What is hysterosalpingography?
Hysterosalpingography (HSG or uterosalpingography) is a radiological technique performed to verify the health of the fallopian tubes (salpingi) and study the morphology of the uterine cavity. Hysterosalpingography is therefore a purely female diagnostic test, which consists in the injection of a contrast liquid through the cervix, and in the subsequent evaluation of the radiological scans obtained.
Purpose of the test
Hysterosalpingography is often referred to as an "infertility test". A possible obstruction of the fallopian tubes in fact hinders the fertilization of the egg, becoming a possible cause of infertility.
The information on the morphology of the female genital apparatus, obtained by hysterosalpingography, allows to draw a differential diagnosis of the possible causes of female infertility. For example, it is not uncommon for the presence of uterine polyps, ovarian cysts or malignant tumor growths - arising near the tubes - to prevent fertilization. In similar situations, hysterosalpingography can immediately identify the cause of infertility.
Similarly, the test also detects possible congenital anomalies of the salpingi, which are also possible imputed in the inability to conceive.
Hysterosalpingography allows us to visualize the morphology of the uterine cavity and salpingi, although it does not provide any information on the actual function of the fallopian tubes.
Indications
The hysterosalpingography test is recommended in all situations where the woman is unable to conceive or complete a pregnancy.
The indications for hysterosalpingography are:
- Spontaneous abortions
- Congenital anomalies of the uterus (eg uterus septum, hypoplastic uterus)
- Acquired abnormalities of the uterus (eg endometrial polyps, submucosal myomas, synechiae or intracavitary adhesions, uterine fibroids)
- Fistulas of the genital tract
- Suspected alterations of salpingis
- Tuberculosis
Contraindications
The woman may not always be subjected to hysterosalpingography. The test is not recommended in the following situations:
- Metrorrhagia (unexpected and painful bleeding in the inter-menstrual period)
- Acute / subacute inflammation of the tubes (salpingitis)
- Endometrial Infections (Endometritis)
- Contrast allergies
- Pregnancy in progress
Performing hysterosalpingography during a state of pregnancy would result in immediate abortion
When to take the test
In order to obtain a precise and clear radiographic evaluation, the hysterosalpingography test must be performed between the eighth and twelfth day of the menstrual cycle. More generally, the woman can undergo the test in the period between the end of the menstrual flow and the beginning of the ovulatory period. During this phase - in which fertilization is almost denied - the endometrium appears thin and the interpretation of radiological screening is facilitated.
Procedure
The hysterosalpingographic examination consists in the introduction of a non-ionic iodinated contrast medium in the uterine cavity, and in its subsequent analysis by radiographic scans.
A few hours before undergoing hysterosalpingography, it is advisable to take pain-antispasmodic drugs (eg Buscopan), to minimize the perception of discomfort or pain during execution.
Before injecting the contrast medium, disinfection of the external genitals and of the uterine port is required. The patient must be positioned on a radiological table, in a gynecological position. Subsequently, the radiologist - using the aid of a catheter or exocervical cups - injects about 10 ml of contrast liquid in order to visualize, through X-ray, the uterine morphology.
The contrast liquid must be injected slowly, in order to avoid an annoying and dangerous distension of the uterine cavity.
The injection of the contrast liquid must be continued until the tubes become opaque and the same contrast medium diffuses into the peritoneal cavity through the fimbriae (thin branches of the terminal portion of the tubes).
After removal of the catheter, the peritoneal area must be disinfected, and the contrast medium completely aspirated.
Risks and complications
Fortunately, the complications derived from hysterosalpingography are scarce, almost nil. Many patients, after undergoing the test, experience only mild side effects, such as:
- Small vaginal discharge
- Abdominal cramps (comparable to menstrual pain)
- Feeling dizzy
- Weakness
- Spotting mild and transient
Although unlikely, the most serious risks include uterine lesions, pelvic infections and allergic reactions to contrast fluid or materials used during the test.
Currently there are no valid alternatives to hysterosalpingography in terms of diagnostic cost / effectiveness ratio.
