Let me start by saying, I am NOT a physician, just a Sonographer who has been dealing with Infertility for years now. This information is in no way supposed to take place of what your physician will tell you or what they may advise for you. This is just what I have learned and I wanted to share. Going through infertility testing can be very difficult. It can be quite time consuming, expensive and nerve wracking. I’m a firm believer in educating yourself on your own health.
Find out what factors you may be able to change that are impacting your fertility. The big thing is, the more you are educated, the more you are prepared and being prepared can lower the stress levels. With today’s post, I hope you can learn a little more about these two infertility testing options and can be a little more prepared for your infertility journey. If you’re looking for support, you’re in the right place. I’d be more than excited if you shot me an email or messaged me on any of our social media platforms and connected. I’m very excited to be a part of your support team in any way that I can. Best of luck to you! But for now, get educated 🙂
Hysterosalpingogram: Infertility Testing
What is an HSG?
Let’s break it down into basic terms Hysterosalpingogram (Hystero : Uterus, Salpingo : fallopian tubes Gram: xray). An HSG, officially called a Hysterosalpingogram is an outpatient procedure performed to evaluate the opacity of the Fallopian tubes and evaluate the endometrial canal of a female patient. This procedure is performed if a woman is trying to conceive without any luck. This is done to look at the lining of the uterus, the dilation of the cervical canal and the opacity of the Fallopian tubes. In short, to check for “blocked tubes”.
When in the cycle do they do it?
This procedure is typically performed on day 5-12 of a patients menstrual cycle. Most doctors ask that you provide a negative pregnancy test result, as performing this while pregnant would not be advised. It needs to be done before ovulation and any chance of pregnancy, so done early on in the cycle. Some women find that after having an HSG, this can increase their chances of falling pregnant that cycle. Sometimes small blockages can be knocked loose with the dye and can fix the slight infertility problem they were having.
What to expect prep wise?
Typically, you call your doctor on day one of your cycle, they schedule your appointment for you. The outpatient facility will prep you. You are told to abstain from intercourse until after your procedure. Once you get there, as close to your appointment time as you can, empty your bladder to make the procedure as easy as possible. Some doctors even recommend taking an NSAID prior to appointment time so you have some in your system. Often times, the HSG can make you feel crampy afterwards, so having this medication in your system will help lessen the pain you go through.
Does it hurt, what happens?
This can be different for every woman. Personally, I had a slight cramping on my left side. I had a very small blockage that the dye being injected broke free. Otherwise, I had a normal study. This was not a painful procedure for me at all. You’ll feel the speculum in the cervix and then the catheter. Some women have a hard time tolerating this, others, like myself, had no problem. It is expected to be crampy afterwards. Honestly, we went on a little weekend getaway with my best friend to celebrate my birthday when I had my first HSG and I don’t think it made any impression on me. No extra cramps, no pains, etc.
Expect to lay on an Xray table (not usually that comfortable), with your legs spread, similar to a GYN exam. The doctor will clean you with betadine first. This stuff can leak out later and stain. It is a dark red color and can appear looking like blood, so make sure to wear a pad after the procedure. The doctor will then insert a speculum, again similar to a GYN exam, into the vagina and then clean and prep the cervix for the insertion of the catheter. An Xray machine, called a fluorscope will be placed over your pelvis and the doctor can use xray to watch the dye being injected. The doctor may ask you to move around in a different position in order to get a better image, this may cause cramping, but, do the best that you can. Once the imaging is finished, the doctor will remove the catheter and speculum.
Is there anything I can do to decrease the pain ?
Ask your doctor if they have any over the counter medication that they recommend you take before the procedure. Some doctors have even been known to prescribe an antibiotic- but this is not necessary for all patients.
If you have cramps, try relaxing, resting, hydrating, using a heating pad, etc. Anything that you normally do to help with those cramps you get that time of the month. My doctor also told me that spotting may happen afterwards, but is completely normal!
What does it show?
It can show normal flow from the cervical canal, up through the endometrium and spilling out into both fallopian tubes. It is an X-ray that will show your uterus and fallopian tubes
What is normal?
An endometrial canal that fills normally with no endometrial mass and no endometrial scarring. Both fallopian tubes will opacify- meaning light up or show up and the radiologist can see, what they call, free spill of the dye through the tubes bilaterally.
What is abnormal?
Any kind of blockage or stenosis that can’t be broken free in the fallopian tubes. Any blockage, full or partial of the tubes, any scarring or masses of the endometrial canal.
If something is abnormal, what can be done?
Sometimes you can have a tube be cleaned out or removed if it becomes too painful.
Knowing the result of the test can help determine your treatment plan of action.
Another possible testing necessity :
A hysterosonogram (aka HSN, hysterosono, saline sono, saline infused ultrasound) is different than an HSG (no xray- just ultrasound, so no raidation). This is a minimally invasive pelvic ultrasound guided look at the lining of your uterus, called the endometrium. This is done with the intention of looking for polyps or masses in the endometrial canal.
Similar to set up for an HSG, you’ll find yourself on an ultrasound table after emptying your bladder. A doctor will insert a speculum into the vagina and insert a small catheter through the cervix. Following this insertion, the internal, Transvaginal probe will be inserted into the vagina. The doctor can then use the catheter to inject saline into the endometrial canal to check and see if there are any polyps, masses, fibroids, etc. that could be causing any infertility issues, abnormal bleeding or pelvic pain. Once the images are taken, the ultrasound probe and the catheter will be removed. You may feel some cramps or twinges as this exam is being performed and afterwards.
I know this is a TON of information. If you have any questions, don’t hesitate to ask me or truly, ask your physician. No question is “stupid”! The more you know, the better. Good luck with everything and I hope this helps get you mentally prepared. Again, feel free to shoot me an email at email@example.com if you need to!
Infertility is a diagnosis- not a definition!