Delayed conception is a problem that many people face these days. So, you probably know that various tests have to be done to find out the reasons for this. At such times, especially in your fallopian tubes (i.e. the tubes that carry eggs from the ovaries to the uterus), this important test is called a hysterosalpingogram, which is done to see if there are any blockages or if there is any change in the shape of the uterus. We also call this HSG for short. This is actually a test that uses X-ray technology and a special liquid is injected. So, today we will talk about this HSG test in a way that you can understand well.
What time is this HSG test done?
Well, there is a best time to have this HSG test. Your doctor will schedule it for the first two weeks of your monthly menstrual cycle . That means it's done after your period has ended but before ovulation. This specific time is chosen for two reasons:
1. You can be sure that you are not pregnant when you take the test.
2. Since menstruation is not occurring at the time of the test, it will not interfere with the test.
When should an HSG test not be performed?
This is also a very important point. Not everyone can have this HSG test. Especially in these cases, the HSG is not done:
- If you are pregnant: This test is not done at all during pregnancy.
- If you have a pelvic infection: If you have this test while you have such an infection, it can spread further. Therefore, if you have such a condition, this test is postponed until it has cleared up.
Why do we need an HSG test?
A doctor will often recommend an HSG test if they suspect you may be having problems conceiving. The main purpose of this is to determine whether your fallopian tubes are open or blocked.
Think about it, for a healthy pregnancy to occur, a sperm has to travel down the fallopian tube and meet with an egg. Then, the fertilized egg (embryo) has to travel back down the fallopian tube and implant in the uterus. So, if these fallopian tubes are blocked, none of this will happen properly. Blocked fallopian tubes are a major cause of infertility.
The doctor can also get an idea of several other things from the HSG test:
Check if the tubal ligation surgery is successful
Some women have a surgery called `(Tubal ligation)` to stop having children. That is, the fallopian tubes are tied. So this HSG test is also used to see if the surgery was successful and the tubes are completely closed. Also, when some people want to have a child again, these tied tubes are reconnected (`(Tubal reversal)`). The HSG also helps to see if it was successful.
Identify uterine abnormalities and plan further testing
The HSG test can also help to determine if there are any abnormalities in the shape of the uterus or if there are any lumps or growths in the uterus, such as fibroids. If this is the case, it can help the doctor plan what tests to do next. For example, a test called a sonohysterography can further clarify the results of the HSG. Or, a test called a hysteroscopy can be used to treat certain conditions inside the uterus.
But currently, the HSG test is mainly used to check whether the fallopian tubes are open or not, because there are other tests that are simpler and provide more complete information about the uterus.
Who performs the HSG test?
This test is usually performed by your gynecologist, radiologist, or reproductive endocrinologist. After the test, the radiologist will review your X-ray images, create a report, and send it to your doctor.
How exactly does this test work?
Simply put, an HSG test involves injecting a special liquid (also called dye) into your uterine cavity and fallopian tubes. This dye allows the shape of your uterus and fallopian tubes to be clearly seen on an X-ray image.
- If the X-ray shows that the dye is flowing through the fallopian tubes, it means that your tubes are open.
- If the dye encounters an obstacle somewhere and cannot flow, it means your fallopian tubes are blocked.
Do you understand? It's very simple.
What do you need to know before the HSG test?
To determine if you are a good candidate for an HSG test, your doctor will discuss your complete medical history. If you are monitoring your Luteinizing Hormone (LH) levels, your doctor may also review those test results to make sure you are not pregnant. They will also check to see if you are allergic to any of the dye used in the HSG.
The doctor will also explain to you whether there are any risks involved in this test. However, the risks of an HSG are very low, so there is nothing to worry about.
How to prepare for the HSG test?
You should follow your doctor's instructions exactly. This usually includes the following:
- Pain medication: You may be asked to take a pain reliever (the kind you can buy at the pharmacy) about an hour before the test. This can help reduce any discomfort during the test.
- Medication to prevent infection: Sometimes, you may be given antibiotics before the test to reduce the risk of infection.
- Have someone to drive you home: After the HSG test, you may find it difficult to drive, as you may experience some pain or cramping. Therefore, it is best to have someone to drive you home. If you are not comfortable with that, you can drive yourself, but it is better to have someone, right?
What happens during an HSG test ?
This test takes less than five minutes , and you can go home the same day.
During the test, an X-ray machine takes pictures as the doctor injects dye into your uterus and fallopian tubes.
Preparing to pierce the die:
1. You will be made to lie on a table, as if you were having a pelvic exam, with your knees bent and your legs apart. The machine that takes the X-ray pictures (called a ``fluoroscopy machine'') is above the table.
2. Then the doctor inserts a device called a ``speculum'' into your vagina and widens it a little. This allows the cervix to be clearly seen.
