Hysterosalpingography (HSG) is a type of X-ray test where you can see the shape and size of your uterus. The HSG test shows if there is a block at the fallopian tube.
Furthermore, during the test, doctors insert a narrow tube by the cervix and vagina. A substance called “contrast material” will be inserted inside the uterus.
Then the doctors perform a sequence of fluoroscopy or x-ray followed by a dye. The dye looks white on the x-ray because it first moves in the uterus than in the tubes. Now, if something is wrong with the shape and size of your uterus, then the dye will outline it.
Furthermore, the dye will fill the space if a tube is not blocked. It then oozes into your pelvic cavity, and the body reabsorbs it.
HSG test price is between $200 to $730.
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Step-by-Step Method of HSG test
It would help if you lay down on the table which has stirrups. But if they do not have stirrups, then after lying down on a table, you need to bend the knees where each of your legs will be at one side of the table, and the feet will be flat on the table.
First, the doctor will do a pelvic exam. Either the nurse, doctor, or technician will slide a speculum into the vagina. It is a similar metal device used for a gynecological exam.
Also, if you feel any pain when you do your annual gynecological exam, this procedure will be painful as well.
Now the doctor will place an x-ray machine just above your stomach. After this, they will slide a swab that will clean off your cervix. The clean-up lessens the risk of any infections.
Moreover, if the cervix is sensitive when touched, it will feel achy and irritating. However, there will no pain during the process.
Furthermore, the nurse will insert a cannula (a plastic catheter) in the cervical opening. Now, most women feel a bit uncomfortable when this happens. But you might not feel anything as well.
Lastly, by the catheter, a dye will be inserted. Most of the time, doctors use iodine-based dye. During the dye insertion, you might feel a warm sensation. Now the dye goes to the uterus by the fallopian tubes.
If it does not go through the tube, that means the tubes are closed or blocked. However, if they pass through the tube, then they will spill out in your pelvic cavity.
Furthermore, if the tubes are closed or blocked, you will feel discomfort and slight pain when the dye is inserted. If you feel any pain, then you need to tell the doctor immediately.
Once the dye is injected, the doctor will take the x-ray. Then for every x-ray photo, the doctor will ask you to hold your breath for a few seconds. Sometimes the doctor will tell you to change your position for better x-ray results.
For instance, the doctor might ask you to lie on your side. This might be uncomfortable as the x-ray is above your stomach and the speculum is inside you. If you cannot turn to your side, then ask for help.
Once the doctor is satisfied with the pictures, the speculum, and the x-ray machine will be removed.
Precautions before HSG test
The HSG test is done after the menstrual cycle and before ovulation. Moreover, this is the best time to do this test as it reduces the risk of doing the test when someone is pregnant. Also, the doctor will suggest you call them to schedule the test on the 1st day of your menstrual cycle.
Furthermore, the test is performed while the person is awake, and there is no need for general anesthesia. Also, you do not need to fast the night before the test.
The doctor might recommend taking a painkiller 60 minutes before the test is scheduled on the day of the procedure. This will reduce the discomfort during the test. Some doctors also give antibiotics to reduce the chance of getting infected.
Precautions after HSG test
After you are done, you might feel cramps on your stomach, similar to when you have your period. Also, there might be vaginal bleeding or vaginal discharge. If you experience this, then use a sanitary napkin instead of tampons, as tampons might cause infection in the area.
HSG test side effects
There are some side effects of the HSG test where few women feel nausea and shakiness after the test. However, it is normal to feel this way:
But few symptoms are the cause of infection includes:
- Extreme pain or cramping
- Vaginal discharge has a foul smell
- Heavy bleeding from the vagina
The radiologist will send the result to the doctor. The doctor will look at the result with you. If there is any problem with your result, there will be more tests or the doctor might want to examine.
Is the HSG test procedure painful?
Some women feel cramping and stiffness when the dye is inserted. But if someone’s fallopian tube is blocked, then there will be severe pain. However, there are many over-the-counter medicines like ibuprofen that can relieve discomfort and pain.
Talk to the doctor if you are going to take medicine. It would help if you took the painkiller 45 – 60 minutes before the HSG test to reduce or prevent the pain during the procedure.
Benefits of HSG test
Doctors use two types of contrast or fluid when they perform HSG tests – one of them is oil soluble, and the other is water-soluble. Also, many anecdotal reports state that it enhances the pregnancy rate after the rest.
A study in the Netherlands showed that women under 38 who have subfertility have a higher chance of being pregnant after the test. Also, the chances are higher when the doctor uses oil-soluble contrast instead of water-soluble contrast.
