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Hysterosalpingography

Last updated Jan. 18, 2019

Approved by: Maulik P. Purohit MD MPH

NIH

Hysterosalpingography is a special X-ray examination that uses fluoroscopy and a contrast material to evaluate the uterus and fallopian tube. This image shows a woman with genital tuberculosis. The Hysterosalpingogram demonstrates a bilateral tubal occlusion and intravasation of contrast medium in the uterine wall and pelvis (arrows). Uterine cavity appears normal.


Background Information:

What are the other Names for the Procedure?

  • HSG (Hysterosalpingography)
  • Uterosalpingography

What is Hysterosalpingography radiology procedure? (General Explanation)

  • Hysterosalpingography is a special X-ray examination that uses fluoroscopy and a contrast material to evaluate the uterus and fallopian tube
  • Fluoroscopy provides images of the target organ in real-time. Thus, internal organs, such as the uterus and fallopian tube can be seen in motion
  • During fluoroscopy, the uterus and fallopian tube is filled with a contrast material, in order to view them and evaluate their function and anatomy

What part of the Body does the Procedure involve?

A Hysterosalpingography procedure involves the uterus and fallopian tubes of the patient.

Why is the Hysterosalpingography radiology procedure Performed?

The Hysterosalpingography procedure is performed to diagnose a variety of conditions, such as:

  • To assess the function and anatomy of uterus and fallopian tube in women, who have difficulty getting pregnant
  • To assess tumor masses, adhesions, uterine fibroids, scarring in fallopian tube
  • To investigate excessive menstrual or other vaginal bleeding
  • To check closure of the fallopian tube after a sterilization procedure

What is the Equipment used? (Description of Equipment)

  • The equipment used in Hysterosalpingography typically looks like an X-ray machine, and consists of an examination table and a TV monitor
  • Fluoroscopy converts images produced by the X-ray machine into real-time images, which is used for guidance by the physician

What are the Recent Advances in the Procedure?

There have been no recent advances in the field of Hysterosalpingography procedure.

What is the Cost of performing the Hysterosalpingography radiology procedure?

The cost of Hysterosalpingography procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding the Hysterosalpingography procedure and what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
  • Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.ncbi.nlm.nih.gov/pubmed/25287031 (accessed on 10/15/2014)

http://www.ncbi.nlm.nih.gov/pubmed/25282944 (accessed on 10/15/2014)

http://www.ncbi.nlm.nih.gov/pubmed/25245887 (accessed on 10/15/2014)

Prior to Hysterosalpingography radiology procedure:

How does the Hysterosalpingography radiology procedure work?

The Hysterosalpingography procedure works in the following manner:

  • X-rays are passed through the patient’s body and information is recorded on a recording plate, on the other side of the body
  • Fluoroscopy uses contrast material along with an X-ray machine, to produce real-time images of the organs, or joints in motion

How is the Hysterosalpingography radiology procedure Performed?

The Hysterosalpingography is performed as an outpatient procedure.

  • The patient is positioned on the examination table with her feet on stirrups, similar to the position used for a regular gynecological examination
  • A speculum is inserted into the patient’s vagina, the cervix is cleansed, and a catheter is inserted in the cervix. The speculum is removed after the catheter insertion
  • The patient is placed suitably for the fluoroscopy camera and a contrast material is filled into the uterine cavity and fallopian tube, through the catheter that was inserted earlier
  • The images are taken using fluoroscopy and X-rays
  • The patient may be asked to rest on the examination table, to obtain delayed images, if any abnormalities are seen during the procedure
  • After the procedure is completed, the catheter from the cervix is removed
  • The entire procedure takes about 30 minutes and patients are able to resume their normal activities, immediately after the procedure is completed

Where is the Procedure Performed?

A Hysterosalpingography procedure is performed as an outpatient procedure, at a hospital.

Who Performs the Procedure?

An ultrasound technician usually performs the Hysterosalpingography procedure under the guidance of gynecologist.

How long will the Procedure take?

A Hysterosalpingography procedure takes about 30 minutes to perform.

Who interprets the Result?

A radiologist or a gynecologist interprets the results of the Hysterosalpingography procedure.

What Preparations are needed, prior to the Procedure?