3. Next, the cervix is cleaned and a small tube (catheter) is passed through the cervix into the uterus. This tube may be a thin plastic tube (a cannula). Or, it may be a thin plastic tube with a small balloon at the tip. This balloon inflates when it is inserted, so that the tube does not move around when the dye is inserted.
Inserting the die:
1. Then the doctor removes the speculum and tells you to keep your legs spread out on the table.
2. Now the doctor will slowly pump the dye into your uterus. At the same time, the radiology technician will turn on the ``fluoroscopy machine`` over your pelvic area. You may feel some cramping in your stomach at this time.
3. If your fallopian tubes are blocked, the pressure from the dye may stretch them a bit, which may make the pain a little more intense.
4. The doctor may also turn you into different positions to see how the dye moves along the fallopian tubes.
5. If your fallopian tubes are open, the dye will appear to be leaking out of the tubes and spreading into the intestinal tract (this dye is then absorbed by the body and will not cause any harm). If the tubes are blocked, the dye will not come out.
After taking enough X-ray images, the doctor will remove the cannula, or tube with the balloon, from your body. This is done without reinserting the speculum.
Is the HSG test painful?
It's normal to feel some pain or discomfort during an HSG test. This can be felt during the test and after it's done. You'll feel a cramping sensation in your abdomen as the doctor inserts the dye into your uterus. If your tubes are blocked, this cramping may be more intense.
This numbness can last anywhere from five minutes to several hours after the test. It can be mild to moderate. As mentioned earlier, taking a nonsteroidal anti-inflammatory drug (NSAID) can help relieve this pain.
What can you expect after the test?
After the test, you will need to use a pad to absorb the extra dye that comes out of your vagina. This discharge is often sticky and may contain a few small drops of blood. In addition, you may experience side effects such as:
- Stomach cramps (Cramps)
- Dizziness
- Upset stomach or nausea
- A small amount of vaginal bleeding for a day or two
Depending on how well you feel, you can resume your daily activities after the HSG test.
What are the risks of this test?
Although radiation is used to take X-ray images during an HSG, the amount of radiation is very low . Therefore, an HSG is not considered a risky test. However, there are some very rare complications that can occur:
- Infection
- Injury to your uterus
- An allergic reaction to the dye solution
Remember that these are very rare events.
What are the results? What do they tell us?
Your doctor will tell you about the test results and advise you on what to do next.
If the HSG test shows that there is a blockage in the fallopian tubes, the doctor may suggest other tests/procedures, such as a laparoscopy, to further investigate and treat the problem. Or, they may refer you to fertility treatments that do not require the fallopian tubes to be open, such as in vitro fertilization (IVF).
What are the special occasions when you should see a doctor?
After the test, if you notice any of these symptoms, it could be a sign of an infection. If so, you should see your doctor immediately:
- Fever
- Chills
- Fainting
- Vomiting
- Heavy vaginal bleeding
- Foul-smelling vaginal discharge
- Severe cramping or pain in your abdomen
Is it worth taking care of these?
Does the chance of pregnancy increase after an HSG test?
Sometimes there is talk of something called "tubal flushing." This is the process of injecting dye into the uterus and fallopian tubes, similar to an HSG, but without taking an X-ray. Some studies have shown that injecting dye this way (especially during the first three to six months after the dye is inserted) can increase the chances of getting pregnant. Some studies have also shown that this effect is greater when the dye contains an ``oil-soluble contrast medium''.
However, the quality of these studies varies, so more research is needed before HSG can be considered a fertility treatment, in addition to being a diagnostic tool.
Can HSG test open blocked tubes?
When the dye solution is inserted, there is a chance that any minor blockages will be cleared, increasing your chances of getting pregnant. But more research is still needed to prove this for sure. So it's hard to get too hopeful.
What are the side effects of the HSG test ? (A reminder)
The most common side effect of an HSG test is cramping . Your doctor may recommend that you take painkillers for a few days after the test. You may also notice a sticky vaginal discharge as the dye leaves your body. However, these symptoms will go away after a few days.
Is it okay to get pregnant soon after an HSG test?
Usually, it's okay to try to get pregnant a few days after an HSG test. However, it's best to talk to your doctor about this and ask them to confirm.
Final Take-Home Message
Okay, so the HSG test is an important test that helps you find out if there are any abnormalities in your uterus or fallopian tubes that are preventing you from getting pregnant. Remember, blocked fallopian tubes are a major cause of infertility. So, the results of this HSG test will help your doctor get one step closer to figuring out why you are having trouble conceiving.
Don't be afraid. If you have any questions or concerns about this test, discuss them openly with your doctor. That way, you'll feel more comfortable going through this process.
Please discuss your test results with your doctor and make a decision about what to do next. We wish you all the best!
` Hysterosalpingogram, HSG, infertility, fallopian tube blockage, uterus, women's health, X-ray examination
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