Hence, HSG does not only diagnose the reason behind infertility but also increases the chances of getting pregnant in the future.
How to manage HSG discomfort?
It might be nerve-wracking since you are lying on the back, a huge x-ray machine is over you, the legs are apart, and a speculum is inside. Moreover, the doctor or nurse might tell you to roll to your side for a better x-ray picture, and you need to do that while the speculum is still inside your body.
However, in most cases, it is painless when the dye will pass to the uterus by the fallopian tubes and then in the abdominal cavity. But if the tubes are closed or blocked, then the dye will cause pressure.
Now, this can lead to some discomfort or be painful. How the good thing is even if you feel severe pain, it will not last more than one minute.
If you even feel slight pain at the procedure time, let your doctor know right away. You do not need to bear it and assume that it is normal.
If you tell them, then the doctor will remove the catheter. Once it is removed, there will be no pressure, and you won’t be feeling any pain.
Furthermore, most of the time doctor will suggest you take an ibuprofen 40 – 60 minutes before the test. This will reduce the slight cramp during the procedure. Also, if you feel anxious and scared before the test, it will raise your perception of discomfort and pain.
What do the test results mean?
Once you go through the test, you will get your result in a day or two. The test helps the doctor to know three vital factors that are:
Whether the fallopian tubes are open or blocked
If the tubes are blocked, then eggs cannot meet the spear; hence conception is impossible. There might be various potential reasons for this, and many treatments will resolve this issue.
The shape of the uterus
If a woman cannot become pregnant or had any miscarriage, one of the reasons might be the abnormal shape of the uterus. This test shows if the size of the uterus is normal or not.
If there is any polyps or fibroids
Polyps or fibroids can interfere when the embryo is growing or implanting. The good news is with minor surgery, one can treat the abnormality in the uterus.
The normal test result is when the dye will spill freely from the fallopian tube, and the shape of the uterus is normal. However, this does not mean that fertility is normal. This means if something is wrong with fertility, the test result could not detect it.
If the cause of infertility is hormone-based, then it will not be seen on the test. Also, not every uterine-related fertility issue will be visualized with the test.
Furthermore, a study suggests that about 35% of the case has false negatives. This means the test showed that the uterus shape is normal, but reflects abnormality when hysteroscopy is done.
Hysteroscopy involves a small and thin telescope type of camera by the cervix, which will look inside the uterus.
Note that this test does not identify endometriosis. This can only be diagnosed or ruled out after the exploratory laparoscopy.
There is a problem if the dye does not flow out of the tubes or shows an abnormal shape of the uterus.
Also, the study suggests that 15% of women have false positives. This means the dye does no go past the uterus than in the tubes.
Most of the time, the blockage will be at the meet point of the uterus and fallopian tubes. When this happens, the doctor will do the test again or recommend you do a different test.
Besides, the test will only show the blockage but will not explain the reason behind it. For that, you need to do either hysteroscopy or laparoscopy.
Safety Concerns and Possible Risks
An HSG is mostly a safe method. But there are still many women who are concerned about the risks and safety of the test.
Generally, during the time of the x-ray, the technician or nurse will cover the pelvic area. At the time of the test, the x-ray machine aims right above the pelvis.
Furthermore, the amount of radiation during the test is meager. Also, this will not cause any problem or other effects even if the person gets pregnant after few weeks.
But the test shouldn’t be don’t when one is pregnant. If you doubt that you might be pregnant, then tell the doctor before the test.
Less than one percent face infection after HSG test. Also, it is more common in women who are at risk of pelvic inflammatory disease (PID) or already have infections.
Moreover, if you get a fever or have severe pain after the test, call the doctor and explain your problem. Besides, if a woman has a history of abdominal surgery (like appendectomy), PID, or sexually transmitted diseases, the doctor will prescribe an antibiotic before the test as a precaution.
Also, there might be another risk of fainting after or during the test, so if you feel nausea after the test, tells the doctor. The doctor might tell you to lie down for few minutes or until you feel better.
Lastly, there can be an allergic reaction due to iodine. Hence if you are allergic to shellfish and iodine, then tell the doctor before the exam. Also, if the patient has itching, swelling, or irritation after the exam, then tell the doctor.
During the HSG test, most people feel nervous, and it is normal. If you feel stressed, then do tell your doctor. Sometimes the nurse might hold your hand, which will make you feel better and at ease.
Furthermore, the test is a quick process, and for most, it is completely painless. Also, if you feel any pain most of the time, it is mild and short-lived. However, if this is not the case, then tell the doctor.
Before the test, tell your doctor your medical history and if you need any antibiotics or painkillers.