Diagnostic Workup: HSG

What Is It?

Hysterosalpingogram, more commonly referred to as HSG, is a procedure used to xray the female reproductive organs, specifically the endometrial cavity (interior of the uterus) and fallopian tubes.

This simple, but slightly invasive procedure is used to determine the structural functionality of the woman's organs, particularly the tubes, and can detect the presence of fibroid growths also.

In brief, the procedure involves the following steps:

  • The patient should take acetaminophen or ibuprofen about an hour prior to the test.
  • With the patient in the same position as that used for a pelvic exam, a speculum (also such as that used in a well-woman exam) is inserted vaginally to make the cervix visible.
  • A thin tube called a cannula is inserted into the cervix.
  • An xray contrast dye is injected through the cannula into the uterus.
  • With the aid of an xray machine, the movement of the dye is observed as it passes through the uterus and the fallopian tubes. Optimally, the dye should pass all the way through both tubes and spill into the pelvic area.

Because HSG uses xray, this test may be performed in a radiologist's office or the radiology department of a hospital, which will then report their findings back to your referring physician. Among the possible findings to be considered:

  • Normally shaped uterine cavity and open tubes
  • Abnormally shaped uterine cavity
  • Fibroid tumors
  • Polyps
  • Scar tissue
  • One or both partially or completely closed tubes

The Good Shepherd Infertility Information and Resource Center runs through HSG details, including tips on preparation and contraindications. More general information is found from the Olson Center for Women's Health at UNMC. The Advanced Fertility Center of Chicago presents a few radiographic images of HSG patients.

Who Benefits From It?

In general, HSG assists in diagnosis for women who are experiencing inability to conceive and have concerns that their uterine cavity and/or tubal patency are less than optimal. "Tubal patency" refers to whether or not the fallopian tubes are open, which allows the egg to travel from the ovaries to the uterus. More specifically, the following conditions combined with inability to conceive may warrant an HSG:

  • Prior reproductive surgery
  • History of sexually transmitted disease, or risk factors for STD's
  • Previous ectopic (tubal) pregnancy
  • Unexplained infertility
  • Recurrent miscarriage from unknown causes

Women who have been diagnosed with pelvic inflammatory disease (PID), those who are allergic to iodine, those with a present vaginal infection, and those experiencing present vaginal bleeding should not undergo HSG. Complications from an HSG may include pelvic infection, allergic reaction to dye used, or bleeding.


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