- Infertility to assess uterine morphology and tubal patency.
- active pelvic infection
- recent uterine or tubal surgery
- the procedure should be performed during the proliferative phase of the patient’s menstrual cycle (days 6-12), when the endometrium is thinnest
- this improves visualization of the uterine cavity, and also minimises the possibility that the patient may be pregnant 1
- if there is any uncertainty about the patient’s pregnancy status, a beta hCG is warranted prior to commencing.
- after an antiseptic cleaning of the external genital area, a vaginal speculum is inserted with the patient in the lithotomy position; the cervix is cleaned with an aseptic solution.
- catheterisation of the cervix is then performed; the type of device used depends on local practice preferences
- e.g. 6 Fr Foley catheter with balloon inflation, or
- any one of a range of available HSG catheters or metal cannulas 3.
- whatever the device, it should be primed with contrast prior to commencing to avoid the introduction of gas bubbles which may provide a false positive appearance of a filling defect.
- water soluble iodinated contrast is subsequently injected slowly under fluoroscopic guidance.
- some radiologists use iodinated oil (Lipiodol) as contrast when the indication is for lack of fertility. Some authors report increased fertility after its use: this remains controversial however 8.
- a typical fluoroscopic examination includes a preliminary frontal view of the pelvis, as well as subsequent spot images that demonstrate uterine endometrial contour, filled Fallopian tubes and bilateral intraperitoneal spill of contrast, to establish tubal patency.
Common but self-limiting
- abdominal cramping
- per vaginal spotting
- venous extravasation
Rare but serious
- pelvic infection
- contrast reaction
Conditions which may be detected with HSG include:
- uterine congenital anomalies
- submucosal uterine fibroids
- uterine malignancy
- intrauterine adhesions
- uterine (endometrial) polyps
- obliteration of fallopian tubes : usually secondary to previous pelvic inflammation. It must be differentiated from incomplete tubal opacification due to tubal spasm, or underfilling of the uterus with contrast 2
- tubal polyps 6
- tubal malignancy
- salpingitis isthmica nodosa (SIN) 4
- tubal spasm 6: can be physiological
- 1. Simpson WL, Beitia LG, Mester J. Hysterosalpingography: a reemerging study. Radiographics. 26 (2): 419-31. doi:10.1148/rg.262055109 - Pubmed citation
- 2. Chalazonitis A, Tzovara I, Laspas F et-al. Hysterosalpingography: technique and applications. Curr Probl Diagn Radiol. 38 (5): 199-205. doi:10.1067/j.cpradiol.2008.02.003 - Pubmed citation
- 3.Tur-kaspa I, Seidman DS, Soriano D et-al. Hysterosalpingography with a balloon catheter versus a metal cannula: a prospective, randomized, blinded comparative study. Hum. Reprod. 1998;13 (1): 75-7. doi:10.1093/humrep/13.1.75 - Pubmed citation
- 4. Creasy JL, Clark RL, Cuttino JT et-al. Salpingitis isthmica nodosa: radiologic and clinical correlates. Radiology. 1985;154 (3): 597-600. Radiology (abstract) - Pubmed citation
- 5. Renbaum L, Ufberg D, Sammel M et-al. Reliability of clinicians versus radiologists for detecting abnormalities on hysterosalpingogram films. Fertil. Steril. 2002;78 (3): 614-8. Fertil. Steril. (link) - Pubmed citation
- 6. Simpson WL, Beitia LG, Mester J. Hysterosalpingography: a reemerging study. Radiographics. 26 (2): 419-31. doi:10.1148/rg.262055109 - Pubmed citation
- 7. Ubeda B, Paraira M, Alert E et-al. Hysterosalpingography: spectrum of normal variants and nonpathologic findings. AJR Am J Roentgenol. 2001;177 (1): 131-5. AJR Am J Roentgenol (full text) - Pubmed citation
- 8. Johnson NP, Hadden WE, Chamley LW. Fertility enhancement by hysterosalpingography with oil-soluble contrast media: reality not myth. AJR Am J Roentgenol. 2005;185 (6): 1654. doi:10.2214/AJR.05.51581 - Pubmed citation