HSG stands for hysterosalpingography . This is a procedure in the field of gynecology, which is used in infertility patients to study the patency of the fallopian tubes.
- Methods for determining pipe patency
- Types of procedure
- Progress of the operation
- Pain during HSG
- Contraindications
- Preparation
- results
- Consequences
The fallopian tubes are canals that are 10 centimeters long and only 0.1 to 1 cm in diameter. They begin in the uterus and “strive” to the ovaries. Along them, the egg, which has merged with the sperm, moves into the uterine cavity. If the tubes are obstructed, then conception cannot take place, making natural pregnancy impossible.
The pipes may be partially obstructed. Then an ectopic pregnancy occurs. This means that the fertilized egg cannot freely pass through the tube and is attached to it, beginning to develop there. This condition requires urgent surgery because it threatens the health and life of the patient.
Methods for determining pipe patency
Current methods for determining the patency of the fallopian tubes are:
- Diagnostic laparoscopy
- Fertiloscopy and transvaginal hydrolaparoscopy
- Ultrasound hydrosonography, echohysterosalpingoscopy
- GHA
Hysterosalpingoscopy is carried out by introducing contrast and performing X-ray, and then analyzing the information by a doctor. Most contrast agents contain iodine. They have a low toxic effect when interacting with the radiation of an X-ray machine.
Necessary examinations before the HSG procedure under sedation (during sleep)
- complete blood count + platelets + ESR - valid for 2 weeks;
- biochemical blood test (total protein, glucose, bilirubin, ALT, AST, alkaline phosphatase - valid for 1 month;
- coagulogram (APTT, PTI, fibrinogen, INR) - valid for 1 month;
- blood type, Rh factor (on a stamped form, a stamp in the passport is not accepted) - valid for an indefinite period;
- HIV - valid for 3 months;
- Wasserman reaction - valid for 3 months;
- HBs antigen - valid for 3 months;
- HCV antibodies - valid for 3 months;
- ECG - valid for 2 weeks;
- Flora smear is valid for 2 weeks.
How to check patency if for some reason an HSG is not possible? Read about such methods below, but they are outdated and uninformative
. Therefore, we do not recommend resorting to these types of diagnostics, but we consider it necessary to mention them.
Types of procedure
- USGSS (ultrasound HSG/sonographic)
This is an ultrasound diagnosis in which saline, furatsilin or glucose solution is injected into the uterus. This method is considered low-informative. In addition, only one specialist can perform an examination at a time. No pictures are taken, so other doctors cannot see the picture.
Advantages of USGS: speed, minimal pain, minimal invasiveness, no radiation exposure.
- X-ray GSGGGSG
Verografin, Urotrast or Urografin is injected into the patient's uterus through a catheter, and then a series of x-rays are taken. Advantages of the procedure: the ability to be studied by other specialists, the ability to compare images over time, unlike USGSS.
Disadvantages of the method: irradiation of the woman, the likelihood of exacerbation of inflammation in the appendages, pain during and after X-ray X-ray HSG. Although the radiation is not so strong, a woman is not advised to conceive a child during this menstrual cycle, because it may have developmental abnormalities.
Advantages of contacting MEDSI
We not only provide high diagnostic accuracy, but also adhere to a loyal pricing policy.
- Experienced doctors.
Our gynecologists regularly improve their qualifications and have the necessary skills and knowledge to diagnose and further eliminate identified pathologies - Modern expert class equipment.
It allows you to conduct research with minimal radiation exposure (if we are talking about x-ray diagnostics). In addition, the clinic uses special catheters, which make it possible to reduce discomfort. - Comfort of visiting the clinic.
We ensured there were no queues. It is also important that the clinic is located near a metro station. This is convenient for all MEDSI patients (Muscovites and those coming from other cities) - Quality and availability of all services provided.
We not only provide high diagnostic accuracy, but also adhere to a loyal pricing policy
To make an appointment for fallopian tube hysterosalpingography in Moscow and to find out the cost of diagnostics, call +7 (495) 023-60-84. The specialist will select the optimal time to visit the clinic. You can also make an appointment using the SmartMed app.
Specialized centers
Reproductive Health Center
- Experienced specialists in the field of reproductive health
- Wide range of medical services
- Laboratory of Assisted Reproductive Technologies (ART)
More details
Progress of the operation
First, the patient is examined by a gynecologist using mirrors, then local anesthesia is performed. Then they take a cannula (this is a small tube) and insert it into the patient’s cervix. The specialist takes a syringe and injects a contrast agent through the cannula, which blocks the X-ray radiation.
