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A hysterosalpingogram is a study performed to evaluate the uterine cavity and whether or not the the fallopian tubes are open or obstructed. This study is often performed as part of an infertility work-up at the recommendation of a gynecologist.
How is it done?
You will be positioned on your back on a special table that has live X-ray capabilities (fluoroscopy). Similar to a gynecological exam, a speculum is placed in the vaginal canal. A small caliber tube with a tiny balloon on the tip is then inserted into the cervix and the balloon is inflated. When the balloon inflates, you may experience a pinch or cramping. Then radiologic dye (iodinated contrast material) is injected while the radiologist looks with the fluoroscope to observe the shape of the uterine canal and to observe whether contrast flows through one or both fallopian tubes. The radiologist takes images during the study to document the findings. When the procedure is finished, the tube is removed.
Does it hurt?
It is not uncommon to experience some cramping and minimal bleeding during and for a few hours after the procedure. This is normal. Some patients have very little discomfort. The level of cramping and discomfort varies depending on the patient but is usually tolerable and is very similar to the discomfort of a typical menstrual period. The exception is during the balloon inflation when there may be more significant discomfort. For that reason, the radiologist tries to work quite rapidly to obtain the necessary images and avoid prolonging any discomfort.
How long does the procedure take?
You can expect to be in the Radiology Department for one to two hours for your exam. This includes the time it takes to sign in to the department and get set up for the exam. The time to perform the exam itself is approximately 45 minutes. The procedure time can vary depending on the ease with which cervix is located, and the ease of placement of the catheter. The catheter tip is placed within the cervix, a muscle that tends to push the tube (and balloon) out. Therefore, the tube can fall out at any point during the study and require the radiologist to start again. Naturally, this may cause some anxiety for you but it is a normal and natural occurrence. It does not indicate that anything is wrong but simply means that the procedure may require more time.
Are there any risks?
The most common side effects are vaginal bleeding and cramping that may last up to a day or two after the procedure but more commonly resolve within a few hours. There is always a chance that there may be more significant bleeding or perforation of the uterus that requires the aid of a surgeon. This is an exceedingly rare occurrence. Perforation and severe bleeding are a very low risk since a soft, floppy catheter is used and the radiologist observes the procedure with fluoroscopy while injecting the contrast. Infection is also a possibility, but the risk is very low as the procedure is performed with clean technique. For instance, Betadyne solution is used to wash the cervix before the tube insertion. Sterile instruments are used but the procedure is not done in a sterile room, very similar to the conditions a patient would experience for a gynecologic exam.
What if I have an allergy to iodine or contrast material?
Because radiologic dye (iodine based) is used during the study, it is important to tell the physician and technologist if you have an allergy to the iodinated contrast that is used in many radiologic procedures—preferably prior to the day of the procedure. If you do have an allergy, a preparation including Prednisone pills taken the day before the procedure, and Benadryl given the day of the procedure, are used to avoid a contrast reaction.
