Here, I summarise everything we know about the reasons why women need a hysterosalpingogram test.
Based on my experience as a diagnostic radiographer who has worked with specialised radiologists on HSG tests. Review of scientific publications on this topic.
When you have been trying for a baby for a while and no luck, when you go to your doctor for advice, the HSG is likely to be one of the first tests that your doctor will recommend.
When you are told that you are having an HSG, most of the time you will go to the internet and start googling about the tests.
You will find a lot of informative information, some patient experience will scare you. However, in general, it is usually patients who have had difficulty with the test and those who have had no problems do not usually feel the need to post.
I believe you are reading this because you have found it on your search! Happy reading!😀
( Feel free to educate yourself and ask any questions in the comment section, I will be glad to help find your answers!)💁
In this article I summarise our current knowledge on hysterosalpingograms (HSG). I address the most common questions from online users about the hysterosalpingogram test.
Written by Juliet Semakula, a diagnostic radiographer.
Disclaimer: no affiliate links
▶️ What is a hysterosalpingogram (HSG) test?
HSG is an X-ray procedure that is used to view the inside of the uterus and fallopian tubes.
It is often used to see if the fallopian tubes are partly or fully blocked. It also shows if the inside of the uterus is a normal size and shape.
In essence the HSG can help spot issues in your reproductive anatomy that may be preventing you from getting pregnant.
Female reproductive organs:
The main reason an HSG test is done is to demonstrate any abnormalities congenital of the uterus and tubes that could be affecting fertility and its management.
▶️Tubal factors
Blocked fallopian tubes usually means that it is impossible for a woman to conceive as sperm cannot reach the egg in the tube.
⚠️Studies show that certain infections like chlamydia and adhesion around the fallopian tube can lead to blockage.
⚠️ Also, polyps, mucus, tubal spasm, and congenitally abnormal tubes could also cause tube blockage.
So, there is a need to flush out debris from the fallopian tubes, which may not necessarily block the fallopian tube but may hinder conception along the tube.
So, there is a need to establish whether the tubes are open, and this requires contrast media to be pushed through the tubes while viewing the process on live x-ray imaging.
Image before contrast: Image after contrast:
▶️ What do studies say about the outcome of hysterosalpingogram (HSG) tests?
When there are many studies on a subject, some research teams publish large summaries of these studies.
By selecting the most reliable I will focus on what to expect before and after the procedure and I will try to answer frequently asked questions about HSG?
The role of hysterosalpingography in opening blocked tubes?
According to scientific publications almost 30% – 35% of female infertility has been attributed to ovarian factors such as ovulatory dysfunction, cervical factors and tubal pathologies and peritoneal factors. (Nezhat & Dun.,2012)
The act of inserting contrast or dye into the fallopian tube is thought to have a potential therapeutic effect. As it can flush out the debris or mucus that may be obstructing the free passage of a fertilised egg or sperm
What you should know before the HSG test (Preparation)
🟢The exam should take place between 7-10 days after the beginning of your last menstrual period.
🟢A course of antibiotics may be prescribed prior to the test depending on your referring provider’s recommendations.
🟢You can eat and drink as per usual the day of the test.
🟢Ibuprofen can be taken several hours prior to the test to decrease possible discomfort as per your doctor’s advice.
🟢If you take an anxiolytic, please arrange for a ride to and from the appointment.
⚠️Caution!⚠️
Remember to relax before the test and focus on positive thoughts because there is power in positive thinking!
Frequently asked questions:
▶️Is it normal to have pain during the HSG test?
It is common and not alarming to have pain during a hysterosalpingogram test.
Some patients experience only minor discomfort, while others experience severe menstrual cramps. Any discomfort is usually brief, and taking an over-the-counter pain reliever can help to reduce it.
During my years of practice, I have seen patients terminate the test during the procedure when they feel they cannot bear the pain or discomfort! It’s ok, do not feel bad.
▶️Are there possible complications of the hysterosalpingogram test?
According to scientific studies, HSG has a 1.4-3.4% rate of infection but the whole procedure is done in a very sterile environment so the chance of infection after the procedure is very low.
Rare allergic or allergic-like reactions from contrast can happen to some patients but since my years of practice I have not seen any cases.
▶️Does having an HSG test increase the chances of fertility?
Usually after you have had the test, you wonder if you will be able to conceive straight away.
According to scientific studies, it clearly states that HSG has helped many women conceive in the first three to six months after the tubal flushing, which has raised the possibility that tubal flushing could also be a treatment for infertility. (Mohiyiddeen ,2020)
📚Other PEDMED studies, HSG tests done on 158 patients were reviewed after 6 months. There was a 33% overall pregnancy rate. And another study shows 83 % of women got pregnant in the space of 6 months after the HSG test. (Barwin1971)
So, it is true HSG tests can increase the chances of fertility for some people.
