What is an HSG test? A tests for Blocked Fallopian Tubes

What is an HSG test?

Hysterosalpingogram (abbreviated as HSG) is a method of using X-rays to display the condition of the uterus and fallopian tubes. Most people mistakenly think that HSG can only detect blocked fallopian tubes, but in reality, it can also detect abnormalities in uterus shape and fallopian tube swelling (hydrosalpinx).
 

Who needs an HSG？

The fallopian tubes are one of the crucial factors for a successful pregnancy. If there are issues with the fallopian tubes, it can significantly impact both natural conception and assisted reproductive techniques like intrauterine insemination (IUI). The success rate of tubal pregnancies can also be impacted by hydrosalpinx.
 

HSG is helpful in diagnosing:

Fallopian tube blockages (location and degree) Hydrosalpinx Abnormalities within the uterine cavity The effectiveness of fallopian tube ligation or reconstruction surgery
 

Procedure of HSG

HSG typically takes 30 minutes and entails the following steps: Insert a vaginal speculum (duckbill) into the vagina Clean and sterilize the cervix Insert a catheter into the cervix canal and uterus Inject contrast agent into the uterine cavity through the catheter Take X-ray images Remove all equipment and sterilize
 

What should you pay attention to before and after the HSG test?

Before HSG test

• Avoid sexual intercourse from the end of your menstrual period until the day of the HSG.
• Wear comfortable clothing and avoid metallic accessories.
• Take off any metal jewelry, eyeglasses, watches, dentures, and other accessories during the procedure.
• Since you might come into contact with iodine or blood, which can stain light-colored clothing, it is best to wear dark-colored pants or a skirt.
• Bring sanitary pads with you as there may be a small amount of bleeding on the day of the examination.
• You do not need to fast or restrict water intake.
• Empty your bladder before the HSG test.
• Prior to the exam, stay away from greasy or spicy foods, and avoid overeating to avoid nausea.
• It is advised to bring a friend or family member along in case you feel uncomfortable.

 

After HSG test

• HSG does not necessitate hospitalization or anesthesia.
• A minor bleeding, increased vaginal discharge, and mild abdominal discomfort are normal occurrences after the examination.
• Follow the doctor's instructions for using relevant medications to relieve pain and prevent infection.
• If you experience severe abdominal pain or heavy vaginal bleeding following the procedure, seek immediate medical attention.
• The doctor might insert vaginal gauze. If so, kindly take it off the same night before taking a bath.
• After returning home, you can resume your normal diet and drink plenty of plain water to facilitate the elimination of the contrast agent.
• Increase your consumption of dairy, eggs, fresh fruits and vegetables.

 

When is the best time to do the HSG test?

It is advised to schedule an HSG test between the 7th and 11th day of your menstrual cycle in order to ensure accurate results.
 

Who shouldn't get an HSG？

Patients who are pregnant, have pelvic inflammatory disease, or have contrast agent allergies are not candidates for HSG.
 

Is an HSG test painful? Side effects of HSG test

HSG can be uncomfortable, but in most cases, the only discomfort you might experience is a feeling of fullness. Due to extreme anxiety or spasms, some patients may experience observable pain. There may be mild discomfort following the insertion of the catheter, placement of the vaginal speculum, and injection of the contrast material. Patients with tubal blockages might feel more pain than usual. Most people experience relief from the discomfort after being allowed to rest lying down for 30 minutes in such circumstances.

Following HSG, it's common to experience some minor bleeding, increased vaginal discharge, and mild abdominal discomfort. However, you must seek immediate medical attention if you experience significant bleeding or severe pain after the test.

A small number of patients may be allergic to the contrast agent, resulting in symptoms like rashes, swelling, or itching. Before having HSG, patients with a history of allergies to contrast agents should let the doctor know.
 

Contrast agents in HSG: Oil-based versus water-based

At Lee Women’s Hospital, HSG contrast agents are classified by their texture into 2 types: oil-based and water-based.

Oil-based contrast agents	Water-based contrast agents
Oil-based iodinated solution (ethiodized oil)	Water-based iodinated solution (diatrizoate)
Higher Density	Lower Density
Clear Imaging	Blurred Imaging
Mild discomfort	Sensation of Foreign body

It is widely believed that using oil-based contrast agents is less painful. This is due to the faster flow rate of water-based contrast agents, which increases the sensation of a foreign object. Oil-based contrast agents, on the other hand, have a relatively slower flow rate because of their higher density, which causes less discomfort for the patient.
 

Does HSG increase pregnancy chances？

Why is it easier to get pregnant after HSG? According to Dr. Chun-I Lee, there's a chance that flushing obstructions out of the fallopian tubes with a contrast agent could increase the likelihood of getting pregnant. This explains why there is a "golden three months" period following HSG. The natural pregnancy rate for subjects using water-based contrast agents is approximately 29%, while it rises to 38-39% for those using oil-based contrast agents, according to a study published in the New England Journal of Medicine.
 

Treatment After HSG

The doctor might suggest "Timed sexual intercourse" if neither partner has any potential issues, such as poor egg or sperm quality or abnormalities in the uterine lining. To improve the likelihood of a natural conception, this involves monitoring follicles, taking progesterone, and administering injections that trigger ovulation. However, mild cases of infertility may choose intrauterine insemination (IUI), whereas severe cases might require in vitro fertilization (IVF) for a more effective and quicker route to pregnancy if there are additional infertility issues like ovarian or uterine problems, such as tubal blockages, adhesions, or chocolate cysts.

Furthermore, it's crucial to determine the tubal blockage's condition if you're having IVF. Depending on the location of the blockage, if it causes tubal swelling (hydrosalpinx) or accumulation of fluid, it can be detrimental to the implanted embryos. In such cases, the swollen portion of the fallopian tube may need to be surgically removed.