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Definition:
The hysterosalpingogram is an x-ray test that takes a picture after dye has filled the inside of the uterus and fallopian tubes. It is a useful test in helping determine the cause of infertility.It often is done for women who are having a hard time becoming pregnant (infertile). It is sometimes also used to evaluate patients who have had several miscarriages or patients with an IUD (intrauterine device) that cannot be seen on regular examinations. This test can show areas of scarring inside a fallopian tube or changes in the uterine cavity, as might occur with a polyp or other growth in the uterus.

The pictures can show problems such as an injury or abnormal structure of the uterus or fallopian tubes, or a blockage that would prevent an egg moving through a fallopian tube to the uterus. A blockage also could prevent sperm from moving into a fallopian tube and joining (fertilizing) an egg. A hysterosalpingogram also may find problems on the inside of the uterus that prevent a fertilized egg from attaching (implanting) to the uterine wall. You may click and See a picture of a hysterosalpingogram below.

Why It Is required to be  Done
A hysterosalpingogram is done to:

*Find a blocked fallopian tube. The test often is done for a woman who is having a hard time becoming pregnant. An infection may cause severe scarring of the fallopian tubes and block the tubes, preventing pregnancy. Occasionally the dye used during a hysterosalpingogram will push through and open a blocked tube.

*Find problems in the uterus, such as an abnormal shape or structure, an injury, polyps, fibroids, adhesions, or a foreign object in the uterus. These types of problems may cause painful menstrual periods or repeated miscarriages.

*See whether surgery to reverse a tubal ligation has been successful.

How To Prepare
Before a hysterosalpingogram, tell your doctor if you:

*Are or might be pregnant.

*Currently have a pelvic infection (pelvic inflammatory disease) or sexually transmitted disease (such as gonorrhea or chlamydia).

*Are allergic to the iodine dye used or any other substance that has iodine or if you have had a recent infection in the pelvis.. Also tell your doctor if you have asthma, are allergic to any medicines, or have had a serious allergic reaction (anaphylaxis) from any substance (such as the venom from a bee sting or from eating shellfish).

*Have any bleeding problems or are taking any blood-thinning medicines, such as aspirin or warfarin (Coumadin).

*Have a history of kidney problems or diabetes, especially if you take metformin (Glucophage) to control your diabetes. The dye used during a hysterosalpingogram can cause kidney damage in people with poor kidney function. If you have a history of kidney problems, blood tests (creatinine, blood urea nitrogen) may be done before the hysterosalpingogram to check that your kidneys are working well.

*Definitely tell your doctor if there is a chance you might be pregnant.

*If you have regular periods, it is best to have this test done in the week right after your period ends. This is before ovulation occurs in your cycle, so there would be the least risk of exposing an early pregnancy to the dye used in this test. Some doctors will require you to have tests for pelvic infections before having a hysterosalpingogram.

This test should be done 2 to 5 days after your menstrual period has ended to be sure you are not pregnant. It should also be done before you ovulate the next month (unless you are using contraception) to avoid using X-rays during an early pregnancy. You may want to bring along a sanitary napkin to wear after the test because some leakage of the X-ray dye may occur along with slight bleeding.

You may need to sign a consent form that says you understand the risks of a hysterosalpingogram and agree to have the test done. Talk to your health professional about any concerns you have about the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form .

Some doctors recommend that you take antibiotics before the test. If this is your doctor’s practice, he or she will give you a prescription for this medicine.

How It Is Done
A hysterosalpingogram usually is done by a radiologist in the X-ray room of a hospital or clinic. A radiology technologist and a nurse may help the doctor. A gynecologist or a doctor who specializes in infertility (reproductive endocrinologist) also may help with the test.

Before the test begins, you may get a sedative or ibuprofen (such as Advil) to help you relax and to relax your uterus so it will not cramp during the test. You will need to take off your clothes below the waist and drape a gown around your waist. You will empty your bladder and then lie on your back on an examination table with your feet raised and supported by stirrups. This allows your doctor to look at your genital area.

