HYSTEROSALPINGOGRAM
A hysterosalpingogram or HSG is an x-ray procedure which helps to see the fallopian tubes are patent (open) and if the inside of the uterine cavity is normal. HSG is performed as outpatient procedure that usually takes less than 5 minutes . This is done when the menstrual period ends but before ovulation.
FUNCTIONS OF FALLOPIAN TUBES :
• Collect the oocyte which released from the ovary from the open end of the tube (fimbrial end has the finger like projections).
• Facilitate passage of sperms from the uterine cavity towards the oocyte.
• Provide an environment favorable for fertilization. All this includes adequate nutrients, appropriate temperature, pH and many other factors.
• Propel the fertilized embryo into the uterine cavity.
HYSTEROSALPINGOGRAM PROCEDURE :
• Patient is positioned under a fluoroscope ( x-ray imager which can take pictures during the study) on a table.
• The examination of the patient’s uterus is done and speculum is placed in vagina.
• Cervix is cleaned, and a cannula is placed into the opening of the cervix.
• The uterus is filled with a liquid containing iodine (a fluid that can be seen by x-ray) through the cannula. • The contrast will be seen as white on the image and can show the contour of the uterus as the liquid travels from the cannula, into the uterus, and through the fallopian tubes.
• As the contrast enters the tubes, it outlines the length of the tubes and spills out their ends if they are open.
• Abnormalities inside the uterine cavity may also be detected by observing the x-ray images when the fluid movement is disrupted by the abnormality.
• The HSG procedure cannot evaluate the ovaries function or to diagnose endometriosis, also cannot identify fibroids that are outside of the endometrial cavity, either in the muscular part of the uterus, or on the outside of the uterus.
• Often, the side views of the uterus and tubes are obtained by having the woman change her position on the table. After the HSG, a woman can immediately return to normal activities.
An HSG usually causes mild or moderate uterine cramping for about 5-10 minutes. However, some may experience cramps for several hours. These symptoms can be greatly reduced by taking medications used for menstrual cramps before the procedure or when they occur.
HYSTEROSALPINGOGRAM ENHANCING FERTILITY :
• Some studies show a slight increase in fertility lasting about 3 months after a normal HSG. However,HSG mostly performed only for diagnostic reasons.
RISK AND COMPLICATION OF HSG:
Risk is less than 1% of the time.
• Infection – The most common serious problem with HSG is pelvic infection. This usually occurs when a woman has had previous tubal disease (such as a past infection of chlamydia). In rare cases, infection can damage the fallopian tubes or make it necessary to remove them.
• Fainting – Rarely, the woman may get light-headed during or shortly after the procedure.
• Radiation Exposure – Radiation exposure from an HSG is very low, less than with a kidney or bowel study. This exposure will not cause harm, even if a woman conceives later the same month. The HSG should not be done if pregnancy is suspected.
• Iodine Allergy – Rarely, a woman may have an allergy to the iodine contrast used in HSG. Women who are allergic to iodine should have the HSG procedure performed without an iodinecontaining contrast solution. If a woman experiences a rash, itching, or swelling after the procedure, patient should contact doctor.
• Spotting – Spotting sometimes occurs for 1-2 days after HSG. Patient should notify if she experiences heavy bleeding after HSG. TUBAL BLOCK HSG – Hysterosalpingography :
• One tube is blocked – Unilateral Cornual Block (Spillage of dye on one side only)
• When both tubes are Patent or Normal (free spillage of dye on both the sides)
• When both tubes are Blocked – Bilateral Block (No spillage of dye on both sides)
HYSTERO-CONTRAST SONOGRAPHY (HYCOSY):
Ultrasound contrast agents are used for tubal assessment using contrast mode. This shows the passage of hyperechoic contrast agent through tubal lumen and delineates it and locates the site of block or constriction. Results of HyCoSy have been found to correlate well with laparoscopic findings, better than SIS but more expensive than HSG.
CAUSES OF BLOCKED FALLOPIAN TUBES :
• Most common cause of blocked fallopian tubes is an infection which is Pelvic Inflammatory Disease (PID). Various organisms cause infections of the genital tract, Chlamydia and Tuberculosis being the commonest.
• Other causes of blocked fallopian tube include Surgery on or around tubes, Endometriosis, Fibroids, Past history of ectopic pregnancy, past history of tubal sterilization operation . Other ways to evaluate tubal patency:
• Laparoscopy can also determine if tubes are open, using a procedure called chromopertubation.
• An alternative procedure to evaluate tubal patency is a sonohysterosalpingogram (SHG). For SHG, a catheter (narrow tube) is placed in the uterus through the vagina and saline and air are injected. In patient who have open fallopian tubes, tiny air bubbles may be seen going through the fallopian tubes during the ultrasound. However, this procedure is inferior to HSG for assessment of tubal patency.
• Other cases where Laparoscopy can successfully treat blocked tubes, Myomectomy when fibroids block fallopian tubes, adhesiolysis of endometriotic adhesions .
• Hysteroscopic cannulation is also done for blocked fallopian tubes when the block is proximal and at the cornual (near the uterus) region of fallopian tube. In some cases, blocked fallopian tubes cannot be opened with Laparoscopy or Hysteroscopy. In these cases, IVF is the only available option.
CONCEIVE WITH BLOCKED FALLOPIAN TUBES :
If one tube is blocked and the other tube is open and functioning normally, natural conception is possible. If at all one does conceive naturally in spite of blocked or bad tubes, there could be a very high suspicion for Ectopic Pregnancy.
IUI BE TRIED IN CASE OF BLOCKED FALLOPIAN TUBE :
One of the main functions of the Fallopian tube is to facilitate the passage of sperms towards the ovum, hence in case of blocked tube, IUI cannot be done .
TREATMENT OPTIONS FOR BLOCKED FALLOPIAN TUBES :
In case of irreversibly blocked tubes, IVF or IVF ICSI is advised by bypassing the fallopian tubes.
• Even if the tubes are blocked, IVF ET is successful as fertilization is done outside the body (In the IVF Lab) and the embryo or blastocyst is transferred directly into the uterus.
• The functions of fallopian tube are done in the IVF Laboratory in petri dishes, test tubes and incubators and therefore IVF is also called test tube baby.A diagnosis of blocked fallopian tube usually means that both the partners have high chances of having normal eggs and sperms, and attempting IVF has high chances of success in such cases.