  • Hysterosalpingography is usually performed 1 week after menstruation and before ovulation, as it excludes the chances of the patient being pregnant
  • Patient may be given laxatives the night before the procedure, to empty their bowels, in order that the adjacent  structures, such as the uterus and fallopian tubes are seen better
  • The physician should also be notified, if the patient is pregnant, or if there is any possibility of getting pregnant, as this procedure is not suitable for pregnant women
  • Patients should inform the physician, if they have a chronic pelvic infection, any sexual transmitted disease, or a history of the same
  • If patients are allergic to the contrast material or had had any recent illnesses, they should inform their physician about it

What is the Consent Process before the Procedure?

  • A physician will request your consent for Hysterosalpingography procedure using an Informed Consent Form
  • Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent
  • You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the Hysterosalpingography procedure:

  • It is a painless and minimally invasive procedure
  • It provides important information about the function and anatomy of the uterine cavity and fallopian tubes
  • It can be used to open the fallopian tubes in some cases
  • No radiation remains in patient’s body after the procedure

Following are the risks of the Hysterosalpingography procedure:

  • There is very minimal chances of cancer due to radiation exposure
  • This procedure may disturb the pregnancy, if the patient is pregnant at the time of the procedure
  • Contrast material may cause allergic reactions, if the patient is allergic to it

What are the Limitations of the Hysterosalpingography radiology procedure?

Following are the limitations of the Hysterosalpingography procedure:

  • The procedure is helpful to only evaluate the uterus and fallopian tube
  • To further examine the ovaries, uterine wall, and other pelvic structures, an ultrasound or MRI scan is preferred

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

  • What is a Hysterosalpingography procedure?
  • Why is this procedure necessary? How will it help?
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed?
  • What are the risks while performing the procedure?
  • What are the complications that might take place, during recovery?
  • What are the possible side effects from the procedure? How can I minimize these side effects?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any lifestyle restrictions or modifications required, after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • What are the costs involved?

During the Hysterosalpingography radiology procedure:

What is to be expected during the Hysterosalpingography radiology procedure?

The following may be expected during the Hysterosalpingography procedure:

  • The patient may feel a slight discomfort, when the catheter is inserted into the cervix
  • They may also feel a little warmth and discomfort, when the contrast material is injected
  • The procedure may cause some lower abdominal pain, which goes away quickly
  • The patient may experience vaginal spotting for few days after the procedure.

What kind of Anesthesia is given, during the Procedure?

Anesthesia is rarely used during a Hysterosalpingography procedure.

How much Blood will you lose, during the Procedure?

The Hysterosalpingography procedure is a minimally invasive one; hence, the blood loss involved during the procedure is minimal.

What are the possible Risks and Complications during the Hysterosalpingography radiology procedure?

The following may occur during the Hysterosalpingography procedure:

  • This procedure may disturb the pregnancy, if the patient is pregnant at the time of the procedure
  • The contrast material may cause some allergic reactions, if the patient is allergic to it

What Post-Operative Care is needed at the Healthcare Facility after the Hysterosalpingography radiology procedure?

No specific post-operative care is needed at home after the Hysterosalpingography procedure. 

After the Hysterosalpingography radiology procedure:

What is to be expected after the Hysterosalpingography radiology procedure?

The patient may experience vaginal spotting for few days after the Hysterosalpingography procedure.

When do you need to call your Physician?

Do contact your physician after the Hysterosalpingography procedure, if you experience:

  • Any significant pain
  • Or, if  there is bleeding from the catheter insertion site

What Post-Operative Care is needed at Home after the Hysterosalpingography radiology procedure?

No specific post-operative care is needed at home after the procedure. 

How long does it normally take to fully recover, from the Procedure?

  • Hysterosalpingography is a minimally-invasive and painless procedure that takes about 30 minutes to perform
  • The patient may resume their normal activities immediately after the procedure

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

A Hysterosalpingography procedure usually does not involve the removal of any body tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Hysterosalpingography radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The hospital, where the procedure is performed
  • Healthcare providers, physicians, and radiologists, who are involved in the process

The patient is advised to inquire and confirm the type of billing, before the Hysterosalpingography procedure is performed.

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Oct. 22, 2014
Last updated: Jan. 18, 2019