Hysterosalpingography: First steps to identifying female infertility

Hysterosalpingography (HSG) is one of the most important procedures to diagnose the causes of female infertility. Also known as hysterography, uterosalpingography, uterotubography, or simply HSG, it aims to give an inside view of the shape of the uterus and the permeability of the patient’s fallopian tubes.

Using an iodinated contrast medium, administered through the vagina using a catheter, the radiologist will capture images to see how the fluid passes through the cervix, uterus and fallopian tubes. This test aims to discover abnormalities in the uterus as well as fallopian tubes that may explain why, after months of trying, the patient does not manage to become pregnant in natural ways.

What is hysterosalpingography?

As we have already mentioned in this article, hysterosalpingography checks the shape of the uterine cavity and the patency of the fallopian tubes.

By using X-ray images, we can evaluate if there are any abnormalities present inside the uterus such as septa, unicornuate or bicornuate uterus, polyps or myomas that hinder the implantation of the embryo or even cause a miscarriage. It also allows us to assess if there are adhesions or scars present in the uterus that may also interfere with the ability of the embryo to implant.

One of the main purposes of hysterosalpingography is to demonstrate the tubal patency, i.e. that the fallopian tubes – where the egg and sperm meet – are open. If either or both of them are blocked, it would be one of the reasons why fertilisation between the egg and sperm does not occur.

The most important information provided by this test are indications as to which treatment is most likely to be successful.

If the fallopian tubes are blocked, in vitro fertilisation treatment is necessary  to realize artificial insemination, both fallopian tubes must be open to allow the egg and sperm to meet. Once fertilised the embryo will then travel to and implant in the uterus. Artificial insemination can be performed even with obstructed fallopian tubes, although it is not recommended given the low chances of success of the treatment in this situation.

At IVF-Life our fertility experts, together with our team , will evaluate every possibility available for our patients and, together, we will be able to choose the best treatment for you to achieve a successful pregnancy.

How does hysterosalpingography work?

The radiologist will capture X-ray images of how the contrast medium fills the uterus and fallopian tubes, drawing their shape and giving us an idea of their state.

With the help of a catheter, the contrast medium is introduced through the cervix into the uterus which will appear white on the X-ray. If the fallopian tubes are permeable, it should be possible to see how the fluid is released into the abdomen. If this is not the case, it is due to a blockage in the fallopian tubes or other structural abnormalities within the uterus.

We can also see if the fallopian tubes are swollen or dilated due to an accumulation of fluid, as it happens in the case of hydrosalpinx. This occurs when the patient has suffered a tubal infection or had abdominal surgery.

Patent tube vs Blocked tube

Is the test uncomfortable?

The reality is, yes. It is a test that is somewhat uncomfortable for patients, although you may take a sedative or muscle relaxant to reduce the discomfort of the procedure and speed up your recovery.

The good news is that an improved version of hysterosalpingosonography, called hysterosalpingosonography (HSSG) exists. This procedure is less uncomfortable, avoids the use of x-rays, as it is performed using ultrasound, and provides the same results as HSG.

Hysterosalpingosonography assesses the uterine cavity and fallopian tubes using transvaginal ultrasound by following the form of the endometrium.

How should I prepare for hysterosalpingography?

Hysterosalpingography is a simple and quick process. It only takes about 25-30 minutes, although it can take longer depending on the patient. It is performed in an x-ray room, where the woman lies on an obstetric table under the x-ray machine and places her legs in stirrups as if she were having a visit at her gynaecologist. It does not require anaesthesia, although it does require a series of instructions for proper preparation:

– The procedure is performed during the first few days after the end of the period, to ensure that the patient is not pregnant. X-rays could be harmful to the embryo.

-The specialist may recommend the use of a laxative to clean the intestines and facilitate the image capture.

-Only with a prescription from your doctor, you may take a sedative or muscle relaxant to reduce the discomfort of the procedure.

-During the recovery process, you may feel slight discomfort, similar to menstruation. To help you feel better you may take an anti-inflammatory drug.

-It is normal if you have light bleeding or brownish discharge in the days following the test.

A good diagnosis makes the difference

At our fertility clinics, we carry out extensive and personalised examinations to obtain a complete overview of all the factors that may influence female and male fertility.

We do not want to add to the emotional and financial burden the patient experiences. This is why we study each case in depth, assessing different aspects, from the quality of the embryo chosen for transfer to the receptivity of the patient’s endometrium.

We focus on genetics and immunology, two very important aspects in identifying why implantation failures or recurrent miscarriages occur.

This method ultimately allows us to optimise treatment to obtain the best chance of success and create life in as few attempts as possible.