Basics of Fertility

Hysterosalpingography (HSG) Test: Purpose, Procedure & Risks

Across different parts of the world, infertility seems to be a huge and widespread problem these days. There are several reasons for woman infertilitymale infertility, and certain unknown facts about not achieving pregnancy (popular unknown infertility). In specific cases, couples try for several years to obtain pregnancy, but the efforts go wasted due to unknown causes. However, today with advanced and innovative technology treatments of infertility is possible. Many tests like HysterosalpingographyHysteroscopyLaparoscopy, and Genetic testing exist to uncover the concise reason behind infertility in such cases. The test outcomes assist the physicians to identify and target the exact cause of supporting unaccomplished pregnancy in the respective patient. One of such prevailing infertility condition includes blocked fallopian tubes in a woman. Fallopian tubes enact a substantial role in the functioning of fertilization. It is the locus where fertilization inside a woman takes place. After rupturing an ovary sac, the egg promptly goes towards a fallopian tube to wait for the sperm to infuse it. Whereas, sperm travel through the cervix of the uterus, goes deep inside the fallopian to fertilize the egg. After the fertilization, the mature egg or embryo travels back from a fallopian tube to reach the uterus. At the moment, if a fallopian tube is barred, then the sperm will find it difficult to progress and pass the obstruction to reach the egg. In HSG test such obstruction is identified and suitable treatments are suggested to successfully achieve the pregnancy.

In this article you will find details about the following mentioned questions:

  • What Is a Hysterosalpingogram (HSG) test?
  • What are the vital steps involved in the HSG test procedure?
  • How to prepare for the HSG test?
  • How does the patient experience during the HSG test?
  • How does one conceive successful pregnancy after HSG Test?
  • Is radiation released during the HSG test safe?
  • What are the specialized types of essential equipment used in the HSG test?
  • What are the HSG test side effects?
  • What do the valuable results of the HSG test signify?
  • What is the HSG test cost in India and around the world?

Tubal-factor infertility is a problem caused by scar tissue, pelvic infections, surgery, endometriosis or hydrosalpinx. These conditions hinder the free traveling of eggs and sperm into the fallopian tube to result in fertilization. According to The American Society for Reproductive Medicine (ASRM), around 25 to 35 percent of female infertility is potentially caused by blocked tubal factors. Hysterosalpingogram (HSG) is a crucial and effective test to ascertain the reason for blockage in the uterus of the woman. An HSG test is also recommended by a doctor in case of recurrent miscarriages to check the irregular shape or structure of uterus including the endometrial lining. These structural problems are usually caused due to polyps or fibroids, which makes it difficult to sustain a pregnancy. However, removing them with an excellent medical test like the HSG test, one may achieve pregnancy naturally without spending any additional money. 

What Is a Hysterosalpingography?

Hysterosalpingography (HSG) is a medical test procedure to perform an in-depth inspection of the uterus in a woman. The procedure is also known as uterosalpingography. It refers to the radiologic procedure where the shape, uterine cavity, and patency (openness) of the uterus are measured. In this procedure, a special medical instrument dye is employed to look through special X-ray inside the womb and fallopian tubes. A physician injects a radiopaque material in the cervical canal. The process also includes the use of fluoroscopy along with image intensification for a precise viewpoint. To perform an HSG procedure, it takes about 30 to 45 minutes on an average depending on the case and expertise of the surgeon. To analyze the internal conditions, the insertion of a thin catheter is viable via the uterine cervix. Along with the catheter, a special radio-opaque contrast material dye is also inserted to capture a proper view of the inner surface of the uterus.

The HSG test makes it easier to look inside uterus and fallopian tubes closely. The complete procedure is also accompanied by fluoroscopic x-ray, which provides mobile images of fallopian tubes with high resolution. In the absence of blockage, the dye smoothly goes inside and moves freely in the organ. In case the blockage of the fallopian tubes hinders the movement of the instrument inside, it concludes that the passage of the fallopian tube is clogged. Significantly, when an obstruction is present inside the fallopian tube, a laparoscopy or other surgeries are required to operate such blockage. If it becomes challenging to treat such cases, then a doctor may suggest for an In Vitro Fertilization (IVF) treatment straight-away without the case going for any second opinion. In IVF procedure, experts perform a surgery to remove the obstruction and provide with successful results. HSG is strictly conducted after menstrual periods end, but prior to ovulation. 

