HSG is an X-ray based technique used as an alternative to the gold standard of laparoscopy and hysteroscopy for assessing tubal patency and the uterine cavity. It is performed as an outpatient, without anaesthetic, in the X-ray department of the Lister Hospital by Consultant Radiologists.
The test should be booked within the first half of the menstrual cycle before ovulation by ringing the X-ray department directly. At the initial consultation the doctor you see will complete an X-ray request form, give you an information sheet and a prescription for prophylactic antibiotics.
In the X-ray department the patient is asked to lie underneath an X-ray machine. A speculum is inserted into the vagina, the cervix is cleaned and a small tube (catheter) is gently inserted through the opening of the cervix into the uterus. Fluid containing iodine (contrast) is gently introduced through the catheter into the uterus while X-ray images are seen on a monitor. If the fallopian tubes are open the contrast will fill the tubes then spill from the ends of the tubes. An HSG may detect abnormalities of the uterine cavity and blocked tubes. It can not detect the presence of endometriosis and may not be able to detect the presence of scar tissue (adhesions) around the tubes or ovaries. Unlike a laparoscopy it also does not offer the potential to treat abnormalities that might be affecting the chances of conception. However, it does not require a general anaesthetic.
An HSG usually causes mild or moderate uterine cramping for about five minutes; however, some women may experience cramps for several hours. The symptoms can be greatly reduced by taking medications used for menstrual cramps at the same time as the antibiotics 1-2 hours prior to the procedure.
Antibiotics are given to minimize the risk of a patient developing a pelvic infection after HSG, which is an uncommon complication (the risk is less than 1%).
The chance of pregnancy after either HSG or laparoscopy to check tubal patency may be slightly higher in the 2 or 3 cycles after the test.
