Why You Would Need a Hysterosalpingogram

Hysterosalpingogram (HSG) is a diagnostic imaging procedure used to examine the uterine cavity and fallopian tubes. The examination utilizes ionizing x-rays to visualize the inner surface of the uterine cavity for any problems, as well as the patency of the fallopian tubes. Any blockage of the fallopian tubes would be easily appreciated via HSG, making this diagnostic modality highly valuable when evaluating a female patient for infertility secondary to reproductive tract abnormalities.

Women who have no known comorbidities such as pelvic inflammatory disease, previous ectopic pregnancy, or endometriosis are good candidates for hysterosalpingography, since the exam is a reliable way to rule out tubal occlusion. It is superior to laparoscopy in that it is less invasive and more efficient in doing this.

The initial assessment and workup of an infertile couple varies between different centers and in different countries. In the Philippines, infertility in the face of a normal semen analysis, normal hormone levels would logically lead to HSG.

Ideally, the procedure of hysterosalpingography is performed during the follicular phase of the menstrual cycle. Radiographic contrast medium provides the visualization of the reproductive tract as it is injected into the uterine cavity through the vagina and cervix. An x-ray of the abdominal and pelvic regions is taken, showing the path of the contrast medium and any deviations from the normal anatomy. The procedure requires that the patient be given analgesics before or after to reduce pain. Doctors often prescribe antibiotic medications to mitigate infection

Normal HSG results would demonstrate the filling of the uterine cavity and both fallopian tubes with no defects, as well as spillage of the dye into the abdominal cavity near the ovaries. Abnormal results may include rupture of the fallopian tubes, which would be seen as asymmetrical spillage of the contrast medium into the abdominal cavity. In other words, the point of rupture on a defective fallopian tube can be identified and localized. Proximal ruptures, which would be near the uterus, as well as distal ruptures near the ovaries can also be identified, localized and managed accordingly.

Moreover, fallopian tube occlusions would demonstrate an absence of dye in the affected tube, or only a partial filling. The contralateral (i.e. opposite) fallopian tube would fill up normally if there were no problems.

If the results for hysterosalpingography are abnormal, then the couple is referred to undergo in-vitro fertilization, which may or may not include intracytoplasmic sperm injection (IVF with ICSI). Since the previous workup leading up to HSG showed that hormone levels were normal, hormone therapy is not necessary. Women whose hysterosalpingogram results are normal and are under 35 years of age have a working diagnosis of “unexplained infertility” and are candidates for further workup.