Hysterosalpingography – what is it? how is the exam?

Hysterosalpingography – What is it? How is the Exam? Stay tuned for everything about this test. Also, among fertility tests performed on women who want to become pregnant, a test known as a hysterosalpingography is usually performed. This test is so little known that it raises many questions and concerns in patients starting fertility treatment.

What is?

Hysterosalpingography is a medical test to detect infertility in women. This fertility test is based on introducing a radiopaque contrast agent (iohexol) into the uterine cavity and fallopian tubes to observe the edges and shape of these structures and detect possible irregularities or obstructions. The specialist observes a fertility problem, the displacement of the dye throughout the uterine cavity and checks for possible anomalies or defects in these organs.

What does hysterosalpingography detect?

As we have already said, hysterosalpingography allows you to observe the structure of the uterus and tubes, as well as the functionality of the latter. Therefore, changes in the tubes and uterus can be detected with this test:

  • Tubal changes, such as hydrosalpinx or salpingitis, which can make the tubes clogged or inflamed.
  • Uterine structural changes such as T-shaped uterus, didelphys, bicornuate, unicornuate or closed uterus.
  • Abnormal uterine formations such as fibroids , endometriosis , or adhesions.
  • To detect certain pathologies, hysterosalpingography may not be sufficient, so other diagnostic techniques, such as hysteroscopy, must be used.

What are the conditions for practicing hysterosalpingography:

The main condition is that you must not be pregnant (which is obvious but is included in the consent you must sign before practicing). As for the preparation, you should take antibiotics to prevent infections and pain relievers before the test. In addition, the procedure states that you should take one valium the night before and another on the same day as the test.

In theory (I’ll explain why I say “theory”), testing should be done on the seventh and tenth day after starting the rule, because that also lowers the chances of getting an infection and because that’s reliable proof that you’re not. pregnant.

Cause pain?

The most normal thing is that they cause discomfort (much like menstrual cramps) but it’s bearable pain. That yes, this can remain for a few hours after having practiced the analysis and despite having taken the previously recommended medicines.

What aftereffects can it cause?

In addition to pain, it is normal to have some vaginal bleeding (I suppose it’s more due to the speculum process than the analysis), malaise, dizziness, nausea and infections (hence the importance of taking the previous medications). Serious complications such as perforations can also occur, although this is very unlikely.

When is it done?

Hysterosalpingography is a fertility test that is mainly done when it is needed to study the inside of the female genital tract, either for any of the following problems:

Fertility and Sterility:

It is an essential test in any sterility and/or fertility study to see if the uterus and fallopian tubes are open and ready to receive the fertilized egg.

Uterine Malformation:

This test can diagnose uterine abnormalities such as uterine septa, bicornuate uterus, or Rokitansky malformation.

Review after tubal ligation operation:

Once this surgical intervention is done, the specialist may order this test to make sure that the tubes have been correctly blocked.

Uterine polyps and other tumors:

Hysterosalpingography can identify benign and malignant tumors of the uterine endometrium.

Asherman’s Syndrome:

This test can reveal the disappearance of the uterine cavity, uniting its walls after surgery or curettage.

How is it done?

Before performing the  hysterosalpingography , the doctor will ask if you agree to undergo the test and ask you to sign the informed consent document that details what the test consists of. They will likely give you a time to undergo hysterosalpingography on another day.

It is not necessary to change your routine the day you have the test, although you should take the antibiotics and pain relievers that your gynecologist may have previously prescribed. Avoid, of course, getting nervous about the test, as it will only last a few minutes, and try to arrive a little earlier than the agreed time, so you don’t get nervous or in a hurry.

Next, we explain step by step how hysterosalpingography is performed:

  • They will ask you to be in a gynecological position, that is, naked from the waist down and with your legs up so that the practitioner can properly explore the vulva area.
  • The doctor will insert a speculum into the vagina to visualize the cervix , that is, the entrance to the uterine cavity.
  • With or without anesthesia, insert a small plastic tube into the cervix . Once in place, they will begin introducing a radiopaque contrast medium that can be seen on an x-ray.
  • They will place you next to an X-ray machine and start introducing a substance into the uterine cavity. This substance is a radiopaque contrast medium, that is, it can be visualized on an x-ray. They may ask you to change your position so the specialist can get a better look at the image.
  • When the process is finished, the doctor will take the ideal image and remove the tube placed through the cervix and you can get dressed again.

During hysterosalpingography , you should not feel pain, although some women do experience some pain when they enter the contrast medium into the uterine cavity, which is usually caused by an abnormality in the uterus. Also, sometimes the entrance to the cervix is ​​numbed with a small pinch of local anesthetic which can be a little irritating. However, you often choose not to anesthetize, as the test should not be painful.

Hysterosalpingography results:

The results of hysterosalpingography can be known once the test is complete. However, to avoid some data being misinterpreted, the gynecologist will need a few days to study and evaluate them carefully.

He will report the result of the hysterosalpingography and will inform the diagnosis as well as the treatment if the test has changed and is definitive.

In the image hysterosalpingography you can observe an oval figure contrast, the uterine cavity, with two thin lines leaving its main ducts of the fallopian tube. Under normal conditions, the contrast medium will pass through these ducts and you will see how it pours into the abdominal cavity.

Care after hysterosalpingography:

It is possible for the woman to feel mild discomfort during the day the hysterosalpingography was performed. If you experience more acute abdominal pain , cramping or other subsequent discomfort. The doctor may prescribe a drug like Buscopan to relieve these pains.

It is also possible to have light vaginal bleeding or brown discharge during the days after Hysterosalpingography .

In any case, it is not necessary to have any special consideration or rest after performing the hysterosalpingography , unless the doctor tells you to.

Pregnancy after hysterosalpingography:

When a woman has a mild tubal obstruction, hysterosalpingography can help uncover the fallopian tubes thanks to the passage of liquid contrast. Therefore, there are women who get pregnant easily after Hysterosalpingography , in the same month or in a short period of time.

If the result of Hysterosalpingography  is normal or if it is not a problem in just one of the tubes, that would be a natural pregnancy or by artificial insemination, and fertilization may occur in the affected fallopian tube.

However, if both tubes are blocked or have changes in morphology, uterine fertilization could not take place, so IVF would be needed to achieve pregnancy.

Useful links: 

It would be necessary to evaluate the results of the other tests of the fertility study both male and female to make a decision with all the information.

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