HSG Test or Hysterosalpingography, or uterosalpingography is a medical test performed by a trained professional expert to evaluate the condition of your uterus and fallopian tubes. A contrast medium is injected into your uterus, and an X-ray is taken to determine if the cavity is normal and ensure that the fluid spills out of your fallopian tubes. This fluid usually contains a chromatic dye which accounts for easy detection. As such, X-ray contrast is a process in which a substance like air or metal like barium is used to obtain the contrast of an image through radiography. A positive contrast medium absorbs X-rays more strongly than the tissue being examined. On the other hand, a negative contrast medium absorbs X-rays less strongly. Usually, the HSG technique uses a radio-opaque material and fluoroscopy involving image intensification. Usually, in case of studying tubal rupture, the spilling of material into the peritoneal cavity is observed.
Hysterosalpingography helps to determine shape of uterine cavity and shape and patency of fallopian tubes. Usually, it’s done during the follicular phase of menstrual cycle when the follicles are most proliferated. Having the HSG test done during day one to day fourteen of menstrual cycle is most advantageous as this is the period which has least chances of pregnancy.
A HSG test, as such, doesn’t take more than 5 narrow minutes. However, you should try to be at the chamber around 30 minutes earlier than your scheduled time to prepare for the test. Your health care expert might suggest you an over-the-counter pain reliever (analgesic) or antibiotic with regards to the fact that you mayn’t feel very well after the test. The test is a bit painful to do, so you would want to discuss the antibiotics that are being prescribed to you with your health care expert.

Why is Hysterosalpingography Test Performed?

With HSG test, your doctor will be able to confirm whether a woman’s fallopian tubes are open and uterus has a normal shape or not. It also make sure the cavity is not affected by fibroids, polyps or scar tissue. In simple words, Hysterosalpingography is a histological test used to diagnose the internal organs related to the female reproductive system. Through this test, the doctor can easily detect the various causes of infertility and other problems related to pregnancy.
HSG is also done after a few months of tubal sterilization, i.e., tubectomy to check whether the fallopian tubes have been fully blocked or not. HSG test also helps to highlight symptoms of common fertility or reproductive tract disorders, including uterine malformations, Asherman’s syndrome, tubal occlusion and even PID (Pelvic Inflammatory Disease).
In simple words, HSG test is done mostly to determine a woman’s true reproductive potential. Since it’s a radio test, it’s usually performed in the radiological department of the hospital or any outpatient radiology facility. It might also be done in a clinic or a health care giver’s office.

How is Hysterosalpingography Performed?

HSG Test hardly takes more than a mere five or so minutes. However, the process is extremely complicated and requires professional medical expertise.
The cervix is visualized with a speculum inserted into the vagina and cleaned with an antiseptic solution. A thin, plastic catheter is placed inside the cervix and a small amount of contrast dye is passed through the catheter into the cervix, filling the uterus and fallopian tubes. Then with an X-ray, the practitioner can watch as the dye fills the uterus and travels into the tubes. The tubes are considered open when the dye is able to move completely through the length of the tube, spilling the dye out on the other side. This is a brief summary of how HSG Test is usually performed. However, if you want a more detailed step by step guide, turn on to the next paragraph.
The procedure, in detail, is as follows:
  1. You are made to lie on your back with your feet braced to yourself simply like you do during a pelvic examination test. Speculum, a metal instrument which is used to dilate an orifice in the body, is inserted into your vagina to hold the vaginal walls apart for easy viewing of cervix.
  2. Next, the cervix is cleaned of germs or mucus.
  3. The upper apex of cervix is may be temporarily numbed, i.e., local anesthesia might be done to provide relief from pain. Brace yourself for a small but sharp pinch or collision as this is done.
  4. There are two different methods to insert the dye inside the cervix. In one method, the cervix walls are grasped by a device and a thin tube called cannula is inserted within it to administer the dye. In another method, a narrow glass tube with high capillarity is inserted into the cervical opening with a balloon covering one of its ends. This extra measure helps keep the tube in its place.
  5. After this, the speculum is removed and you’re placed under X-ray surveillance.
  6. Meanwhile, the fluid from the cannula or glass tube spreads into your lower abdomen, filling your uterus and fallopian tubes. There might be slight cramps due to this fluid. By any means, the fluid makes your fallopian muscles stretch if they are already blocked.
  7. Now, X-ray imaging is performed by the medical experts. This imaging is possible due to the slow spreading of the contrast medium (fluid) into your uterus and fallopian tubes. You will be asked to accordingly change position for part imaging. If there is no blockage in your fallopian tubes, the fluid will spill out of their extreme distal ends to be then absorbed by the body.
  8. After imaging, cannula or glass tube is gently removed.
It is hoped that this step by step guide can help you understand exactly how HSG is performed.
Meanwhile, just a short word of advice for anyone who is undergoing the HSG test. Most people are comfortable driving home alone after having the HSG done on themselves. However, it’s highly recommended that you bring along someone else to drive for you on the way back as there might be a bit of pain or abrasion in your vagina.

