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Hydropsalphingogram (HSG)

HSG Stands for Hystero Salpingo Gram. It is a procedure that looks at the inside of the uterus and fallopian tubes and the area around them. It is often done to assess the patency of the fallopian tubes of a woman.

During a HSG, a dye (contrast material) is put through a thin tube that is put through the vagina and into the uterus. Because the uterus and the fallopian tubes are hooked together, the dye will flow into the fallopian tubes. Pictures are taken using a steady beam of X-ray (fluoroscopy) as the dye passes through the uterus and fallopian tubes. The pictures can show problems such as an injury or abnormal structure of the uterus or fallopian tubes, or a blockage that would prevent an egg moving through a fallopian tube to the uterus. A blockage also could prevent sperm from moving into a fallopian tube and joining (fertilizing) an egg.

A HSG may also may find problems on the inside of the uterus that prevent a fertilized egg from attaching (implanting) to the uterine wall..

  • It is a very basic diagnostic day procedure. Patient will get discharged from the hospital on the same day.
  • The procedure is not expensive
  • There are very minimal or no side effects
  • HSG can be done under local anesthesia or under general anesthesia (GA). This depends on the patient’s decision which can be based on the cost and pain bearing capacity. HSG under GA can be painful in many cases.

Doctors may suggest HSG as a diagnostic option as part of the standard infertility workup of a couple. If a laparoscopy or HSG has been done in the recent past (within 6 months) and if all reports are available, then the doctor may not recommend HSG.

The following processes have to be followed before a HSG Procedure

  • Pre Anesthesia Checkup – If HSG is being done under GA, then the patient needs to be evaluated for suitability to administer anesthesia. For this, a PAC has to be done. This includes Chest X Ray, ECG, basic sugar tests and a few other blood investigations. Only if the anesthetist clears a patient in the PAC, the patient can proceed to HSG. This process is usually done a few days prior to the HSG procedure.

In some cases, a physician may provide the clearance for anesthesia.

  • Generally there are no other special preparations needed for this test. However, depending upon your diagnosis, you may need to take antibiotics to guard against possible infection. To ensure that you are not pregnant, the study is done between Day 7 and 10 of your cycle. Prior to the procedure you may take an anti-inflammatory medication.

HSG is performed by a trained and gynecologist and is accompanied by a X-Ray technician and an anesthetist if it is being done under GA. The process is follows

  • If the anesthetist has declared the patient as fit for GA, then the patient preparation process starts a one hour before the procedure. Patient is given the required medicine, change of dress etc.
  • Patient is then moved to the HSG room.
  • If the HSG is being done under GA, the anesthetist will administer anesthesia to the patient.
  • Doctor injects a radiographic contrast medium (dye) into the uterine cavity through the vagina and cervix. If the fallopian tubes are open, the contrast medium will fill the tubes and spill out into the abdominal cavity. It can be determined whether the fallopian tubes are open or blocked and whether the blockage is located at the junction of the tube and the uterus or whether it is at the end of the fallopian tube
  • Then X-Ray photographs are taken of the lower abdomen area. All blocks and structural anomalies of uterus will be revealed in the x-ray film.
  • Patient is then shifted to the recovery rooms.
  • In most cases, patient recovers from the effects of anesthesia in about 15 minutes. Patient is discharged from the hospital in about 2 hours time – after food and liquid intake without vomiting.
  • Based on the findings in the HSG procedure, doctor will suggest the next steps.
  • Follow all the instructions given by the doctor.
  • Ensure all medication and injections are taken as per doctor’s advice. This includes the date and time of medications.
  • The patient needs to be nil-oral for HSG. So no food or liquid intake on the day of procedure unless advised by the doctor
  • Inform the doctor about any allergies, infections, asthma etc.
  • A personal attender may be needed on the day of HSG since the patient will be under the effect of anesthesia for some time.
  • It is preferable to leave all expensive jewelry at home before coming for HSG. This is because all of it may have to be removed prior to the procedure.
  • Follow all the instructions given by the doctor.
  • Ensure all medication and injections are taken as per doctor’s advice. This includes the date and time of medications.
  • Listen and understand the discharge instructions given by the hospital. This information is important to handle any post procedure complications
  • Inform the hospital about any pain, nausea, fever or vomiting bouts.
  • In case of bleeding or spotting, please inform the hospital immediately.

Typically, a HSG procedure should not take more than 30 minutes. There is some amount of patient preparation that needs to be done and that takes about 1 hour. If the HSG is done with local anesthesia, then the patient can discharged in about 1 hour after HSG.

If the HSG is done under general anesthesia, patients need about 2 to 3 hours to recover from the effect of anesthesia. In some rare cases, it can be more than that too.

So, if it is HSG under local anesthesia, plan to be at the hospital for about 3 hours.

If it is HSG under GA, plan to be at the hospital for about 5 hours.

Tubal blocks can be on one side only or may be on both sides. Depending on the severity of the block or the anomaly, the doctor may suggest different course of action. Please consult your doctor for more details. The possible options are

  • If one tube is patent, the doctor may plan for a couple of IUI cycles if ovulation occurs in the ovary which is not blocked.
  • If both tubes are blocked, doctor may suggest IVF as an option.
  • If there are structural anomalies in the tubes, uterus etc, other corrective procedures may be suggested.