HSG Test Procedure:

The test is usually performed in a radiology department of the hospital. Under the surveillance of a medical specialist, the complete HSG test should be performed. One must keep herself relax during the procedure and assist the doctor while performing the procedure. Below is the step by step HSG procedure:

  • Step 1: The patient will be asked to lie down on the table present below the x-ray machine. Further, the patient will be asked to relax and place her feet into the stirrups which are similar to a pelvic examination. A tool known as the speculum is then placed into the vagina to progress the procedure. Speculum helps in holding the walls of the vagina apart to view clearly inside the uterus and accurately inject the cannula. Subsequently, the cervix present in the patient is cleaned thoroughly to avoid any infection.
  • Step 2: There are two methods of performing the HSG test. The first method includes injecting the dye into the vagina. A device grips the cervix intact so that it does not move in the insertion process. An instrument known as a cannula is entered into the cervix to monitor shape, structure, and presence of blockage inside the uterus. Whereas, the second method involves a thin plastic flexible tube to be inserted inside through the cervical opening in the patient. The plastic tube has a small inflated balloon at the end. The balloon helps in keeping the tube intact to give a proper view of the targeted area in the patient.
  • Step 3: The tenderly holding specula is gently removed from the cervix, while one is resting under the X-ray machine. The fluid is then gradually inserted into the uterus and fallopian tubes through a cannula or a tube. During the dynamic process of insertion, one may further feel cramps and mild pain because the fluid will gently stretch the tubes if they are found blocked in the resultant x-ray images.
  • Step 4: When the contrast medium fills the uterus and fallopian tubes with liquid, the X-ray machines previews the images formed. In such a scenario, a doctor may also ask the patient to change her position as per the requirement of the test. In case the fallopian tubes are free of potential obstruction, the liquid will spill and move slowly towards the end of the tubes. When the liquid is spilled completely, the body will efficiently absorb the liquid.

Once the clear images are captured, and a doctor is confirmed about the completion of the procedure, then the cannula is removed from the patient. One may be given with an injection to relieve the pain. However, the patient will feel slight pain and cramps afterward, but these are handled carefully through appropriate medication and taking rest for the entire day after the procedure gets completed.

Preparing for the test:

One must keep the below-mentioned points in the notice before going for the HSG procedure.

  • One must only consider an Infertility specialist for HSG test: Usually, a test is performed in a hospital, clinic, health care provider’s office (OB/ GYN’s office) or at the radiology department of a clinic or hospital. However, it is better to get an appointment with the gynecologist to accompany throughout the process and to get the root cause of the problem efficiently.
  • It is beneficial to check if any insurance covers such a test: HSG being a diagnostic test can be covered under insurance, irrespective of infertility treatment. Therefore, one must check with their insurance provider for compensation. Although this option varies to a great extent depending on the location or clinic.
  • Specific days in which HSG procedure should be performed: It is crucial to note that the HSG test should only be performed between 5th to 10th day of the patient’s menus cycle. One must be assured first that she is not pregnant before planning to go for the HSG test. If one does not have a regular menstruation cycle and she is not sure about her ovulation time, then a qualified doctor will perform a pregnancy test before commencing with HSG test.
  • Inform the doctor about the known allergies, which might be caused due to Iodine, Betadine, or Novocaine: Usually, it’s rare that a patient will evolve allergies due to the dye instrument while performing the HSG test, but there is always an exception to the case. Therefore, if a patient has any poor earlier experience with such a test, then she must inform the doctor about it to avoid such severe circumstances again.
  • On the day of the performing the test, one must take an anti-inflammatory tablet like Advil or Motrin an hour before the procedure: It is very common that a patient might feel terrible cramps and pain in her abdominal due to insertion of the instruments. It will be helpful if one takes other medicines as well along with antibiotics as per the guidance of the medical specialist to avoid such pains.
  • It is also advised to confirm with the doctor first, which tablet or medicine will be suitable for the procedure: In certain cases, a doctor provides with an effective course of medication to avoid infection. In those cases, women should only follow the regime of medicine prescribed by a doctor timely.
  • It is essential to bring a pad along: It is normal for the patient to bleed for some time after the HSG test is performed. A patient’s uterus will further leak the contrast dye, which was utilized while performing the test. Therefore, carrying a pad will become helpful for the rest of the day to avoid staining on the clothes.
  • Comfortable clothing will help during the procedure: Soft and comfortable clothes will help a patient to bear soreness after the procedure, as the body becomes tender after the HSG test.
  • One should get somebody along for the procedure: A person taken along for the test might help in providing moral support. They might also help you drive home and recollect patient consciousness after the test.
  • It is also advisable to take a leave from work for the specific day to relax: HSG test is not a major test, but due to an inference of medical instrument in the vagina, one may evolve nausea and dizziness. Therefore, going office right after the test in the condition of spotting and cramping is not considerable. 