The contrast fills the uterus and enters the tubes. The doctor takes from 4 to 6 x-rays. Then the cannula is removed from the neck. Over time, the contrast agent is absorbed into the blood and removed naturally.
Informativeness of hysterosalpingography in comparison with other research methods
The sensitivity and specificity of research methods (hysterosalpingography (HSG of tubes, HSG of fallopian tubes) and hysterosalpingosonography) are approximately the same and amount to about 80% according to data from a number of foreign authors and our own research results. However, their information content, of course, is not 100% - which is recorded when using laparoscopy.
Thus, both methods are highly sensitive and, if the result is negative, can definitely exclude the disease. That is, in the case of patent fallopian tubes, the information content of the methods is quite high and practically gives a complete answer to the question posed when diagnosing infertility.
If the result is positive, the probability of tubal obstruction is above 70%. That is, if during research we receive results indicating that the tubes are not “ideal,” then most likely there is a “tubal-peritoneal factor of infertility.”
The presence of false-negative results is most likely associated with spasm of the isthmic section of the fallopian tubes, or with a violation of the technique of performing this study. The specificity of the methods increases significantly and reaches 90% in the case of bilateral distal occlusion of the fallopian tubes (that is, in the presence of hydrosalpinxes).
The HSG technique allows us to assume the presence of peritubar adhesions based on the use of a number of diagnostic criteria:
- “atypical tube location” is a symptom in which the fallopian tube is located not horizontally, but vertically;
- pronounced “tortuosity” of the fallopian tube – “convulation”;
- the presence of a “corolla” effect around the fallopian tube – “double contour”;
- the absence of spreading of the contrast agent as the fallopian tube exits and its accumulation in the fimbrial region - “loculation”.
Arrow – accumulation of contrast agent. Symptom of "loculation"
Pain during HSG
Many people are interested in the question of whether it is painful or not to perform HSG of the fallopian tubes. During the procedure, pain is possible, so the doctor administers lidocaine in advance. This is a drug that has a local anesthetic effect. That is, there will be no general anesthesia.
After HSG, there may be aching pain in the lower abdomen for 2-4 days. The pain may be mild, moderate or severe. It depends on the patient’s pain threshold, the condition of her appendages and her uterus. In some cases, even with good local anesthesia, patients feel pain when contrast is injected before taking pictures. After the procedure, their stomach also hurts.
In some cases, abdominal pain may be tolerable and does not cause much discomfort. Moreover, these sensations are stronger when the liquid is administered through a syringe and cannula, and half an hour after the procedure the pain disappears.
Where is it held?
The procedure is performed in the operating room and only in it
. Although this is an x-ray examination, it cannot be carried out in an x-ray room. This procedure must be carried out under sterile conditions, that is, the conditions must be the same as, for example, during operations on the heart or spine. Such conditions cannot be achieved in an X-ray room. Who sat in this place in front of you and with what illnesses? Therefore, only in the operating room.
If you decide to have an HSG done in our clinic, then the cost of hysterosalpingography (the price of the HSG procedure itself) is 10,000 rubles
.
The final cost of hysterosalpingography includes anesthesia and 3 hours of stay in our hospital, observation by doctors and nurses
and is
20,900 rubles
.
From October 1, 2021, the cost of GHA increases by 5,000 rubles.
Contraindications
Doctors (and patients themselves) definitely need to know when not to do hysterosalpingography, that is, GHA.
- pregnancy
Before the HSG, the patient is given a pregnancy test to be sure that a fetus is not developing in her body.
- allergy to contrast
The patient may have an allergic reaction to medications that contain iodine. Other active substances with unstable electrons are more toxic and can significantly harm humans.
- any inflammation of the cervix, vagina or appendages
Chronic infection may become active after the procedure, which is explained by the effect of the contrast agent. For this reason, an examination by a gynecologist and a vaginal smear are prescribed. Tests will show how healthy the flora is in the patient’s vagina and whether there is inflammation.
Doctor's opinion
The diagnostic value of hysterosalpingography for determining the causes of infertility is high.
You can immediately examine the uterine cavity and oviducts. Visually see structural anomalies (bicornuate, saddle-shaped), pathologies (polyps, myomatous nodes, synechiae), diseases (hydrosalpinx), adhesions, bends. Determine the level of obstruction and the possibility of prompt elimination. — Malakhova Victoria Yurievna Reproductologist, obstetrician-gynecologist
Contraindications to the procedure:
- acute infectious diseases;
- inflammatory processes of the organs of the reproductive system;
- varicose veins, accompanied by the formation of blood clots;
- menstruation;
- period of childbearing and breastfeeding;
- malignant tumors of the cervix;
- dysfunction of the thyroid gland;
- allergy to iodine;
- renal, hepatic and cardiovascular failure.
