Tubal Factor

	HSG procedure
	HSG specific instructions
	Treatment Options

Hysterosalpingogram

An HSG is an x-ray procedure performed to determine whether the fallopian tubes are open and to see if the shape of the uterine cavity is normal. An HSG is an outpatient procedure that takes less than 15 minutes to perform. It is usually done after menstruation has ended, but before ovulation, to prevent interference with an early pregnancy.

The HSG is done with the patient lying on a table under a fluoroscope (a real time x-ray imager). The gynecologist then does a pelvic examination, places a speculum in the vagina, cleans the cervix, and places a catheter into the opening of the cervix. The physician then gently fills the uterus with liquid containing iodine (contrast) through the cannula. The contrast then enters the tubes, outlines the length of the tubes, and spills out their ends if they are open. Any abnormalities in the uterine cavity or fallopian tubes will be visible on a monitor. The HSG is not designed to evaluate the ovaries or diagnose endometriosis. Frequently, side views of the uterus and tubes are obtained by having the patient changer her position on the table. After the HSG a patient can immediately resume normal activities, although some physicians ask that the patient refrain from intercourse for a few days.

Frequently Asked Questions

HSG Specific Instructions

Your doctor has ordered an x-ray of your fallopian tubes called a hysterosalpingogram or HSG. Dye will be injected into the uterus and fallopian tubes via a narrow tube inserted through the cervix. This test will help to detect any abnormalities inside the uterus or fallopian tubes.

The procedure is done in the X-Ray Department located on the 4th floor of Foothills Hospital. It will be done by your physician or by another gynecologist if your physician is not available.

It will be timed in the early days of your cycle usually between days 6-10, after you have stopped bleeding but before ovulation.

An HSG is similar to having a Pap test but is more uncomfortable. It lasts approximately 15 minutes but you will probably have cramps during the procedure and may have cramps for a few hours following. You should be prepared to take the rest of the day off work if you do have cramps.

We will prescribe something for pain for you and also an antibiotic as a preventative measure against pelvic infection. The risk of infection is very small. However, we ask that you contact the clinic should you experience any fever or persistent pain following the procedure. There is no other preparation for the test. You may eat and drink as usual. Please take a sanitary pad with you when you go for the x-ray in case you have spotting after.

Treatment options - Laparoscopic Surgery/Pelvic Surgery

If the fallopian tubes are blocked your physician may perform a laparoscopy to assess the degree of tubal damage. At time of laparoscopy the entire pelvis will be assessed for the presence of endometriosis and adhesions (scarring). If the tubes are confirmed to be blocked, scarred, or damaged, surgery may correct the problem. However, women with severely damaged tubes are unlikely to have a successful pregnancy even with surgery. In these cases in vitro fertilization (IVF) offers them a far better chance for successful pregnancy. Because very badly damaged tubes may fill with fluid (hydrosalpinges) and lower IVF success rates, your physician may recommend removal of the tubes if you have decided to proceed with IVF.

Treatment options - Tubal Reanastomosis

A small fraction of women who have their tubes tied for sterilization regret their decision and wish to have children in the future. Tubal reversal surgery requires open surgery on the abdomen. The surgeon removes the blocked portion of the fallopian tubes and then sutures the tubes back together with extremely fine sutures under the microscope. The blocked portion of each tube is removed and the two healthy ends of the tube rejoined or reanastomosed under the microscope. This is considered a major surgical procedure and has more post-operative discomfort than laparoscopy and recovery takes longer.

The method of tubal ligation has significant influence on the success rate. The closer the ligation is to the uterus, the more likely the success. The length of the remaining undamaged tubal stumps after tubal ligation also has significant relationship with the chance of success. The longer they are better the chances for successful reversal and pregnancy. One advantage of tubal reversal is that if it works well, the woman will be able to conceive naturally afterwards.

The risk of ectopic pregnancy is increased following tubal reversal. Women who become pregnant should have an early ultrasound to rule out ectopic pregnancy.