How does the patient experience during the HSG test?

A patient suffers considerable discomfort during the HSG test procedure. When a speculum is inserted inside the vagina, one may start feeling cramps and develop mild to severe pain. If a patient feels extreme discomfort and feels severe pain during the test, then mild anesthesia will be given to her to complete the test. Even after the test is successfully performed, a patient may exhibit mild pain with cramping similar to the periods for the whole day. If the fallopian tube is blocked, then certain kind of discomfort will generate each time the contrast dye liquid leaks from the vagina. 

Many women with a blockage in fallopian tubes feel a severe painful sting when the dye is being injected deep inside. Women having blocked fallopian tubes might suffer extreme throbbing than other patients. Normal drug store medicines may help in relieving such pains in a longer run. However, it is helpful to discuss with a doctor at least an hour or two back prior to the HSG test about the consumption of the medicine.

Pregnancy after HSG Test:

After the test is completed, one will have a sticky fluid dropping out of her vagina. This fluid is a liquid of dye used in the HSG test. At times, the fluid will drip along with some blood spots. Therefore, a pad is essential to bring in these types of vaginal tests. It is also advised to avoid using tampon after this process. One may also feel the following symptoms after having the HSG test done: 

  • Scanty vaginal bleeding
  • Cramps
  • Feeling weak, dizzy, or ill to your stomach

After the HSG test procedure, one is expected to get recovered by the next day and resume back with the normal routine. If one still feels severe HSG test side effects, then she must visit a doctor immediately. After the HSG test procedure, one should not suffer heavy bleeding, fever, or severe pain. Therefore, contacting a doctor becomes prominent in such an instance. It has been observed in many cases, which after going through the HSG test, women tend to conceive shortly. Pregnancy after HSG test happens because of dislodged dye insertion inside the uterus and fallopian tube, which ultimately releases the minor blockage like endometriosis lesion by emptying the fallopian tubes for conventional operation.

Is Radiation of HSG test safe?

In a usual X-ray test, a woman’s pelvic area is covered first by an attendant. Particularly in HSG test, the aim of the radiation is directly on the pelvic area of the patient. Therefore, doctors use a minor range of radiation, so that it does not create any problem to a woman’s uterus. Due to the involvement of radiation, doctors avoid using the HSG test while one is pregnant. Therefore, if one knows that she is pregnant, she must speak out to the doctor to try an alternate method.

What does the equipment look like?

The types of equipment utilized for the HSG test examination include a radiographic table, one or a couple of x-ray tubes plus a television-like monitor, which is located inside the examining cabin. Fluoroscopy device converts x-rays in video images for ease of vision. It is also used in watching and guiding the course of the procedure. The video is generated by the x-ray machine and a detector that is suspended above a table on which the patient reclines. 

