Hysterosalpingography is a procedure used to look at the structure of the uterine cavity. It also is used to look at the Fallopian tube structure and whether they are open or blocked. The procedure is done with a special X-ray dye. X-rays are taken after a catheter is inserted into the cervix and the dye injected.
Why is a Hysterosalpingogram done?
Hysterosalpingography is most commonly used for the workup of women with infertility. The test allows us to see if there are any congenital or structural abnormalities of the uterine cavity which can contribute to miscarriages. The test allows us to see the structure of the Fallopian tubes and whether they are dilated or blocked. The test has even been reported to help with fertility because of the dye passing through the fallopian tubes.
The test is done in the radiology department. Some contraindications to the test include pregnancy, allergies to dye, menstruation, infection and diagnosis of pelvic inflammatory disease. It is either done completely by a radiology doctor or sometimes the gynecologist does the procedure and the radiologist is there to assist with the X-ray part. A technologist usually assists with the procedure as well. The radiologist usually provides a report to the ordering doctor.
The patient lies on their back on the X-ray table with the legs flexed and separated. The vulvar area is cleaned. A speculum is inserted into the vagina and the cervix is exposed. A thin catheter is then inserted into the cervix. Contrast is then injected slowly. There is intermittent X-ray during this part to see the dye and where it goes.
X-ray pictures are taken of the uterine cavity. We look at the Fallopian tubes filling with the contrast. The goal is to demonstrate the injected contrast spilling from the Fallopian tubes. This tells us that they are open and not blocked. Some women experience pain during the injection of contrast. Complications are rare and may include allergic reactions, infections and abdominal cramping.
What are some abnormalities we see on Hysterosalpingograms?
Abnormalities of the uterine cavity can be seen like congenital abnormalities of the shape and structure. Examples include a uterus with two horns (bicornuate uterus) or that with a septum (separate uterus).
Masses in the uterine cavity can be seen like uterine fibroids or cancer. Ultrasound or MRI may be needed to better distinguish the possibilities.
Scarring or adhesions in the uterine cavity is called Asherman syndrome. This will be seen as linear defects in the uterine cavity on HSG. Prior pregnancies, procedures and surgery can result in scarring. This can contribute to infertility.
Non spill of contrast from Fallopian tubes
Non spill of the contrast from the Fallopian tubes can be from prior inflammation and pelvic inflammatory disease.
Polyps and masses of the Fallopian tubes
Polyps or masses of the Fallopian tubes can be identified on HSG. Usually with tumors, the Fallopian tubes will be blocked, dilated and has a mass.
Dilated Fallopian tubes
Hydrosalpinx or dilated tubes can occur from a variety of causes but can lead to infertility. Most commonly I see this with pelvic inflammatory disease.
Salpingitis isthmica nodosa
Salpingitis isthmica nodosa can be seen on HSG and is related to scaring of the tubes. The cause is a matter of controversy. The condition can lead to infertility. The appearance on HSG is characteristic with small pockets of contrast seen along the tubes.
Hysterosalpingogram is a commonly done procedure to evaluate women with infertility. The test is good for showing abnormalities of the uterine cavity and tubes which may result in infertility. It is generally well tolerated and often definitive for confirming patency of the fallopian tubes.