An X-ray may be taken to make sure that there is nothing in the large intestine (colon) that could block the view of the uterus and fallopian tubes. Sometimes a laxative or enema is given a few hours before the test to empty the large intestine.

Your doctor will put a smooth, curved speculum into your vagina. The speculum gently spreads apart the vaginal walls, allowing him or her to see the inside of the vagina and the cervix. The cervix may be held in place with a clamp called a tenaculum. The cervix is washed with a special soap and a stiff tube (cannula) or a flexible tube (catheter) is put through the cervix into the uterus. The X-ray dye is put through the tube. If the fallopian tubes are open, the dye will flow through them and spill into the belly where it will be absorbed naturally by the body. If a fallopian tube is blocked, the dye will not pass through. The X-ray pictures are shown on a TV monitor during the test. If another view is needed, the examination table may be tilted or you may be asked to change position.

After the test, the cannula or catheter and speculum are removed. This test usually takes 15 to 30 minutes.

How It Feels
You probably will feel some cramping like menstrual cramps during the test. The amount of pain you have depends on what problems the doctor finds and treats during the test.

Risks Factors
There is always a small chance of damage to cells or tissue from being exposed to any radiation, including the low levels of radiation used for this test. The chance of damage from the X-rays is generally very low compared with the potential benefits of the test.

There is a small chance (less than 1 in 100) of a pelvic infection, endometritis, or salpingitis after the test. The chance may be higher for women who have had pelvic infections before. Your doctor may give you antibiotics if he or she thinks you might develop a pelvic infection.

There is a small chance of damaging or puncturing the uterus or fallopian tubes during the test.

There is a small chance of an allergic reaction to the iodine X-ray dye, especially if you are allergic to any shellfish.

In rare cases, if an 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 (pulmonary embolism). Most hysterosalpingogram tests use water-based dyes.

It is common for patients to have a small amount of bleeding from the vagina and some pelvic cramping for a few days after the procedure. If you have heavy bleeding, fever, or increasing pain in the pelvis, you should call your doctor. Some women experience an allergic reaction to the contrast dye. The most significant risk from this procedure is infection, which happens in close to 3 out of 100 patients. Most doctors use a water-soluble dye when they do this procedure; there are some risks associated with oil-based dyes that are still used in some centers, including rare scarring problems in the uterus or (rarely) breathing complications if the oil moves into a blood vessel.

As with x-rays, there is a small exposure to radiation. In large amounts, exposure to radiation can cause cancers or (in pregnant women) birth defects. The amount of radiation from a hysterosalpingogram is too small to be likely to cause any harm. However, since the x-ray exposure is directed right at the pelvis and ovaries, it is very important to be sure you are not pregnant at the time of the test.

After the test is over
After the test, some of the dye will leak out of the vagina. You also may have some vaginal bleeding for several days after the test. Call your doctor immediately if you have:

*Heavy vaginal bleeding (soak more than one tampon or pad in one hour).

*A fever.

*Severe belly pain.

*Vaginal bleeding that lasts for more than 3 to 4 days.

Results:-
A hysterosalpingogram (HSG) is an X-ray test that looks at the inside of the uterus and fallopian tubes and the area around them.

Hysterosalpingogram  Normal:
The shape of the uterus and fallopian tubes are normal. The fallopian tubes are not scarred or damaged. The dye flows freely from the uterus, through the fallopian tubes, and spills normally into the belly.

No objects (such as an intrauterine device, or IUD), tumors, or growths are seen in the uterus.

Hysterosalpingogram   Abnormal:
Fallopian tubes may be scarred, malformed, or blocked so that the dye does not flow through the tubes and spill into the belly. Possible causes of blocked fallopian tubes include pelvic inflammatory disease (PID) or endometriosis.

The dye may leak through the wall of the uterus, showing a tear or hole in the uterus.

An abnormal uterus may show tissue (called a septum) that divides the uterus.

Growths, such as polyps or fibroids, may be present.

Resources:

https://www.health.harvard.edu/fhg/diagnostics/hysterosalpingogram.shtml

http://www.webmd.com/infertility-and-reproduction/guide/hysterosalpingogram-21590?page=2

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