Hysterosalpingogram (HSG)

About Hysterosalpingograms

A hysterosalpingogram (HSG) is an exam that looks at the condition of the uterus, fallopian tubes and abdominal area around them.

It is primarily used to determine reasons why a woman may have difficulty becoming pregnant or sustaining a pregnancy. It is also done for women who have had tubal ligation or permanent contraceptive devices implanted into the fallopian tubes to verify the effectiveness of these procedures.

Hysterosalpingograms use a fluoroscope to take images of the reproductive organs. A fluoroscope uses x-ray technology but takes continuous images rather than a single image like a traditional x-ray. A contrast material is used to enhance the images and make any abnormalities more visible.

During a hysterosalpingogram, a small tube called a catheter is placed into the cervix through the vagina. The contrast material is injected through the catheter into the uterus. The catheter has a small balloon on the tip which will be inflated to create a seal and keep the contrast from flowing back through the cervix. Since the uterus and the fallopian tubes are connected, the contrast will flow through the uterus and into the fallopian tubes. If the fallopian tubes are not completely blocked, the contrast may then flow from the fallopian tubes into the abdominal area.

The fluoroscope images can show an abnormality of the uterus or a blockage of the fallopian tubes. A blockage could prevent the egg from ever becoming fertilized. Occasionally, an HSG can have a therapeutic effect. The contrast may flush unseen blockages and enable conception without additional medical procedures; however, that should not be relied upon. Abnormalities in the uterus could prevent fertilization or implantation of an egg or could be the cause of miscarriages.

Permanent contraceptive device placement

An HSG is needed three months after the placement of a permanent contraceptive device (i.e. Essure or Adiana). This ensures that the micro-inserts are properly in place and that the fallopian tubes are completely blocked.

When should an HSG be done?

This procedure should be done within the first 10 days of your menstrual cycle, but after blood flow has stopped. This is usually between days 7 and 10. This is to ensure you are not pregnant and to avoid using x-rays, which emit radiation, during an early pregnancy. If you are not having menstrual periods, a pregnancy test may be required.

Risks Involved in This Procedure

Risks involved in a hysterosalpingogram include the following:

• Risk of x-ray exposure; however, it is well below the level that generally causes adverse affects.
• Reaction to the contrast medium or medications used; however, this is rare.
• Infection; however, this is uncommon.
• Puncture of the uterus or fallopian tube. This is rare.

Scheduling, Insurance and Preparation

Scheduling

Contact your personal physician for a referral for this exam. Then call 720-493-3700 to schedule.

Insurance Coverage

Infertility workup procedures such as a hysterosalpingogram are often not covered by insurance. Check with your insurance company to be sure. If your insurance company will cover the exam, please bring your insurance card with you. If an HSG is not covered by your insurance, please plan to pay for the procedure at the time it is performed.

Conditions to Let Us Know About

In advance of your procedure, let your scheduler, technologist, or radiologist know if any of the following circumstances apply to you:

• Pregnant or may be pregnant
• Any inflammatory conditions
• A bleeding problem or currently taking blood thinners (such as aspirin, Warfarin or Coumadin)
• Diabetes or a history of kidney problems
• Chronic pelvic infection or an existing sexually transmitted disease
• Any medications you are taking
• Any allergies, including allergies to barium, CT contrast, or iodine
• Asthma
• Any active infection or fever

Preparation Guidelines

Following are the general preparation guidelines for an HSG. You may receive additional or differing guidelines based on your specific situation. Please contact us at 720-493-3700 if you have any questions.

• Schedule the procedure during the first 10 days of your menstrual cycle, but after the blood flow will have stopped (usually between days 7 and 10).
• HSG patients must have a blood serum pregnancy test completed through their referring physician office within 24 hours of the scheduled HSG procedure.  For example, if the exam is scheduled on a Wednesday at 2:30pm, the pregnancy test must be performed at or after 2:30pm of the prior day (Tuesday, in this case).  The patient must have the test completed with sufficient lead time for results to be faxed to Invision Sally Jobe by the time of the scheduled procedure.
• HSG patients must also abstain from having sexual intercourse from day one of their menstrual period, until 24 hours after the HSG procedure has been completed.
• If you are receiving sedatives from your doctor (e.g. Valium, Xanax), arrange for someone to drive you to and from the procedure.
• You may take an over-the-counter anti-inflammatory medication (such as Aleve or Motrin) prior to the procedure to alleviate cramping.
• You may want to bring a sanitary napkin or panty liner with you to use after the procedure.

What to Expect

During the Procedure

Here is generally what will happen during a hysterosalpingogram:

1. A technologist will obtain a medical history, ask you some questions, and answer any questions you may have.
2. You will change into a gown. You will need to undress completely from the waist down and remove any jewelry in the abdominal and pelvic areas. You may use a secure locker for your personal items during your exam.
3. You will empty your bladder.
4. You will go to the exam room. The technologist will help position you on the table. You will lie on your back with your knees up and your feet flat.
5. The fluoroscope will be centered over the lower abdominal area.
6. The technologist will insert a speculum into your vagina then cleanse the cervix and insert the catheter. You may experience some cramping similar to menstrual cramps.
7. Contrast material will be injected into the uterus, fallopian tubes and peritoneal (abdominal) cavity through the catheter and images will be taken. You may be asked to change positions.
8. If specific abnormalities are encountered, you may be asked to wait up to 30 minutes so additional images may be taken. These additional images may help diagnose some disorders.
9. The catheter will be removed.
10. You will change back into your clothes.

This procedure generally takes about 30 minutes.

After the Procedure

Recovery

You may experience cramping for several hours following the procedure. You will have a clear sticky discharge, which is the contrast material. You may also have some light spotting from the procedure. Avoid the following for 24 hours after the procedure to help prevent infection:

• Tampons
• Sexual intercourse
• Sitting in a hot tub or hot bath

If you have any heavy bleeding, severe cramping or a fever following the HSG exam, contact your physician as these are signs of an infection.

Procedure Results

A board-certified radiologist experienced in the interpretation of hysterosalpingograms will analyze the data and results from your procedure. The results will be reported to your physician. Your physician will pass the results onto you.

During the exam, our technologists will be happy to answer questions about the exam itself; however, they will not immediately provide you with the results of your exam.

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