Benefits of performing Hysterosalpingography Test

HSG Test, as such, is a diagnostic procedure. However, it has been known to have therapeutic or curative effect on infertility under several circumstances. For instance, oil-based contrast medium fluid inserted into the reproductive tract increases chances of pregnancy ten times as compared to water-based medium. On the other hand, oil-based contrast medium during HSG Test is known to increase chances of pregnancy by 3.6 times of chances when no HSG has been done at all. This therapeutic action is not attributed to the X-ray imaging itself but the flushing of the fallopian tubes with the contrast medium fluid. This cleans and rids the tubal tract of minor obstacles.
Plus, HSG Test does not only increases chances of conceiving or becoming pregnant- it also highlights any oddities like cysts or else within the reproductive chamber during X-ray imaging. It’s not necessary that these alien bodies should disrupt fertility. X-ray catches them easily and can warn the patient who might not have felt any external symptoms due to such oddities at all. Some of these cysts might even be malignant! HSG Test literally “throws light on them”.

Risk Factors and Side Effects of Performing Hysterosalpingography Test

HSG test is avoided at all costs if the woman is pregnant, has some pelvic infection or is facing heavy uterine bleeding at the time of the procedure. If an HCG is performed on pregnant women, there may be complications like infection, allergic reaction to the materials used in the test, intravasation of material and even embolization in case oil-based contrast medium fluid is used.
The medical operator might also instill air into the uterine cavity accidentally which limits proper diagnosis of tract due to outwardly induced filling defects. (Use of Tenzer Tilt can however prevent this from happening).
After an HSG Test has been performed on you, expect light to heavy sticky vaginal discharge as some of the contrast medium fluid starts draining from the uterus. There might even be drops of blood accompanied by it. This is probably due to insertion of the cannula. You can use a light sanitary napkin to soak through this discharge but try avoiding tampons. There are some other common side effects such as pain and/or discomfort, abdominal pain or cramps and vaginal spotting.
Now, coming to the risks of performing HSG test which are extremely rare. However, if you’re facing any of the following, consider consulting a gynecologist or clinic expert.
  • Extreme vomiting
  • Severe abdominal pain or cramping that doesn’t stop even after a day
  • Fainting
  • Fevers or chills
  • Foul smelling fluid discharge from vagina
  • Heavy bleeding from vagina that hasn’t stopped after sometime
There is an uncommon risk of infection involved with HSG Procedure. If you have bleeding that resembles a period or develop a fever, or continue to feel pain for more than a few days, you should contact your physician.
FAQs
1. Are there any alternatives to performing HSG Tests? Anything else that can help with diagnosing my fertility?
You can go for laparoscopy, which requires general anesthesia.
You can go for hysteroscopy, which gives a detailed viewing of the inside of the uterus. However, it can’t provide an imaging of the tubal section, i.e., inside the fallopian tubes.
You can go for sono-hysteroscopy, which is hysteroscopy using ultrasound. Like its predecessor, it can’t provide diagnosis of the fallopian tubes.
2.What is local anesthesia?
 The use of drugs administered with a syringe to prevent pain in a particular part of the body.
3. What is infertility?
 Infertility is a condition in which a couple has been unable to get pregnant after twelve or more months of continued trying by mutual sexual co-habitation without the use of any form of birth control.
4. What is contrast medium?
 Contrast medium is a radiological substance (usually a fluid) inserted into the body to obtain clear images of internal organs during X-ray study.
5. When during my menstrual cycle is it best to undergo a HSG Test?
 The HSG test has to be done after you’ve finished your menstrual cycle but before you’ve ovulated. This means that the best time for you to have a HSG is about two to five days after you’ve finished your period. You should be extremely careful about timing your appointment accordingly.
However, if you’re someone whose periods come and go with great irregularity, try consulting your doctor and discussing this factor in detail before booking an appointment with him or her.
6. How painful is it? What painkillers can I take after a HSG Test?
 Most people complain that undergoing a HSG leads to cramping that is quite similar to when you’re experiencing period cramps. Sometimes, the abdominal cramping might persist even after the test has been completed. This usually depends on what aspect is being treated particularly.
You can go for Valium or Advil. However, discuss this extensively with your doctor before deciding on what painkiller to take.
7. Can lifestyle affect a woman’s fertility?
 Yes. There can be impacts on a woman’s fertility due to lifestyle factors. For instance, being underweight, overweight or consuming heavy or light doses of alcohol can be detrimental to conceiving.
8. What does the basic fertility tests in women include?
 For testing your fertility, there might be lab tests including urine test, progesterone test, thyroid function test, prolactin level test and ovarian reserve tests. Imaging tests might include ultrasound tests, hysteroscopy, sono-hysteroscopy, laparoscopy and hysterosalpingography. You may not be prescribed all these tests together though. Everything depends on the mode of treatment your doctor thinks that you might need. Some tests are done based on the results of previous tests and procedures. Your BBT (Basal Body Temperature) can be tracked at home.
9. How long does a total infertility evaluation take?
 Usually, an entire infertility evaluation can be completed in the course of a few menstrual cycles in most cases. Some insurance companies cover infertility evaluation costs too.

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