HSG test side effects:

There are very minimal chances of any risk or complication, almost one percent. The HSG test procedure is a very safe and secure test to check blockage in inside the fallopian tubes. However, below are a few complications, risks, and HSG test side effects which found to develop after the procedure: 

  • Infection:This is the primary side effect of an HSG test. This only happens in a woman having a history of tubal or the presence of major uterine infections like Chlamydia. The infection rarely causes due to a dye used in HSG test. The infection damages the fallopian tubes. Sometimes, a condition occurs where removing the fallopian tubes becomes essential. So, it is advised to discuss the HSG test side effects, risks, and complications with a doctor. If a patient experiences severe pain and high fever within the subsequent 1-2 days, then one must visit a doctor immediately.
  • Unconsciousness:Some women feel severe discomfort during the procedure and evolves a condition of fainting out, which occurs to be natural and normal after sedation.
  • Radiation Exposure:The HSG test uses mild radiation, which is not harmful. It is very less in terms of kidneys and bowel radiation tests. In fact, the HSG test does not show any side effects if a patient conceived within a month of an HSG test. To avoid severe problems, one must not take the test in pregnancy.
  • Iodine allergy: It is very rare that a woman possesses allergy with iodine contrasts used in the HSG test. Therefore, pre-discussion on allergy substances with iodine usage is significant for a patient, and a doctor both. A patient must inform the doctor about having allergies with seafood, and intravenous contrast dyes. In such cases, the test will be performed with an alternative contrast not containing any compound of iodine. If a patient suffers any rashes, swelling, and itching, then one must inform the doctor immediately.
  • Spotting: It is common to have blood spots for subsequent 1-2 after the HSG test. In case a patient feels heavy bleeding, she must inform the same to the doctor.

A few other risks associated with HSG tests are:

  • Foul-smelling vaginal discharge
  • Vomiting
  • Fainting
  • Severe abdominal pain or cramping
  • Heavy vaginal bleeding
  • Fever or chills

Results of the HSG test:

When the HSG test results are released, the radiologist will send these results to the concerned doctor. The doctor will then discuss all the problems and complexities with the patient. If the report results positive, then it will confirm that fallopian tubes are blocked and another test of laparoscopy will be required. A doctor may also direct a patient for IVF directly to perform bypass surgery. It is observed in many cases that after performing HSG test, chances of conception increases for about 25 percent. Therefore, it becomes quite necessary for a patient to become pregnant successfully with three months of performing the HSG test. There are no confined studies, which prove why HSG test enhances the chances of pregnancy. Whereas, one theory suggests that dye injection works as a blast cleaned with a hosepipe. The procedure helps in tubal flushing with oil-based contrast media, whereas, water-based contrast media is not effective in comparison.

HSG Test Cost:

The average of HSG test cost between Rs. 2500 to Rs. 3000. In other countries, the same test costs about 500 to 700 dollars. HSG test is now the first choice for many before considering themselves under the category of infertile couples. An HSG test does wonder with its oil-based flushing of the fallopian tubes that have proved to increase the fertility chances above 50 % then water base substance. IVF is a difficult and prolonged journey. In IVF the cost is high chances to get pregnant remains low in a woman with obstructed fallopian tubes. Therefore, choosing an excellent HSG test can save a huge amount of money and also provides a woman with a chance to carry a natural pregnancy. Around the world, the average cost of cleaning the fallopian tubes is 600 dollars, which not even a fraction of IVF cost. An IVF internationally costs for about 10,000 dollars per IVF cycle.

HSG test not only provides with a clear image of the internal fallopian tubes blockage, but it helps in releasing such obstruction in many cases. The positive effects of this test remain for three months, also an appropriate time to try for pregnancy. Using oil-based contrast while performing the test helps in removing any unwanted obstruct from the fallopian tubes. Removal of the obstruction ensures the free movement of the eggs, and sperms to fertilize. Whereas, water-based contrast is not much help, but only provides a view of the inside part of the organ. 

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