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Hysterosalpingogram (HSG)


What is it?


A Hysterosalpingogram is an X-ray test that is done in a radiology practice or department. It involves the injection of a radio opaque dye into the uterine cavity under pressure and taking an X-ray to show where the dye has flowed.  


Why is it used? 


It gives useful information about the size and shape of the uterine cavity, the contour of the walls of the cavity of the womb, the state of the fallopian tubes and the presence or otherwise of pelvic adhesions. As such it is a useful part of an initial infertility assessment.  


Who is it suitable for? 


Any woman who is seeking medical advice because of delay in conceiving will potentially benefit from a HSG. This is particularly appropriate for women with; known uterine fibroids, a past history of uterine surgery, pelvic infection or an as yet undiagnosed menstrual disturbance.  


How will I feel? 


There is some local pelvic discomfort associated with HSG's. This comes in part from manipulation of the cervix and also from the uterus as it is stretched by the distending fluid.  


How is it done? 


Fertility North will provide you with detailed written instructions about how to book a HSG at the appropriate time of the cycle. There will also be 2 medications provided; a pain killer - to limit the discomfort that you may feel with the procedure and an antibiotic - as a prophylactic to prevent the procedure introducing bacteria into the womb and causing an infection.

The procedure must be booked for a time in the reproductive cycle when there is absolutely no chance of being pregnant. This is the time from the end of a period until a woman releases an egg cell. For that reason HSG's are booked in the first 10 days of the cycle or even earlier if the usual menstrual cycle is known to be short.

The cervix is identified in a similar manner to when a pap smear is taken, using a vaginal speculum. The dye is introduced through the cervix using either a metal tube that screws into the cervix to create a water tight seal or a plastic tube with an inflatable balloon to create a seal. The dye is then steadily injected under increasing pressure until it is seen to spill from the ends of the tubes into the abdominal cavity. X-rays are taken whilst the dye is being injected.  


What are the risks involved? 


HSG is not regarded as a risky procedure with less than 5% of patients having any problem other than a temporary discomfort during the procedure. Some patients however may have an allergic reaction to the contrast dye.

The manipulation of the cervix may also cause a nervous reaction that provokes a sensation of dizziness or fainting with associated nausea. This is again usually a transient sensation lasting for up to 1 hour but it can require treatment.

The potential risk of infection is reduced by the use of antibiotic prophylaxis to less than 1% but increasing pelvic pain, a discharge or the development of fever within 2 weeks of the procedure warrants prompt medical assessment and possibly further antibiotic treatment.  


Will I need time off work? 


The whole procedure generally takes about 30 minutes to perform and afterwards you feel quite well and normal and may return to work.

If you are in the small group of women who react to the procedure it would be best to rest for the remainder of the day and return to work the following day.