Hysterosalpingogram, a common test for infertility

As part of the initial infertility work-up, your physician will wish to schedule a hysterosalpingogram, or HSG. The HSG is a type of x-ray test, designed to give your doctor a view inside your uterus, fallopian tubes and the surrounding area, in order to check for obstructions and abnormalities which can stop a pregnancy from taking place.

During the HSG, dye is put into a very thin tube, inserted vaginally into your uterus. The uterus and fallopian tubes are connected, so the dye will be able to flow freely and evenly unless there is a blockage, partial blockage, or other problem. Photos taken during the HSG track the dye's progression, allowing your physician to identify issues within the uterus such as polyps, IUD. Sometimes, the movement of the dye will be enough to dislodge an existing obstruction. The HSG is also helpful in determining if a tubal ligation reversal has been successful.

Women are often concerned about the purported pain or discomfort which can accompany the HSG test. Most women who have had the test report they experience a feeling of pressure or cramping, but not pain. Everyone's pain threshold is different however, and if you are concerned about this aspect of the test, your doctor will most likely recommend the use of a pain killer, such as ibuprofen, prior to the HSG. Some physicians will also prescribe an antibiotic in order to thwart any potential infection from occurring. Discuss any medication you decide to take in the days leading up to the test with your physician. Other issues to discuss include:

  • You are or might be pregnant
  • You have or may have a pelvic infection
  • You have a history of asthma
  • Allergies you may have to x-ray dye, bee pollen, shellfish, or any other food or medication
  • A history of kidney issues, diabetes, and the medications you take to control them, especially metformin, also used to control PCOS.
  • Issues with excessive bleeding and blood-thinners you are taking, including aspirin.

After the test, you will remain in a reclining position for about 30 minutes and observed to make sure you do not experience excessive bleeding or an allergic reaction of any kind. Both occurrences are rare. A small amount of bleeding, plus leakage of the dye from the vagina, are to be expected. It makes sense for you to relax for the rest of the day, and you will most likely feel fatigued. Heavy lifting or exercise are best left for another time.

If over the next several days you experience heavy bleeding (typically defined as soaking through one sanitary napkin in an hour), fever or abdominal pain, let your doctor know immediately. Vaginal bleeding of any kind should cease within 3-4 days after the procedure.

The HSG is a valuable addition to your doctor's diagnostic arsenal. Results of the test will be available to you within a few days. Armed with the results, you can then discuss other tests you may need as well as a course of infertility treatment that makes sense for you.

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