After a few months of trying to conceive without success providers start to consider the factors that could be impacting your fertility. One of those factors is the patency of your fallopian tubes, meaning, are your fallopian tubes open and operational?
Why HSG Tests Focus on the Fallopian Tube
Did you know that fertilization actually occurs in the fallopian tube? When you ovulate the egg is picked up by the end of the fallopian tube, specifically by the fimbriae, and the egg travels through the tube on its journey to the uterine cavity. When you are trying to conceive, sperm swim up through the uterine cavity and into the fallopian tubes where they are in search of the egg. When sperm and egg meet, the sperm attach to the egg to try and create an embryo through an extensive process. If the tubes are not open, are diseased, or have scar tissue/fluid in them, the chance of fertilization is drastically reduced. Risk factors for nonfunctioning tubes include a history of chlamydia or gonorrhea, a prior ectopic pregnancy, endometriosis, a history of a D&C, and scar tissue from prior abdominal/pelvic surgery.
HSG Tests Identify Blockages or Damages to the Fallopian Tube
Your provider will likely order an HSG test to rule out any concern that the tubes may be blocked or damaged. A few different providers may complete this procedure for you, such as your ob/gyn, a nurse practitioner or physician’s assistant, or a provider you haven’t met before in a hospital outpatient setting. Many reproductive endocrinology offices like to run HSG tests themselves, as opposed to using a local hospital or outside facility. There are a few reasons that this test may not be right for you — and it is important to talk with your provider about this — but they would include an allergy to the contrast used, an elevated blood pressure of 160/100 or greater, or a current pelvic infection/STD such as chlamydia or gonorrhea, PID or an active UTI.
What Is an HSG Test Like – The Day of
Let’s walk through what you can expect on the day of your test. Your provider may have you take Motrin/Ibuprofen about 30 minutes prior to the test to help with cramping if you do not have an allergy or contraindication to that medication. You can expect to be undressed from the waist down and on a slightly different bed than a traditional obstetrical bed. There will be a radiologist who will assist with the HSG procedure and will likely get you all set up. You should be given a paper drape for your lap, and they may or may not give you a lead drape. Your provider will come in and explain the procedure before starting.
What Does the Procedure Consist of?
The procedure itself consists of inserting a speculum and cleaning the surface of the cervix. A small injection is done to help numb the cervix so that the provider can use an instrument to hold onto the cervix without causing you too much discomfort. Usually, a tool called a Kahn catheter is used and passed through the cervix; occasionally providers may use a balloon instead. Either instrument is capable of instilling contrast (the fluid with dye) into the uterine cavity. The radiologist and provider will communicate that they are both ready, and the provider will instill the contrast.
Once the provider and radiologist have been able to visualize the full scope of the study, everything will be removed from the vagina and the test is complete. Your provider may be able to give you results right at that time or may discuss at a follow-up appointment if the test was not completed by your provider. So the HSG setup takes usually just as long as the procedure itself.
Are HSG Tests Painful?
It is normal to feel cramping and pressure as one of these devices is placed. The test itself is usually under one minute total but can range anywhere from 15 seconds to 2 minutes or so. During the test, pain can last for the duration but usually resolves within 2-3 minutes after the procedure. Some women will have cramping for the rest of the day, but the pain that occurs during the test itself is very short in time and substantially improves quickly once the test is over. Often I hear “That was much better than I expected” when the test is over.
What Results Can You Expect From an HSG Test?
There are a few different results possible:
- The first is that both tubes are open and functioning properly, and there is no follow-up required.
- A second possibility is that one tube may be blocked and another open and functioning, in which your provider will discuss what the best options for you are based on other factors, such as age and treatment preferences.
- A third possibility is that both tubes are blocked and it is impossible for an egg to travel from the ovary to the fallopian tube in which case IVF would be necessary.
- A fourth possibility would be that you have a hydrosalpinx or dilation of one or both tubes (commonly seen with a history of chlamydia or STD). This is problematic because the fluid contained in a dilated tube is toxic to embryos and can reduce the chance of implantation and even cause early losses. If this is seen the solution is typically surgery to remove the diseased tube.
- Lastly, in some instances both tubes will appear as closed but they could have just quickly clamped shut in response to the contrast being instilled and you may need a repeat test at another date or a test called a Femvue. Overall, there are many outcomes that are possible and your provider will need to explain your personal results in detail as well as what they mean for your fertility. You may need to be on antibiotics based on the result in order to prevent the risk of infection being spread to your abdominal cavity.
Contact Us If You Have More Questions
I hope this was helpful in explaining the detailed process of the hysterosalpingogram or HSG procedure so that you can have an educated discussion with your provider about whether this test might be an option for you! I personally perform about 10-20 of these a week, and almost all patients say the test was “better than expected.” It can be a bit intimidating of a procedure as a patient, but know that your provider is trying to be quick and efficient while making sure they get you a comprehensive tubal evaluation!
References
- ACOG Practice Bulletin No. 195: Prevention of Infection After Gynecologic Procedures. Obstet Gynecol 2018; 131:e172.
- Maheux-Lacroix S, Boutin A, Moore L, et al. Hysterosalpingosonography for diagnosing tubal occlusion in subfertile women: a systematic review with meta-analysis. Hum Reprod 2014; 29:953.
- Møller BR, Allen J, Toft B, et al. Pelvic inflammatory disease after hysterosalpingography associated with Chlamydia trachomatis and Mycoplasma hominis. Br J Obstet Gynaecol 1984; 91:1181.
- Rezvani M, Shaaban AM. Fallopian tube disease in the nonpregnant patient. Radiographics 2011; 31:527.