According to my experience, I have seen patients come back for a baby scan after 6 months of having the HSG test. So, there is hope for you: just trust the process and stay positive!
How soon can you start trying for a baby after the HSG test?
There is no such research or evidence that shows getting pregnant right after the HSG test is harmful. If you are concerned about the same, you can ask your doctor during an initial consultation.
Do you need to rest after a hysterosalpingogram test?
It is advisable to rest after having a hysterosalpingogram test because this will help to minimise discomfort after the procedure.
For how long?
Rest for the remainder of the day, do not lift heavy loads because after the procedure you may experience mild cramping or discomfort, it is important to take it easy on yourself.
I would advise a cup of 🍮 on the sofa, watching a good movie to take you off thinking about the test.
▶️Will I be exposed to a lot of radiation?
I have had so many patients who do ask about radiation involved during the test.
I do understand your fear, because you are in the process of trying for a baby yet radiation is used during the test.
I want to reassure in my capacity as a radiation protection supervisor, that the average radiation dose to the female gonads is 2.7 mGy or an effective dose of 1.2 mSv.
To put this into perspective, a person is exposed to background radiation around 3.1 mSv a year or 0.4 mSv per mammogram.
The risk for anomalies in a future embryo or induction of a fatal cancer depends on patient age, but for someone 20-29 years of age, the foetal anomaly risk is 2.7 x 10-5 while that for cancer induction is 1.45 x 10-4, both 1000-fold lower than background rates.
⏰ Risk further decreases with increased patient age.
During the test radiation dose and theoretical risks are not significant, every effort is always made to minimise radiation exposure during the procedure.
In conclusion HSG test are worth trying because they present with benefits if you have blocked tubes.
I hope I have answered some of the questions you have on HSG tests. I wish you a successful test, Do not loss hope God is control!
To support this article, I have identified scientific publications on HSG tests referenced below:
📚Sources:
Dun EC, Nezhat CH. Tubal factor infertility: Diagnosis and management in the era of assisted reproductive technology. Obstet Gynecol Clin North Am. 2012;39:551–66. [PubMed]
Boivin J, Bunting L, Collins JA, Nygren KG. International estimates of infertility prevalence and treatment-seeking: Potential need and demand for infertility medical care. Hum Reprod. 2007;22:1506–12. [PubMed] [Google Scholar]
<a href=”https://www.injurymap.com/free-human-anatomy-illustrations”>Injurymap</a>
van Rijswijk J, van Welie N, Dreyer K, Pham CT, Verhoeve HR, Hoek A, de Bruin JP, Nap AW, van Hooff MHA, Goddijn M, Hooker AB, Bourdrez P, van Dongen AJCM, van Rooij IAJ, van Rijnsaardt-Lukassen HGM, van Golde RJT, van Heteren CF, Pelinck MJ, Duijn AEJ, Kaplan M, Lambalk CB, Mijatovic V, Mol BWJ. Tubal flushing with oil-based or water-based contrast at hysterosalpingography for infertility: long-term reproductive outcomes of a randomized trial. Fertil Steril. 2020 Jul;114(1):155-162. doi: 10.1016/j.fertnstert.2020.03.022. Epub 2020 Jun 16. PMID: 32553471.
Mohiyiddeen L, Hardiman A, Fitzgerald C, Hughes E, Mol BW, Johnson N, Watson A. Tubal flushing for subfertility. Cochrane Database Syst Rev. 2015 May 1;2015(5):CD003718. doi: 10.1002/14651858.CD003718.pub4. Update in: Cochrane Database Syst Rev. 2020 Oct 15;10:CD003718. PMID: 25929235; PMCID: PMC7133784.
Mohiyiddeen L, Hardiman A, Fitzgerald C, Hughes E, Mol BW, Johnson N, Watson A. Tubal flushing for subfertility. Cochrane Database Syst Rev. 2015 May 1;2015(5):CD003718. doi: 10.1002/14651858.CD003718.pub4. Update in: Cochrane Database Syst Rev. 2020 Oct 15;10:CD003718. PMID: 25929235; PMCID: PMC7133784.
Ambildhuke K, Pajai S, Chimegave A, Mundhada R, Kabra P. A Review of Tubal Factors Affecting Fertility and its Management. Cureus. 2022 Nov 1;14(11):e30990. doi: 10.7759/cureus.30990. PMID: 36475176; PMCID: PMC9717713.
Ambildhuke K, Pajai S, Chimegave A, Mundhada R, Kabra P. A Review of Tubal Factors Affecting Fertility and its Management. Cureus. 2022 Nov 1;14(11):e30990. doi: 10.7759/cureus.30990. PMID: 36475176; PMCID: PMC9717713.
Barwin BN. Hysterosalpingography in infertility. Ulster Med J. 1971 Winter;41(1):61-5. PMID: 5150066; PMCID: PMC2385324.