A Hysterosalpingogram (HSG) is a specialized diagnostic procedure commonly used in the evaluation of female fertility. This test provides valuable insights into the health of a woman’s uterus and fallopian tubes, which are key factors in successful conception. It is often recommended when a couple has been trying to conceive unsuccessfully for an extended period and the doctor needs further information about the reproductive system.
This detailed guide will walk you through the HSG procedure, what to expect before, during, and after the test, the recovery process, potential costs (in Indian Rupees), and how to interpret the results in relation to fertility.
1. What is a Hysterosalpingogram (HSG)?
A Hysterosalpingogram (HSG) is a type of X-ray imaging procedure used to examine the uterus and fallopian tubes. The test involves injecting a special contrast dye (typically iodine-based) into the uterus through a catheter. This dye is visible on X-ray images, which allows doctors to identify any abnormalities, blockages, or other issues in the uterus and fallopian tubes that could be contributing to infertility.
Why is an HSG Performed?
The HSG procedure is performed to assess the following aspects of the female reproductive system:
- Fallopian tube patency: This test checks whether the fallopian tubes are clear or blocked. Blocked tubes can prevent sperm from meeting the egg or hinder the fertilized egg’s movement to the uterus for implantation.
- Uterine abnormalities: To check for structural problems in the uterus, such as fibroids, polyps, adhesions (scar tissue), or congenital anomalies (like a septate uterus), which could hinder implantation or cause recurrent miscarriages.
- Infertility diagnosis: A crucial component of infertility testing for women who have struggled to conceive for a year or longer.
- Recurrent miscarriage: To investigate the causes behind repeated pregnancy loss, as uterine or tubal abnormalities could be to blame.
2. How is the HSG Procedure Done?
The HSG procedure is typically conducted in a radiology department of a hospital or clinic by a radiologist or gynecologist. Here’s a detailed guide to help you understand what to expect before, during, and after your HSG test.
Preparation:
- Timing: It’s generally performed between the 7th and 10th day of your menstrual cycle, ensuring the uterine lining is thin and you are not pregnant. This is after menstruation has ended but before ovulation, ensuring the uterine lining is thin and you are not pregnant. This timing minimizes the risk of testing during an early pregnancy.
- Pre-procedure instructions: You may be asked to take a pain reliever such as ibuprofen one hour before the procedure to help minimize any discomfort. Prior to the examination, it’s possible you’ll need to fast for a short period.
Step-by-Step Procedure:
- Positioning: You will be asked to lie on an X-ray table in a position similar to that of a pelvic exam, with your legs in stirrups for easy access to the cervix.
- Speculum insertion: A speculum will be carefully inserted to hold the vaginal walls apart, allowing the doctor to clearly view the cervix.
- Cervical cleaning: The cervix will be thoroughly cleaned using an antiseptic solution to lower the risk of infection during the procedure.
- Catheter insertion: A small, flexible tube (catheter) will be introduced into the uterus through the cervix, performed in a sterile setting to prevent contamination.
- Dye injection: A special fluid, called a contrast dye, is introduced into the womb via a thin tube. If the pathways to the ovaries are clear, this fluid will spread into the abdomen.
- X-ray imaging: During the fluid’s movement, live pictures are taken using X-ray technology. These images allow the doctor to assess whether the tubes are open or blocked and to check the shape and structure of the uterus.
The procedure itself typically takes between 15 to 30 minutes. Most women experience mild cramping or discomfort, but the process is generally quick and manageable.
3. What to Expect After the HSG Procedure?
Recovery:
- Immediate effects: After the procedure, you may experience some cramping, spotting, or light vaginal discharge as the contrast dye is expelled from the body. Any discomfort or symptoms you feel post-procedure are typically short-term and not a cause for alarm.
- Pain: After the procedure, mild to moderate cramping similar to menstrual pain may occur, and some women may feel a sense of bloating.
- Rest: While most women can resume their normal activities the next day, it’s a good idea to take it easy and rest for the first few hours after the procedure.
Post-Procedure Care:
- Infection risk: Though uncommon, a slight possibility of getting an illness exists after this check. Signs of infection include fever, foul-smelling discharge, or severe pelvic pain.
- Follow-up care: In most cases, no special follow-up is necessary unless the HSG reveals abnormalities that require further investigation or treatment.
4. What Do the Results of an HSG Mean?
The outcomes of this test give important details about your womb and ovary pathways. Here’s a breakdown of possible results and what they could indicate:
Normal HSG Results:
- Open fallopian tubes: If the contrast dye flows freely through both fallopian tubes and into the abdominal cavity, it suggests that the tubes are open and functioning properly, allowing sperm to reach the egg and the fertilized egg to travel to the uterus.
- Normal uterine cavity: If the dye fills the uterine cavity evenly without obstruction or irregularities, it suggests that the uterus is structurally normal, without issues such as fibroids, polyps, or abnormal growths.
Abnormal HSG Results:
- Blocked fallopian tubes: If the dye doesn’t pass through one or both tubes, it may indicate a blockage that could affect fertility. Blockages may be caused by conditions like pelvic inflammatory disease (PID), endometriosis, or scarring from previous surgeries.
- Uterine abnormalities: The test may also reveal issues like fibroids, polyps, or congenital uterine abnormalities (e.g., septate uterus) that can prevent implantation or cause miscarriage.
- Adhesions or scarring: Adhesions, or scar tissue inside the uterus, can be visualized during the HSG. These are often caused by previous surgeries, infections, or other conditions that could interfere with pregnancy.
Interpretation of Results:
- Positive result: A positive result means that one or more issues have been found (e.g., blockages, fibroids, or adhesions) that could be contributing to infertility.
- Negative result: A negative outcome means that no obvious abnormalities have been identified in the uterus or fallopian tubes. However, it’s important to note that infertility can still be caused by other factors, such as ovulation disorders or male infertility, which an HSG does not assess.
5. Risks of HSG
While HSG is generally a safe procedure, there are some risks involved:
- Infection: A small chance of illness in the womb or ovary pathways is present, even though it’s not frequent.
- Allergic reaction: Some individuals might react negatively to the fluid used for the pictures.
- Radiation exposure: Since HSG involves X-ray imaging, there is minimal radiation exposure. However, the amount is considered low and generally safe.
- Pain or discomfort: Some women may experience more significant cramping or pain, either during or after the procedure, although this is not typical for everyone.
6. Cost of HSG in India
The cost of an HSG procedure in India can vary depending on the location, healthcare facility, and whether you have insurance coverage. On average, the cost for an HSG in India ranges from ₹4,000 to ₹12,000. Here’s a breakdown of possible costs:
- Public hospitals: In government hospitals, the procedure may be available at a subsidized cost, ranging from ₹4,000 to ₹7,000.
- Private hospitals and clinics: The cost in private healthcare facilities is typically higher, ranging from ₹8,000 to ₹12,000. The cost may vary based on factors like the reputation of the facility, the expertise of the doctor, and the city in which you are getting the procedure done.
For those with insurance, the cost may be partially or fully covered depending on the terms of your policy, so it’s a good idea to check with your insurer beforehand.
7. Conclusion
The womb and ovary passage check is a vital tool for fertility assessment, offering essential information about those organs. While usually quick and tolerable, it can reveal problems that interfere with conception.
Most women recover quickly, with minimal discomfort, and the cost of the procedure in India is quite reasonable compared to international standards. If the examination indicates any abnormalities, your doctor may recommend further evaluations or therapies to address the root issue.
