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{In no situation do we ever recommend that fertility diagnosis or treatment be undertaken without the oversight of a qualified medical practitioner. Please use the enclosed information as quick reference and for discussion aids with your practitioner.}

From hystero, referring to uterine cavity or uterus, and salping, referring to fallopian tubes. HSG is a test used primarily to determine if a woman's fallopian tubes are open or blocked. HSG also gives some idea as to the integrity (condition) of the endometrial cavity (uterine interior.) It is known as the most uncomfortable of diagnostic procedures for females.

Indications:
Infertility or one-partner conception with:

• known history of sexually transmitted infection, ruptured appendix, previous abdominal surgery, or endometriosis
• previous tubal ligation
• previous tubal (ectopic) pregnancy
• unexplained female infertility, with established functioning male fertility

• tubal-factor issues (inflammation, blockage, absent tube, etc.), or
• when infertility cause is unexplained.

• recurrent miscarriage
• concerns about any structural problems of the uterus or tubes

How It Works:
A woman's uterine cavity (uterus) is filled with a fluid that allows an xray image to be filmed of her uterus and fallopian tubes. Results are available immediately as the xray reveals whether or not fluid flows through the uterus and out of the fallopian tubes, indicating clear passage for an egg.

Results
Available immediately to the radiologist or other practitioner who is viewing the xray screen. Patient may also receive results immediately, if discussion occurs within the exam room, or later in an office appointment.

There is some evidence that spontaneous conception (occurring without treatment) rates are increased slightly for a period of up to three months following HSG in some patients. It is believed this may be the result of any very mild tubal blockage being cleared on a short-term basis by the actual movement of the dye through the tubes.

Typical Procedure Protocol:

Pre-procedure:

• semen analysis of male partner
• may require pre-admit paperwork be completed in hospital, as most HSG's are performed in hospital radiology departments
• in some cases, administration of oral antibiotics a few days prior, as a prophylactic (prevention) measure
• determination with provider of type and amount of over-the-counter pain medication (typically, Ibuprofen) to be taken by patient the day of procedure, before procedure

During procedure:
• patient lies on exam table with feet in stirrups
• speculum, similar to that used in typical female exam, is inserted into vagina
• soft, thin tube inserted into cervical opening; a tenaculum (surgical instrument) may be used to assist in holding the cervix open
• contrast dye is injected through the tube and flows into the uterus
• Xray picture is taken as the uterus fills and then as fluid is observed moving (or not) through the tubes
• if no fluid spill is shown through the tubes, patient is asked to roll on her side for a different view by Xray
• instruments are removed and patient remains on table for several minutes recovery period

Average Costs, excluding pre-procedure antibiotics and office appointments:

• US $175. to $600., depending on where procedure is performed and the going rate for geographical area

Expected physical effects

• Mild discomfort during insertion of tube into cervical opening
• More intense pain during dye injection, typically from the pressure of fluid within the uterus, resembles mild to severe menstrual cramping
• Remaining pelvic discomfort lasting from a few hours to a day beyond the procedure

  Physical effects to report to your doctor after procedure

  • Pelvic or abdominal cramping that continues for more than 24 hours past procedure, or that is so severe as to restrict all activities of daily life
  • Fever

Precautions/Risks

• Slight risk of pelvic inflammatory disease (PID) resulting from bacteria introduced into body through procedure itself
• Uncommon risk of allergic reaction to dye itself
• Very uncommon risk of uterine perforation