Hysterosalpingography (HSG) is a medical imaging procedure used to evaluate the female reproductive system. It involves an X-ray dye test that provides insight into the internal structure of the uterus and the patency, or openness, of the fallopian tubes. This diagnostic tool assesses reproductive health.
The Purpose of Hysterosalpingography
Hysterosalpingography is primarily performed as part of a fertility investigation. Its main purpose is to help identify potential issues within the female reproductive anatomy that might hinder conception. The procedure specifically assesses whether the fallopian tubes are open, which is essential for sperm to reach an egg and for a fertilized egg to travel to the uterus.
The test also provides information about the shape and structure of the uterine cavity. This evaluation helps determine if anatomical factors contribute to conception difficulties. An HSG can also be used to check the success of a tubal ligation or its reversal.
Conditions Identified by Hysterosalpingography
HSG helps diagnose specific conditions affecting the fallopian tubes and uterus that can impact fertility. One of its primary uses is to detect fallopian tube blockages. These blockages can occur at different points: proximally (near the uterus), in the mid-segment, or distally (near the ovary). If the contrast dye injected during the procedure does not flow freely through the tubes and spill into the abdominal cavity, it indicates an obstruction.
Tubal issues can include hydrosalpinx, a condition where a fallopian tube is blocked and becomes distended with fluid, often appearing sausage-like on imaging. Tubal scarring, frequently a result of previous infections or endometriosis, can also be identified as it prevents the dye from passing. These tubal abnormalities can impede conception by preventing egg and sperm meeting or fertilized egg transport.
Beyond tubal concerns, HSG can reveal various uterine abnormalities. These include congenital anomalies, which are structural variations present from birth, such as a septate uterus (a uterus divided by a wall), a bicornuate uterus (heart-shaped), or an arcuate uterus (a slight indentation at the top). HSG can also detect acquired conditions like uterine fibroids (non-cancerous growths), polyps (small tissue growths), or intrauterine adhesions (scar tissue, also known as Asherman’s syndrome). These uterine issues can interfere with embryo implantation or lead to recurrent pregnancy loss. The imaging provides details on their size, location, and extent.
Understanding the Results
After an HSG, the radiologist interprets the images and shares the findings with the healthcare provider. If the X-ray images show the contrast dye flowing freely through both fallopian tubes and spilling into the abdominal cavity, and the uterine cavity appears normal in shape, the results are considered typical. Normal results suggest that tubal factors are likely not preventing conception, though other causes of infertility may still be present.
If the HSG reveals abnormal findings, such as blocked fallopian tubes or uterine irregularities, these results guide the next steps in a patient’s care. For tubal blockages, options might include surgical intervention to clear the obstruction or consideration of assisted reproductive technologies like in vitro fertilization (IVF), which bypasses the need for open fallopian tubes. Uterine abnormalities might lead to recommendations for hysteroscopy to further evaluate and potentially treat conditions like polyps, fibroids, or adhesions. HSG results guide personalized treatment plans for fertility challenges.