A Hysterosalpingography, commonly known as an HSG test, is a significant diagnostic tool for fertility evaluations. This procedure is primarily used to assess the openness of fallopian tubes and the shape of the uterine cavity. Beyond diagnosis, an HSG can sometimes clear minor fallopian tube blockages, which can hinder fertility. This article explores fallopian tube blockages, details the HSG procedure, and discusses its potential to resolve obstructions.
Understanding Fallopian Tube Blockage
Fallopian tubes connect the ovaries to the uterus and are important for conception. Each month, during ovulation, an egg travels from the ovary through the fallopian tube, where fertilization by sperm occurs before the fertilized egg moves to the uterus for implantation. Blockage prevents sperm from reaching the egg or a fertilized egg from reaching the uterus.
Blockages can be partial or complete and may occur at different points along the tube. Factors include pelvic inflammatory disease (PID), often from untreated sexually transmitted infections, which causes scar tissue. Endometriosis, where uterine lining-like tissue grows outside the uterus, can also cause blockages or adhesions. Previous abdominal or pelvic surgeries, like those for fibroids or ectopic pregnancies, can also result in scar tissue that obstructs the tubes.
Hysterosalpingography (HSG) Explained
Hysterosalpingography is an X-ray procedure that uses a contrast dye to visualize the uterus and fallopian tubes. It is performed in an outpatient setting, within the first 10 days of a woman’s menstrual cycle, after menstruation but before ovulation, to ensure no pregnancy and clear images. The procedure takes about 15 to 30 minutes.
During the HSG, a speculum is inserted into the vagina to visualize the cervix, which is then cleansed. A thin catheter is placed through the cervix into the uterus. A contrast dye, usually iodine-based, is injected through the catheter into the uterine cavity.
As the dye fills the uterus and flows into the fallopian tubes, X-ray images are taken to observe its movement. If the tubes are open, the dye will spill out into the abdominal cavity, where it is naturally reabsorbed by the body. The primary purpose of this diagnostic imaging is to assess the patency of the fallopian tubes and identify any abnormalities in the uterine cavity.
The Therapeutic Role of HSG in Unblocking Tubes
While primarily a diagnostic tool, HSG can sometimes clear minor fallopian tube blockages. This therapeutic action stems from the “flushing” effect of the contrast dye injected under pressure into the tubes. The force of the fluid can dislodge small obstructions, such as mucus plugs, cellular debris, or mild adhesions, reopening the pathway. This is particularly effective for blockages at the distal end of the tubes or those caused by temporary spasms.
HSG is less likely to resolve extensive scarring, dense adhesions, or blockages at the proximal end of the fallopian tube, which is closer to the uterus. Conditions like hydrosalpinx, where the tube is filled with fluid, generally do not respond to the flushing action of an HSG. Studies indicate increased natural pregnancy rates after an HSG, especially with oil-based contrast media. Some research shows conception rates as high as 38-39% within six months for women with unexplained infertility. This suggests that for certain types of minor obstructions, the HSG procedure can improve fertility outcomes.
What to Expect After an HSG and Next Steps
After an HSG procedure, mild to moderate cramping, similar to menstrual discomfort, may last for a few hours or a day. Light vaginal spotting or discharge, including dye leakage, is also normal and can persist for a day or two. Over-the-counter pain relievers are recommended to manage discomfort. Contact a healthcare provider if severe abdominal pain, heavy bleeding, fever, or foul-smelling vaginal discharge occurs, as these could indicate an infection or other complication.
The results of the HSG test help determine the next steps in a fertility journey. If fallopian tubes are open, natural conception may be encouraged, or other fertility treatments pursued based on additional factors. If one or both tubes remain blocked, further evaluation or treatment options are considered. These may include additional diagnostic procedures like laparoscopy for a direct view, or surgical interventions to repair or unblock the tubes. For significant or irreparable tubal damage, in vitro fertilization (IVF) is recommended, as it bypasses the need for functional fallopian tubes.