A Hysterosalpingogram or hsg is a diagnostic x-ray of the uterus and fallopian tubes. This test allows the gynecologist to observe the inside of the uterus and fallopian tubes for any problems such as blockage of fallopian tubes, endometrial polyps, fibroids, genital tuberculosis or abnormalities in the uterine cavity. Hysterosalpingogram is also done to find problems in the uterus, such as abnormal shape and structure, an injury, adhesions or a foreign body in the uterus. HSG is often used in cases where a sterilization reversal is sought.
A woman must inform the radiologist if she is allergic to iodine dye, suffer pelvic or sexually transmitted disease. Women with bleeding problems such as hemophilia or those on blood thinning medicines such as aspirin must keep the doctor appraised. The gynecologist or radiologist uses a cannula to fill the uterus with iodine. The dye will flow into the fallopian tubes as the uterus is hooked with these tubes, and the pictures are taken using high steady beam fluoroscopy, as the dye passes through. In case of injury or an abnormal structure, the picture can throw up the problems. The pictures are shown on a TV monitor during the test. If another view is needs, the examination table is tilted or the patient may be asked to change positions. A blockage can prevent sperm from moving into the fallopian tube and joining an egg for fertilization to occur.
A HSG can catch if there is any problem inside her uterus that possibly prevents a fertilized egg from implanting to the uterine wall. This helps in outlining the fallopian tubes so that any abnormalities in the tubes or uterine cavity is observed. In cases of infertility due to tubal blockage, HSG is used to evaluate the location and extent of blockage. The Hysterosalpingogram procedure takes a few minutes and can be moderately uncomfortable for the woman, with possibility of cramps. Women who have tubal disease may develop pelvic infection. In rare cases, the woman develops iodine allergy. Some women notice spotting for a couple of days after the HSG.
Risks of Hysterosalpingogram
In less than 1 in 100, there may be a chance of a pelvic infection after the test. The chances are higher in those who have had pelvic infections before. Antibiotics A negligible chance of damaging or puncturing the uterus or fallopian tubes during the test does exist during the test. There could be some allergic reaction to the iodine x ray dye. If oil based dye is used, the oil can leak into the blood. This can cause blockage of blood flow to a section of the lung. But most HSG tests are water based. A woman may feel some cramping similar to menstrual cramps during the procedure and the amount of pain may depend upon the problems that the doctor finds and treats during the test. There could be some vaginal bleeding for several days after the test.
The test result is considered normal if the injected dye spills freely out from the ends of the fallopian tube and the x ray shows normal uterine shape. However, if further tests do not reveal the cause of infertility or recurrent pregnancy loss, the doctor could order for a hysteroscopy. There are chances that while a HSG could show a normal uterine shape, a hysteroscopy show abnormalities.
Oviduct blockage is the blockage in one or both microscopic fallopian tubes that allow a woman's egg to pass from her ovaries to her uterus. The blockage is an impediment for the egg to migrate, implant and begin pregnancy. The result is infertility. In rare cases, even if pregnancy occurs it can be dangerous, if not treated immediately.
Diagnosing oviduct blockage
Laparoscopic chromotubation: Usually done after sedating with a mild anesthetic, laparoscopy involves making a very small incision in the belly button and near the pubic bone area; a small camera helps view the tubes. Laparoscopy helps detect endometriosis, adhesions, and ovarian cysts and also check the tubes.
Chromotubation involves infusing diluted methylene blue dye solution into the uterine and tubal lumen. If the tubes are not blocked, the dye should come out of the ends of the tubes into the peritoneal (abdomen) cavity. This test is considered the most reliable way to determine oviduct blockages.
Both laparoscopic chromotubation and Hysterosalpingogram can sometimes open a blocked tube; hence these procedures can be both diagnostic and therapeutic. The rate of fertility is likely to improve after the procedure.
