HSG

Hysterosalpingography, abbreviated HSG, is a radiographic procedure used to evaluate the uterus and fallopian tubes. It involves injecting a radiopaque contrast dye through the cervix and imaging with fluoroscopy or X-ray to outline the uterine cavity and visualize tubal patency. The study helps detect abnormalities of the uterine cavity, such as congenital malformations, fibroids, polyps, or intrauterine adhesions, and assess whether contrast passes through the fallopian tubes into the peritoneal cavity, indicating patency.

Indications for HSG include infertility evaluation, assessment of uterine anatomy after surgery or abortion, pre-procedural planning for assisted reproductive technologies, and evaluation after sterilization reversal attempts. The study is typically scheduled in the early to mid-follicular phase of the menstrual cycle if pregnancy is not desired, and a pregnancy test may be performed beforehand.

Procedure and preparation: The exam is conducted in a radiology setting. After sterile preparation and cleansing, a speculum is placed, and a catheter is inserted through the cervix. Contrast is slowly injected while real-time imaging records the filling of the uterine cavity and the tubes. Patients may experience cramping or light vaginal bleeding during or after the procedure. Preparation may include ensuring non-pregnancy, discussing analgesia options, and informing the operator about iodine contrast allergy or prior reactions.

Risks and limitations: Possible but uncommon complications include pelvic infection, allergic reaction to iodinated contrast, minor tubal or uterine injury, and exposure to ionizing radiation. A normal study shows a central, triangular uterine cavity and patent fallopian tubes with contrast spill into the peritoneal cavity; abnormalities may require further evaluation.

Alternatives include sonohysterography with saline and ultrasound, magnetic resonance imaging, or laparoscopy with chromotubation for direct assessment of tubal patency.