HSG for Detecting Fallopian Tube Blockages & Other Fertility Issues

Hysterosalpingography (HSG) is a vital tool for understanding the causes of infertility and other reproductive health problems. This minimally invasive procedure provides insight into the health of the uterus and fallopian tubes, helping doctors identify issues that could impact fertility. In this article, we’ll explore how HSG works, what to expect, and potential risks of the procedure.

How does HSG detect fertility issues?

A hysterosalpingogram is an X-ray procedure that examines the uterus and fallopian tubes. During the exam, the radiologist introduces contrast dye through the cervix into the uterine cavity. This allows them to visualize the flow of the dye through the uterus and fallopian tubes on X-ray images, highlighting blockages in the fallopian tubes as well as abnormalities in the uterus. As a result, this exam is particularly valuable for women who are having difficulty achieving or maintaining pregnancy.

What kinds of issues can HSG detect?

HSG can reveal a variety of reproductive abnormalities. These include uterine conditions such as polyps, fibroids, and intrauterine septum as well as fallopian tube blockage.

• Uterine polyps are small, typically benign growths that can develop within the uterine lining. Often, uterine polyps don’t produce any symptoms, but they can cause abnormal menstrual bleeding, and in some cases, they may make it more difficult to become pregnant or increase the chances of miscarriage.
• Fibroids are another type of benign growth that can occur within the uterus and impact a woman’s ability to conceive or carry a pregnancy to term.
• A uterine septum is a membrane that divides the uterus into two separate parts. Although this condition is present at birth, it often causes no symptoms, so it can go undetected until the woman becomes pregnant. A septate uterus can increase the chances of miscarriage.
• Fallopian tube blockage can prevent conception or lead to ectopic pregnancy, in which the fertilized egg becomes lodged within the fallopian tube rather than implanting in the uterus. Ectopic pregnancies are not viable and require immediate medical attention. Fallopian tubes can become blocked for a variety of reasons, including sexually transmitted infection, endometriosis, or previous abdominal surgery.

Is HSG painful?

One of the most common concerns surrounding HSG is the potential for pain and discomfort. The procedure involves inserting a catheter through the cervix to deliver contrast dye, which can cause cramping. This may subside when the injection is complete, but many patients experience spotting and cramping for up to two days following the exam. Knowing what to expect and preparing accordingly can help make entire the experience more manageable.

It can be helpful to research imaging providers to understand how they help make patients comfortable during an HSG. At Iowa Radiology, for example, we use specialized catheters, give careful attention to patient positioning, and regulate the speed at which the contrast dye is injected to minimize discomfort. Additionally, your doctor may recommend taking pain medication before the exam. At our clinics, we recommend 600 mg of ibuprofen taken 30 minutes before the appointment time. During the exam, don’t hesitate to communicate with your provider. Letting them know when you’re experiencing pain allows them to make adjustments to increase your comfort.

What are the potential risks of HSG?

As with any medical procedure, HSG carries some risks. The most common adverse effect is cramping, and serious complications are rare. Fewer than 1% of patients experience allergic reaction to the contrast dye, which is often mild but in rare cases (approximately 1 in 1,000), may be severe. Be sure to tell your provider if you have a family or personal history of allergic reaction to iodine contrast.

The most significant risk is development of an infection after the procedure, which occurs in approximately 3% of patients. For this reason, your referring provider may prescribe prophylactic antibiotics prior to the exam. If, following an HSG, you experience unusual discharge, increasing pain, fever, or heavy bleeding, contact your doctor.

Because HSG is an X-ray procedure, it uses ionizing radiation. While ionizing radiation is associated with an increased risk of cancer, the amount used in most imaging exams, including HSG, is quite low. The effective radiation dose from an HSG is roughly equivalent to what you’re exposed to from the natural environment over the course of five to six months.

The potential risks associated with HSG are generally outweighed by the valuable diagnostic insights it provides. When performed by qualified professionals, HSG is a trusted and safe procedure. Ensuring that you follow your healthcare provider’s recommendations and are aware of what to expect can significantly reduce your chances of experiencing these rare complications.

What can I expect during the exam?

After you check in for your appointment, a radiologic technologist will take a detailed medical history and direct you to empty your bladder. Next, you’ll be provided with a gown or blanket and asked to disrobe from the waist down. In the exam room, you will lie face up, and the radiologist will insert a speculum. After cleansing your cervix with an antiseptic soap, the radiologist will pass a thin, flexible catheter through the cervix into the uterus. The contrast material will be injected through the catheter, and then X-ray pictures will be taken and viewed on a monitor in real time. If needed, you may be asked to change positions. After obtaining the needed images, the radiologist will remove the catheter. The entire exam takes approximately 30 minutes.

HSG is a powerful diagnostic tool that provides essential information about the health of the uterus and fallopian tubes. From identifying polyps and fibroids to pinpointing fallopian tube blockages and uterine septa, this procedure can be the key to understanding infertility issues and guiding effective treatment strategies. If you’re considering HSG, talk with your healthcare provider about any concerns you have, and ensure you understand the procedure’s benefits and potential risks.

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Resources

American College of Obstetricians and Gynecologists. FAQs: Ectopic Pregnancy. Published March 30, 2018. Accessed October 28, 2024. https://www.acog.org/womens-health/faqs/ectopic-pregnancy.

Cha MJ, Kang DY, Lee W, et al. Hypersensitivity Reactions to Iodinated Contrast Media: A Multicenter Study of 196,081 Patients. Radiology. 2019;293(1):127124. http://doi.org/10.1148/radiol.2019190485

Cissons C. Signs and Symptoms of Blocked Fallopian Tubes. Medical News Today. Updated July 26, 2023. Accessed October 28, 2024. https://www.medicalnewstoday.com/articles/321419

Cleveland Clinic. Septate Uterus. Reviewed April 21, 2022. Accessed October 28, 2024. https://my.clevelandclinic.org/health/diseases/22809-septate-uterus.

Holland K. How Do Fibroids Affect Pregnancy and Fertility? Healthline. Updated May 3, 2018. Accessed October 28, 2024. https://www.healthline.com/health/womens-health/fibroids-pregnancy.

LeWine HE. Hysterosalpingogram. Harvard Health Publishing. Published February 2, 2023. Accessed October 28, 2024. https://www.health.harvard.edu/a_to_z/hysterosalpingogram-a-to-z

Radiological Society of North America. Hysterosalpingography. Reviewed August 25, 2024. Accessed October 28, 2024. https://www.radiologyinfo.org/en/info/hysterosalp#eafede9faa28404cae4edbf1342ff40b.

Reese D. Uterine Polyps. WebMD. Reviewed March 3, 2022. Accessed October 28, 2024. https://www.webmd.com/cancer/cervical-cancer/uterine-polyps.

UCSF Department of Radiology and Biomedical Imaging. How to Prepare for a Hysterosalpingogram (HSG) Procedure. Published September 20, 2021. Accessed October 28, 2024. https://radiology.ucsf.edu/patient-care/prepare/hysterosalpingogram.