Uncovering the specific cause of infertility is the first step toward designing a successful fertility treatment. The Hysterosalpingogram (HSG) is one of the initial tests patients undergo in the diagnostic process to determine the health of the uterus and fallopian tubes. Though the name sounds intimidating and stories circulate on the internet about how painful this test can be, we want to reassure you that the test itself is quick, painless, and, even better, patients are able to get their results immediately.
Shady Grove Fertility’s physicians and physician’s assistant (PA) personally perform and read over 2,500 HSG’s annually. “This is the kind of exam where clinical technique and experience really makes a measurable difference in the patient’s overall experience,” states Stephen J. Greenhouse, MD of Shady Grove Fertility’s Fair Oaks, VA office.
Shady Grove Fertility currently has two HSG testing locations open Monday through Friday in the Rockville and Towson locations. It’s important for patients to know that nearly all insurance companies will pay for the test to be performed at Shady Grove Fertility’s facility. “There are some HMO-type plans that might limit where a patient can have the test,” says Dr. Greenhouse, “but I’d say 90% will cover it at Shady Grove Fertility.”
Why Does Everyone Need An HSG?
Most new patients at Shady Grove Fertility will need to have an HSG test before initiating treatment. Sometimes couples with a known male factor infertility, like a low sperm count, wonder why the test is even necessary. Dr. Greenhouse explains, “We often see couples where both partners have a fertility issue, so it’s important to check both partners completely. Otherwise, we might spend precious time trying treatments that won’t work because we didn’t know of a problem in the uterus or fallopian tubes.” The HSG test can detect several kinds of issues, such as polyps, fibroids or scarring in the lining of the uterus, and blockages in the fallopian tubes.”
Likewise, patients who are planning to undergo In Vitro Fertilization (IVF) might wonder why a test to look at the fallopian tubes would be necessary, since the IVF process is designed to bypass the fallopian tubes. Dr. Greenhouse says, “Not only is it important to make sure there are no issues in the uterus that could prevent the implantation of an embryo, but there are actually some tubal diseases that have been shown to reduce pregnancy rates when using IVF.”
The HSG Procedure – What to Expect
An HSG is usually scheduled between days 5 and 12 of a woman’s menstrual cycle.
The process is pretty simple. A small flexible catheter (much thinner than a coffee stirrer) is inserted through the opening of the cervix and into the uterine cavity. A small amount of dye, about three teaspoons, is passed through the catheter, slowly filling the patient’s uterine cavity and then filling the fallopian tubes. The SGF physician or physician assistant watches the fluid move from the uterus, the fallopian tubes and into the abdominal cavity using X-ray imaging. The dye reveals the shape and lining of the uterus and, if it passes freely into the abdominal cavity, it shows that the fallopian tubes are open. Usually, this process takes less than a minute. Many women have said they think the experience is somewhat similar to having a pap smear.
One of the common concerns patients have about undergoing an HSG is whether the test will be painful. “For the vast majority of patients at Shady Grove Fertility, the HSG is not painful,” says Dr. Greenhouse. “If a patient feels discomfort or cramping, it’s usually at about the same level as menstrual cramps.”
Shady Grove Fertility’s expertise in facilitating accurate results and a pain free experience for the patient comes from the fact that the physicians and physician assistant (PA) conduct HSGs day in and day out. Patients may not have the same experience at an outside facility where the methods used could cause the patient unnecessary discomfort.
Dr. Greenhouse explains, “Some radiology centers perform HSG by inserting a balloon catheter into the uterus so they can inject the dye quickly. This can cause the uterus to expand rapidly and result in tubal spasms that may be uncomfortable.” He continues, “The reality is that the test is much more reliable and effective when the dye is injected slowly, and it’s more comfortable for the patient.”
Results on the Spot
Another benefit to having the HSG performed at SGFC is that patients receive immediate results.
“There are so many unknowns with infertility that cause patients anxiety, so we don’t want to add to that by delaying the results of the test,” says Dr. Greenhouse. “The specialist performing the test will let you know whether the test is normal or abnormal right away.” He continues, “For most patients, the results are normal, so it’s a weight off their shoulders to know that before they leave the office.
The results will be reviewed in more detail with the patient during a follow up conversation with her physician. Dr. Greenhouse explains that even when the results are abnormal, a patient’s treatment can usually be tailored to overcome the problem.
Dr. Greenhouse concludes, “Patients don’t need to fear this test. Despite what they may have heard or read online, it can be painless and quick. They can also be reassured by the fact that each step in our process is designed to get them one step closer to their goal of becoming pregnant.”