Endometriosis and Fertility Resource Page

What is hysterosalpingography?
Hysterosalpingography is a contrast x-ray taken of the oviducts (Fallopian tubes) and uterus (the womb). Another names for the procedure include hysterogram, uterography, uterotubography, and uterosalpingography.

What is hysterosalpingography used for?
Hysterosalpingography is useful in the diagnosis of:

Ectopic Pregnancy

Infertility

Blockage of the Fallopian tube(s) [prevents passage of the egg through the Fallopian tube as it attempts to travel from the ovary to the uterus]

Adhesion (formation of scar tissue between opposing sides of the tube, closing up the opening)

Obstruction (blockage by foreign matter)

Adhesions in the uterus [interfere with implantation of the embryo (fertilized egg)]

Uterine Tumors

Injury

What happens during a hysterosalpingography?
Feces in the intestines can interfere with imaging of the reproductive tract. Consequently, the patient will most likely be instructed to take a laxative the night before the procedure. Similarly, an enema may be given beforehand.

During the procedure itself, with the woman lying on her back:

A speculum is inserted (the same device used for internal exams when collecting a pap smear). With the speculum remaining in place to maintain the opening,
A fluoroscope (instrument for visualizing the internal cavity and administering the dye) is inserted.

Dye is injected through the cervix. After the cavity has been flooded with dye,
The x-ray is taken.

What is the dye for?
The dye (”contrast dye”) employed in hysterosalpingography is for making the structure of the organs more visible.

[Note: Since not all of the dye drains out from the uterus immediately, the patient will want to keep hospital clothing on following the procedure.]

If I get my period, do I need to reschedule the test? Hysterosalpingography is not performed while a woman is menstruating.

(The test should not be performed if a woman is bleeding due for unknown reasons, either.)

If the doctor tells me to take a laxative the night before, does that also mean I shouldn’t eat before the test?
Since it takes many hours for food to reach the colon, eating or drinking prior to the test is permissible.

Does the test hurt at all?
Hysterosalpingography is relatively painless. Throughout the procedure the woman should have only sensations similar to those felt during a routine gynecological exam. However, afterward she may experience some cramping (akin to menstrual cramps) or moderate pain resulting from leakage of the dye into the abdomen. If the patient is nervous about the test, the doctor can administer a sedative to help her relax.

Does the test pose any danger?
Risks associated with hysterosalpingography are minimal:

Infection

Perforation (tearing) of the uterus (severe puncture that would necessitate surgery to correct is rare)

Allergic reaction to the dye (rare)

[Caution: Women with pelvic inflammatory disease or who experience unexplained uterine bleeding should not have hysterosalpingography performed.]

The material in this article is provided for informational purposes only. For specific medical advice or diagnosis, consult a healthcare provider. For a physician referral, click the button above.

Last updated 11/1/04

(Source: American College of Obstetricians and Gynecologists, TJSamson)

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Where It’s Done: Hospital radiology suite.

Who Does It: Gynecologist and radiologist with nurse or technician.

How Long It Takes: 15-30 minutes.

Discomfort/Pain: Cramping lasting several minutes when dye is instilled in uterus. May cause additional pain if fallopian tubes are blocked or go into spasm.

Results Ready When: Preliminary results immediately; final report in 2-4 days.

Special Equipment: Contrast dye, speculum, tenaculum, catheter, and X-ray machine.

Risks/Complications: Test should not be done on women who are pregnant or who have an infection. Slight risk of introducing or spreading pelvic infection. Rare risk of allergic reaction to iodine in dye.

Other names: Hysterogram, hysterosalpingography, uterography, uterotubography, and uterosalpingography.

Purpose

To diagnose tubal obstruction as a cause of infertility.

To detect suspected fibroids, polyps, or developmental abnormalities in the uterus and fallopian tubes.

To evaluate the fallopian tubes before or after sterilization reversal surgery.

To evaluate incompetent cervix in women with a history of miscarriage.

How it works
Contrast dye is used to highlight the areas in question for the X-ray machine.

Preparation

The test will be scheduled during the early part of your menstrual cycle (between menstruation and ovulation), when pregnancy is unlikely.

You undress from the waist down and don a hospital gown.

Test procedure

You lie on your back on an examination table with an X-ray machine suspended over your abdomen. Your legs will be placed in special stirrups that go behind your knees.

A speculum is inserted into your vagina to hold open the vaginal walls. Then a thin, grasping instrument called a tenaculum is inserted to hold the cervix in place.

A thin catheter is inserted through the cervix into the uterus. A small balloon inside the catheter is inflated to keep it in place, and radiopaque contrast dye is instilled through the catheter. This usually causes several minutes of cramping and may result in spasm.

The gynecologist and radiologist watch the dye on a fluoroscope screen as it enters the uterus and spreads through the fallopian tubes, looking for abnormalities.
Four to eight X-rays are taken at various intervals as the dye travels through your reproductive tract.

Special precautions

If you suspect that you have a pelvic infection or may be pregnant, ask your doctor to reschedule the test.

Tell your doctor if you are prone to pelvic infections. You may be given prophylactic antibiotics to take before the test is done. It may also affect the choice of dye since water-based dyes are believed less likely to spread infection.

Be sure to take an analgesic such as ibuprofen about 30 minutes before the test to lessen the effect of the cramps.

Variations
Sonohysterogram, a test in which a catheter is inserted into the uterine cavity to instill fluid to distend the uterus, which is then examined via transvaginal ultrasound for space-occupying structures.

After the test

You will remain on the examination table until any cramping subsides and to be sure that you do not experience any adverse effects from the dye.

You may be asked to stay until the X-ray films are developed to be sure that no others are needed.

Then you are free to dress and return to normal activities.

If you experience severe cramping, you should not drive home.

Wear a sanitary napkin for 24 hours after the procedure.

Notify your doctor if you experience or notice excessive bleeding, fever, or unpleasant vaginal odor.

Factors affecting results
None.

Interpretation
The radiologist will study the X-rays for a final report, but certain diagnoses can be made by watching the progress of the dye on the fluoroscope to see whether the shape of the uterine cavity appears normal or has apparent protrusions that might indicate a fibroid tumor or scar tissue; whether the dye leaks, indicating a tear in the uterine lining; and whether the dye flows through and out the fallopian tubes, indicating that they are patent (open).

Advantages

It’s relatively noninvasive.

Negative results (showing that the fallopian tubes are open) are highly reliable.

It shows the internal contours and patency of the fallopian tubes (ultrasound does not).

The test itself may open small blockages.

Disadvantages
It may produce false-positive results: what appears to be a tubal blockage close to the uterus may only be a spasm in that area.

The next step

If the tubes appear to be open, and the uterine contour is normal, no further testing is necessary.

If they appear to be closed, or the uterine cavity is irregular, additional tests (laparoscopy or hysteroscopy) or surgery may follow.

DID YOU KNOW?
Although hysterosalpingography is primarily a diagnostic technique, it sometimes acts as a treatment because the dye unblocks minor obstructions as it flows through the fallopian tubes. Some doctors think that oil-based dyes are more likely to do this than water-based dyes.

(Source: Answers.com)

Medical Tests information about Hysterosalpingogram on Answers.com. The Patient’s Guide to Medical Tests Copyright © 1997 by Houghton Mifflin Company. Published by Houghton Mifflin Company.

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