blocked, the sperm can’t reach the egg, and you can’t become pregnant.

The HSG device uses a special kind of x-ray called fluoroscopy and a contrast material. The doctor uses the fluoroscopy to see the internal of the uterus and fallopian tubes in motion. It is an outpatient procedure meaning you are allowed to go home soon after the test, and there is no need to stay at the hospital overnight.

A Hysterosalpingography (HSG) is usually recommended when you have fertility issues due to which you are not able to get pregnant. The doctor uses this test to see if your fallopian tubes are open or blocked, if there is any scarring in the uterus or its nearby area and if the shape and structure of your uterus are normal.

Your doctor can also use HSG to examine your Fallopian tubes for reasons like [2]:

• Blockage of the fallopian tubes due to scarring or infection
• Tubal ligation (it is also referred to as “getting your tubes tied” it is a form of permanent birth control)
• Re-opening of the Fallopian tubes after a blockage due to a disease or sterilization

Hysterosalpingography (HSG) can also help investigate recurrent miscarriages which may be caused due to uterine problems like:

• Adhesions
• Uterine fibroids
• Uterine anomalies
• Tumors
• Endometrial (uterine) polyps

Hysterosalpingography (HSG) is a minimally invasive test that can provide valuable information about your fertility issues and conception related problems in a matter of minutes.

HSG test takes between 10 and 30 minutes and can be done in a clinic, hospital, or diagnostic center. During an HSG procedure, the doctor will place a contrast medium (a dye used to see the internal organs on the x-ray screen) [3] in the uterus and fallopian tubes. The procedure of the HSG is as follows [4]:

1. Your doctor will ask you to lie on your back with your feet placed in the upwards with stirrups, just like in a pelvic exam.
2. The doctor will then insert a device called a speculum into the vagina. It keeps the walls of the vagina apart and provides clear visibility of the cervix.
3. The doctor will then clean the cervix.
4. The doctor may also inject a local anesthetic for pain relief. You might feel some discomfort during this.
5. After this, the doctor will insert a tube called a cannula into your cervix that will later be used to insert the dye.
6. The speculum is then removed from the vagina, and you will be placed beneath an X-ray machine.
7. The fluid is then slowly inserted through the cannula or the tube into the uterus and the fallopian tubes. The fluid may cause some cramping.
8. As the contrast medium fills the uterus and tubes, X-ray images are taken.
9. If the fallopian tubes are blocked, the fluid will not be passed. If the tubes are not blocked, the fluid will slowly spill out of the tubes and will be absorbed by the body.
10. Once the doctor gets the required image, he will slowly remove the cannula, and you will be allowed to go home.

The benefits of this examination are that there is no radiation remaining in the body. X-rays usually don't have any side effects on the body within the diagnostic range.

HSG test is done within seven to 10 days after the first day of your menstrual period but before your ovulation. It is the best time to take the exam as being pregnant during this time is least likely, and hence it won’t put a fetus at risk [5]. HSG is a simple procedure, and you don’t need to prepare specifically for the examination. However, there are some pointers to keep in mind before you go for the exam.

HSG examination is not recommended in cases of pelvic infections. Consult your doctor if you have any symptoms of pelvic infections or STD (Sexually Transmitted Disease). You should also tell your doctor if you are allergic to iodinated contrast, taking regular medication, or suffering for any other medical condition.

You will have to remove your clothing and wear a gown for the exam. So wear comfortable clothes. You will have to remove any metal objects in your clothes and body before the test that may affect the test. Also, if you think you are pregnant, let the doctor know. They don’t usually perform this test on pregnant women as they don’t want to put the baby at risk.

HSG is a quick test, and it doesn’t cause much discomfort. However, you might feel a little disorientated, you may feel crampy or achy after the procedure, and it will be a good choice to bring a friend or partner when you take the test. They can drive you home after the test.

HSG test tells you if your infertility or any fertility issue is related to fallopian tube blockage or any abnormality of the uterus. The results of the test can mean the following:

• Whether the fallopian tubes are open or not: The test results will show if your fallopian tubes are blocked or not. If they are blocked, your egg can’t meet the sperm for fertilization because of which you are not able to get pregnant. There are many causes for blocked fallopian tubes like pelvic inflammatory disease, endometriosis, sexually transmitted infections, etc. Your doctor will tell you the course of further treatment based on your condition.
• Whether the uterus is in the right condition: If you have had multiple miscarriages, it can be because of an abnormally shaped uterus. An HSG can tell if the shape of the uterus is normal or not. Furthermore, it can tell if there are any fibroids or polyps in the uterus that may cause infertility. If found, they can be treated with surgery or medications.
• No problems with fallopian tubes and uterus: If your HSG shows a normal uterus and the fallopian tubes are not blocked, it means the results are normal. However, this doesn’t mean that you don’t have any fertility problems. It means that whatever is causing your infertility was not identified in the HSG, and further examination is needed.

Moreover, studies show that HSG shows a false negative of about 6%. Hence there is a possibility that your uterus may not have a normal shape even though the test suggests it is normal. Your doctor may perform another test or a different procedure for diagnosing the cause of your infertility.

HSG can find out the uterine or fallopian tube abnormalities that impair fertility. HSG is the process of injecting a dye into the uterus of a woman that helps in getting clear X-rays or images of the uterus and fallopian tubes. It can even contribute to the fertilization of egg and sperm. When the dye moves through the fallopian tubes, it removes blockages and clears the way for the sperm to reach the fallopian tubes and fertilize the egg. This procedure is called tubal flushing, and it can help increase the chances of conception.

Many scientific studies observed that hysterosalpingography (HSG) increases the chances of natural pregnancy in infertile women. One study states that the pregnancy rate after an HSG test has increased about two to three times than in women who have not undergone an HSG test before.

Studies show the chances of pregnancy increase by 25% in couples, for up to three months after the HCG test. Therefore, you can try for pregnancy for up to 3 months after the HCG test. You should have to check with a doctor if you are not able to get pregnant even after trying for months. After the HSG test, your doctor may be able to suggest the best plan for conception for you.

Some procedures can be done instead of Hysterosalpingography (HSG). They are:

• Sonohysterography: It is an ultrasound technique that can show the inside of the uterus. However, it does not provide any information about the fallopian tubes.
• Laparoscopy: Laparoscopy is used to examine your pelvic organs. It can examine both; the uterus and fallopian tubes.

Hysteroscopy: This procedure can be used to examine only the uterus, and it can’t give any information on if the fallopian tubes are blocked or not.

The benefits of an HSG exam are:

• It is a minimally invasive test and complications associated with it are rare
• It can provide valuable information about your fertility issues and conception related problems in a matter of minutes
• After the examination, no radiation remains in the body
• X-rays usually don't have any side effects on the body within the diagnostic range