Hysterosalpingogram – HSG

What is it?
The HSG is an Xray of uterus and tubes. It is done on outpatient basis. A special iodine-containing dye is injected through the cervix . It flows into the uterine cavity and through the tubes. If the tubes are not blocked, the dye will spill out of the tubes into the pelvis, that the tubes are open. X-ray pictures will be taken during the procedure to provide a permanent record of the condition of the tubes and the uterine cavity. The actual progress of the dye flowing through the tubes can be followed on a fluoroscopy TV monitor. X-ray pictures are available in a few minutes and can be examined by the radiologist, the gynecologist, and the patient. HSG is optimally performed within the first 12 days after the beginning of a normal menstrual period.
Why it is performed?

An X-ray of the uterus and tubes (HSG) usually done to assess the tubal patency. Blockage of one or both tubes may prevent union of the sperm and egg (fertilization). In addition, this procedure gives a picture outline of the uterine cavity and may help in detecting abnormalities of the uterus that may cause infertility, repeated miscarriages, or abnormal vaginal bleeding. Occasionally this procedure is ordered to diagnose causes of pelvic pain which originate inside the uterus.

This picture shows a normal uterus and tubes

Is it painful?
The procedure causes some cramping and discomfort. Most patients take pain killer to do well.It is usually done without anaesthesia. A radio opaque dye is injected to pass through the tubes. If tube/tubes patent dye spills into the peritoneal cavity and causes pain, which is tolerabe.

Is there any complications?
During the insertion of the instruments and injection of the dye, there will likely be cramping and discomfort which usually disappears after a few minutes. A small percent of patients may experience prolonged discomfort, especially when the tubes are blocked and the liquid dye is unable to flow out of the uterus promptly.
A small percentage of patients may develop infection of the lining of the uterus, tubes or pelvis following this procedure. This is more common when the tubes have been damaged previously by infection or other causes. Infection in the tubes could lead to infertility, but the risk of infection is low (commonly estimated at 1%). Allergic reactions are possible after injection of the iodine-based dye.

  1. There will be slight vaginal bleeding and/or discharge for a few days after the procedure.
  2. There may be moderate pain or cramping for several hours after the procedure.
  3. Fever (temperature> 100.5 degrees F) with persistent pain may indicate the possibility of early infection..

Alternatives to Hysterosalpingography.

The information gained from an HSG can also be obtained by laparoscopy and hysteroscopy. Information about the uterine cavity may also be gained by a saline contrast ultrasound.