Diagnostic Workup: What Is HSG?

What Is It?

Hysterosalpingogram, more commonly referred to as HSG, is a procedure used to x-ray the female reproductive organs, specifically the endometrial cavity (interior of the uterus) and fallopian tubes.

This simple, but slightly invasive procedure is used to determine the structural functionality of the woman’s organs, particularly the tubes, and can detect the presence of fibroid growths also.

In brief, the procedure involves the following steps:

  • The patient should take acetaminophen or ibuprofen about an hour prior to the test.
  • With the patient in the same position as that used for a pelvic exam, a speculum (also such as that used in a well-woman exam) is inserted vaginally to make the cervix visible.
  • A thin tube called a cannula is inserted into the cervix.
  • An x-ray contrast dye is injected through the cannula into the uterus.
  • With the aid of an x-ray machine, the movement of the dye is observed as it passes through the uterus and the fallopian tubes. Optimally, the dye should pass all the way through both tubes and spill into the pelvic area.

Because HSG uses x-ray, this test may be performed in a radiologist’s office or the radiology department of a hospital, which will then report their findings back to your referring physician. Among the possible findings to be considered:

  • Normally shaped uterine cavity and open tubes
  • Abnormally shaped uterine cavity
  • Fibroid tumors
  • Polyps
  • Scar tissue
  • One or both partially or completely closed tubes

Who Benefits From It?

In general, HSG assists in diagnosis for women who are experiencing inability to conceive and have concerns that their uterine cavity and/or tubal patency are less than optimal. “Tubal patency” refers to whether or not the fallopian tubes are open, which allows the egg to travel from the ovaries to the uterus. More specifically, the following conditions combined with inability to conceive may warrant an HSG:

  • Prior reproductive surgery
  • History of sexually transmitted disease, or risk factors for STD’s
  • Previous ectopic (tubal) pregnancy
  • Unexplained infertility
  • Recurrent miscarriage from unknown causes

Women who have been diagnosed with pelvic inflammatory disease (PID), those who are allergic to iodine, those with a present vaginal infection, and those experiencing present vaginal bleeding should not undergo HSG. Complications from an HSG may include pelvic infection, allergic reaction to dye used, or bleeding.

What Are The Stats?

A meta-analysis of all published studies comparing HSG to laparoscopy with chromopertubation (another diagnostic method) demonstrated HSG to have a sensitivity of 65% in the diagnosis of tubal obstruction and a specificity of 83%.

Several studies have reported a slight increase in unassisted conception during the first few cycles following an HSG. While the exact cause is not known, it is thought that the insertion of the dye might actually “flush out” any very minor blockages, permitting normally functioning reproduction to occur.

A very slight percentage (around 1%) of women will experience an infection resulting from HSG, and of those, a very small minority are serious enough to warrant IV antibiotic therapy.

The discomfort from the procedure of HSG, as with anything, varies with the individual; however, it is reported to be at least “uncomfortable” for the majority of women. Some women experience this discomfort as extremely painful, while others do not. Most doctors usually just prescribe OTC drugs (acetaminophen and ibuprofen); some offices will allow the use of a local anesthetic injected into the cervix. In general, the discomfort is usually described as mild to severe menstrual-like cramping which may last for several hours following the procedure.