If there are contraindications, the doctor will suggest other, safer examination methods.
Preparation
You should know the rules for preparing for HSG, and on what day the procedure is carried out. The preparation is quite simple:
- do not have sex 2 days before HSG
- 7 days before the procedure, stop using intimate hygiene products and douching
- 7 days before HSG, do not use suppositories, vaginal suppositories or tablets, or tampons (switch to pads)
HSG of the fallopian tubes is done after the critical days (within 14 days from the end). The reason is that the uterine mucosa is thin during this period, does not block the entrance to the tubes, and the woman cannot yet be pregnant.
Why does tubal obstruction occur?
The main reasons leading to obstruction of the fallopian tubes are the following conditions:
- previous operations on the abdominal and pelvic organs, incl. appendectomy;
- previous inflammatory diseases of the pelvic organs – adnexitis, oophoritis;
- urogenital infections with sexual transmission;
- endometrioid disease is a condition in which cells of the uterine mucosa are found outside the uterine cavity, incl. in the fallopian tubes, on the pelvic peritoneum;
- abnormal development of the genital organs;
- functional disturbance of fallopian tube peristalsis and other pathological conditions.
results
X-rays, if there are no adhesions, show the uterus, which has fluid, tubes and contrast that leaks into the abdominal cavity. The image allows the specialist to assess how passable the patient’s fallopian tubes are.
Sometimes the contrast “slows down” in a certain section of the pipe, which indicates an obstruction. HSG also detects adhesions in the uterus, adhesions outside the tube, hydrosalpinx, fibroids and polyps, if present. If HSG is performed successfully, the results may still be inaccurate.
The effectiveness of the procedure is 65 percent, and the specificity is 80 percent. The last indicator means identifying a specific disease from among the possible ones. To check the uterine cavity, patients also undergo hysteroscopy.
Indications and contraindications for HSG research
Examination of the uterus and tubes is indicated in the following cases:
- suspicion of pathological changes in the uterus and tubes, which can cause infertility;
- diagnosis of the causes of miscarriage;
- in preparation for IVF;
- submucous fibroids;
- polypous growths;
- endometrial hyperplasia;
- endometriosis;
- adhesions in the uterine cavity and fallopian tubes;
- isthmic-cervical insufficiency.
Consequences
HSG is a safe procedure. Basically there are no complications or consequences. In rare cases, patients develop a severe allergy to the injected contrast. It is necessary to carefully check for allergies those who are prone to allergic manifestations and those who have bronchial asthma.
In rare cases, the procedure is unsuccessful. This happens if the doctor does not have enough experience. It can puncture the uterus, causing bleeding.
If there is a chronic infection, as noted above, a resumption of the process and symptoms may occur. Inflammation of the appendages and endometritis are likely, but such cases are rare.
Is hysterosalpingography painful?
In medicine, there is often a choice: HSG or laparoscopy, and doctors often choose hysterosalpingography because it is less traumatic for the patient’s body.
“Is hysterosalpingography painful?” is one of the most frequently asked questions. HSG is not performed under general anesthesia or local anesthesia. Hysterosalpingography under anesthesia is not an option for those patients whose pain threshold is quite high. But, if a woman has increased sensitivity, then this issue should be discussed with your doctor and a way out of the situation should be found.
The injection of lidocaine into the uterine cavity is usually used as local anesthesia before HSG. Most women who have undergone the procedure report that this intervention is accompanied by tolerable, mild pain in the lower abdomen, which intensifies after the start of contrast administration, but disappears within half an hour after completion of the examination.
After HSG
The first two to three days after the procedure, there may be mucous or scanty spotting from the vagina, and there may be mild pain or discomfort in the lower abdomen. They usually go away with regular painkillers. After the procedure, due to stress, your period may be delayed by 2-3 days.
Two to three days after the procedure, douching, the use of suppositories and sprays, intimate hygiene products, sexual intercourse, bathing and visiting the sauna are not recommended.
After hysterosalpingography, there is an increase in the likelihood of conception, since a contrast agent, especially with an oil base, activates the functioning of the uterine glands and increases the activity of the endometrium.
This method provides a lot of information, but is not the main one in diagnosis. GHA is used to clarify and supplement previously conducted studies; the accuracy of the study reaches 80-85%.