Falloscopy: The newest form of endoscopic examination, falloscopy is helpful to look inside the fallopian tubes. Using a catheter-based system, a flexible tube is inserted through the vagina and cervix which threads through one of the fallopian tube. Very similar to hysterosalpingogram, it allows viewing of tubal walls and checks if it is healthy and also detects obstruction, if any.
Sonohysterography: This is a non-invasive procedure wherein fluid is injected through the cervix into the uterus, and ultrasound imaging is used to determine if any abnormality is present. The procedure is extremely helpful in detecting underlying cause of many problems such as abnormal uterine bleeding, infertility and repeated miscarriage. Like the other diagnostic procedures, sonohysterography is done when the woman is not having her menstrual cycle.
Oviduct blockage treatment
The goal of treating oviduct blockages is to unblock fallopian tubes and increase the chances for a successful pregnancy. Surgical procedures are the primary treatment option to open blocked oviducts. If needed, doctors will use more than one procedure to treat oviduct blockage. Take a look at the various surgical and non-surgical options available today to treat this particular condition.
Laparoscopy: To treat oviduct blockages, laparoscopy is widely preferred. It involves inserting the scope into the abdomen and cutting away scar tissue which blocks the tubes and is a result of infection and/or endometriosis, primary causes for oviduct blockages. It helps in unblocking the oviducts and allows the eggs and sperm to meet and facilitates the egg to become fertilized.
Recanalization: A tiny wire is inserted into the tube to remove the blockage.
Salpingectomy: It involves removing a blocked fallopian tube or sealing it in order to maximize the functioning of the second, unblocked tube.
Tubal Reanastomosis: This is also a laparoscopic procedure in which small incisions are made through the abdomen. The blocked portion of the oviducts or fallopian tube is cut away and the healthy sections of the tube are connected. It is followed by a procedure called Salpingostomy to create a new opening in the tube close to the ovary.
Fimbrioplasty: This plastic surgery that facilitates to reshape ends of fallopian tubes closed off by scar tissue or some other blockage.
Tubal Cannulation: Is a non-surgical option which involves clearing blockages with the use of a catheter, or Cannula that is inserted through the uterus into the fallopian tube.
Asherman's syndrome refers to the formation of adhesions or scar tissues on the endometrium (uterine lining). Most often endometrial scarring occurs as a result of scraping of tissue from the uterine wall while performing dilation and curettage (D& C). Though D&C is mainly responsible for adhesions, uterine surgery and severe infections of the endometrium such as genital tuberculosis are some of the other factors that cause Asherman's syndrome. Normally, Asherman's syndrome shows up with decreased menstrual flow or even amenorrhea, cramping, abdominal pain and is even associated with infertility and recurrent miscarriages.
Causes of Asherman's syndrome
D&C procedure is performed for miscarriages, excess bleeding, elective abortion or to remove the retained products of conception. Some gynecological disorders call for uterine surgery. Sometimes trauma occurs to the uterine lining while performing D&C procedure or other surgery. In case of damage, the wound begins to heal and in the process, fuses with the affected portion causing adhesions. The risk of Asherman's syndrome increases with repeated D&Cs.
Diagnosis and treatment of Asherman's syndrome
Hysteroscopy is the widely used method to diagnose the Asherman's syndrome as it allows the doctor to have a complete view of the uterus directly. However other methods such as sonohysterography (SHG), hysterosalpingogram (HSG) and transvaginal ultrasound examination are also used to evaluate adhesions. Blood tests are done to detect tuberculosis or schistosomiasis.
Asherman's syndrome is normally treated with surgery to remove the adhesions or scar tissue. The surgery involves hysteroscopy procedure wherein scar tissue is removed by using small instruments, micro scissors and a camera. Once the scar tissue is removed, an intra uterine balloon is placed inside the uterus to keep the uterine cavity open. This procedure aids the healing process and prevents adhesions from returning. Patient may also be prescribed oral estrogen medications for promoting growth of regular uterine lining. Patient may be called in for review hysteroscopy after two weeks of the procedure to make sure that there is no reformation of adhesions.
Bibliography / Reference
Collection of Pages - Last revised Date: March 21, 2019