Hysterosalpingography

Hysterosalpingography (HSG) is a radiographic procedure used to evaluate the shape of the uterine cavity and the patency of the fallopian tubes. It combines the injection of a radiopaque contrast agent with fluoroscopic imaging to visualize the uterus, tubes, and surrounding peritoneal space. HSG is commonly performed in the infertility workup and can also detect uterine anomalies, intrauterine adhesions, or post-surgical changes.

Indications include assessment of tubal patency in infertility, evaluation of uterine abnormalities such as septa or fibroids that may affect fertility or pregnancy outcome, and preoperative planning for certain assisted reproductive techniques. Timing typically places the procedure in the early follicular phase of the menstrual cycle or after menses, when a pregnancy is unlikely.

During the procedure, the patient lies on the fluoroscopy table and a speculum is used to access the cervix. A catheter or cannula is inserted into the cervical canal, and contrast is slowly injected while X-ray images are obtained. The examination may cause mild cramping and light vaginal bleeding. Prophylactic antibiotics are sometimes given, and exposure to ionizing radiation is minimized.

Risks are generally low but can include pelvic infection, allergic reaction to contrast, abdominal cramping, vaginal discharge, or rarely uterine perforation. Contraindications include pregnancy, active pelvic infection, and a known severe allergy to iodinated contrast.

Interpretation focuses on whether the contrast spills from the uterine cavity through the fallopian tubes into the peritoneal cavity (patent tubes) and on any filling defects or contour abnormalities in the uterus or tubes, which may indicate polyps, fibroids, adhesions, or congenital anomalies. Alternatives include sonohysterography and laparoscopy with chromopertubation, depending on the clinical question.