Who needs an HSG (hysterosalpingogram)?

11 Oct Who needs an HSG (hysterosalpingogram)?

HSG or hysterosalpingogram? Let’s call it an HSG. After all, hysterosalpingogram may qualify as the most unpronounceable word you’ll meet on your fertility journey. We still can’t say it either – and we tried three times. Anyway, the abbreviation is not important but the procedure is.

An HSG checks out your reproductive health in a rather unique way. A trans-vaginal or pelvic ultrasound scan, together with hormone profiling (e.g. FSH and LH), may not be enough to locate the cause of your problems and to give you the fertility all-clear. IVF patients often undergo an HSG to get a fuller picture of what’s going on. We had one ourselves and all was okay – we certainly didn’t want to spend thousands until we had checked everything out. But many patients with infertility issues don’t have an HSG and still have successful pregnancies.

An HSG is a close examination of your fallopian tubes, uterus and immediately adjoining areas. Water-based (or occasionally oil-based) coloured dye is passed, via a catheter through your vagina, into your uterus, quickly filling it, the attached tubes and – usually indicating all is well – the abdominal cavity. The movement of the fluid is monitored by x-rays.

The ultimate objective of an HSG is to spot problems such as uterine fibroids, scarring, myomas, tubal blockages and irregularities. All of which can cause fertility problems and, in some cases, make conception and pregnancy impossible. Sperm and eggs need an optimal playground: if the tarmac’s cracked and the slides don’t work, the playground’s closed.

An HSG can sometimes solve a fertility problem there and then. If you have debris on your tubes, the fluid occasionally bulldozes it out the way. An HSG also assesses the structure and shape of the uterus and tubes, giving the tubes a bit of a stretch and flushing out troublesome mucus. But it can’t see or budge everything. For a closer look, patients may need a laparoscopy or hysteroscopy.

An HSG is a little uncomfortable, it must be said. The procedure only takes 10 to 15 minutes. During and after the HSG, you may experience cramping as the uterus wonders who on earth is running the bath. You’ll be given medication to counteract the low risk of pelvic infection, possibly an anti-inflammatory and perhaps even a sedative. An HSG is typically done after your bleed, but before ovulation. That way, everyone knows there’s not a pregnancy in there.

A normal HSG result (which happens most of the time) points to a free flow of dye through the uterus and tubes, a lack of scarring and blockages in the tubes and no peculiarities in the uterus. An abnormal HSG result (rare, and there’s invariably a solution) may pick up growths, uterine rips, tubal blockages and damage. The last two are sometimes caused by pelvic inflammatory disease, endometriosis or past STDs.

Speaking of which, hydrosalpinges usually need repairing before an IVF attempt because they can damage the growing embryo and womb lining. Your consultant will advise once the HSG is over.