If you’ve begun the process to evaluate the cause of your infertility, no doubt you are concerned about the testing that will be required. In particular, the HSG may be the test you are most dreading. Possibly, well-intended friends and family have shared their experiences in crisp detail. You’ve gone to Google for reassurance only to stumble upon blogs from other patients who have not had a good experience and are all too happy to discuss and embellish it. Actually, now you are more anxious than before.
The Hysterosalpingogram (HSG) is performed routinely for patients having difficulty conceiving because it is an excellent test not only to see if a patient’s fallopian tubes are open, but to assess whether the uterus has normal shape and make sure the cavity is not affected by fibroids, polyps or scar tissue. The HSG requires the assistance of a certain type of x-ray called a fluoroscopy. At Shady Grove Fertility’s Rockville office, we have an x-ray room dedicated to these procedures. We also perform these procedures at our GBMC location, and utilize the hospital’s x-ray facilities. It may sound complicated, but it is actually a very simple and often quick test that provides valuable information in a matter of a few minutes or less. And the best part? It rarely causes the discomfort you might expect.
What Exactly Happens
A speculum is inserted into the vagina, similar to getting your annual pap smear. The cervix is cleansed with an antiseptic solution, and a small flexible catheter (much thinner than a coffee stirrer) is inserted through the opening of your cervix and into the uterine cavity. Usually the speculum is then removed and you are lying flat on the table during the x-ray imaging. A small amount of dye is passed thru the catheter, filling the uterine cavity and then filling the fallopian tubes. Fluoroscopy is a “live” x-ray that allows us to watch as the dye is traveling through the tubes. The tubes are considered open when spillage of dye occurs at the end of the tubes. This means that the dye has escaped the tube and thus your tube should be able to “pick up” your ovulated egg. Often times, this takes less than a minute, with less than 3 tsp of dye.
Even though this may be a step that patients dread, I often will tell the patients prior to the procedure they will be “pleasantly surprised”. The dye is gently infused into the cavity and although some cramping may occur as the uterine cavity distends with this fluid, it is usually less than menstrual cramping. I’ve found that the patients who comment on intense cramping usually do so because of tubal blockage. If the dye cannot pass thru the tube, there is increased pressure at the point of the blockage. By the time a patient is expresses discomfort, I’ve recognized the problem, the catheter is removed and there is immediate relief. Again, all of this takes a minute or less. And to reduce the cramping, it is our practice at SGF to advise Ibuprofen or similar over the counter non-steroidal anti-inflammatory product 1 hour prior to the procedure.
Are There Any Complications?
Complications are exceptionally rare. Our patients are asked to start an antibiotic prior to the procedure to prevent an infection and are advised to refrain from intercourse for 24 hours. Occasionally, patients will experience spotting a few days following. A potentially serious complication can result if you are allergic to the contrast dye. If you have had any allergic reaction to prior contrast dye (as used with a CT scan, IVP) you need to notify your physician so that you can be prescribed medications to reduce your risk for a reaction.
So, if the prospect of having a HSG causes your hands to sweat and your heart to palpitate, please recognize that if you are like most of our patients, you will quickly jump off the table exclaiming “that really wasn’t so bad”.