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Hysterosalpingography

Authors
Susanna I Lee, MD, PhD
Aoife Kilcoyne, MB BCh BAO
Section Editor
Robert L Barbieri, MD
Deputy Editor
Kristen Eckler, MD, FACOG

INTRODUCTION

Hysterosalpingography (HSG) is an outpatient fluoroscopy procedure that evaluates the uterine cavity and fallopian tube patency. HSG is commonly performed as part of an infertility evaluation or after placement of contraceptive micro-inserts.

This topic will review the indications for HSG, preparation, technique, and test results. Other methods for assessing the uterine cavity and tubal patency are reviewed separately.

(See "Saline infusion sonohysterography".)

(See "Overview of hysteroscopy".)

DEFINITION

HSG is the evaluation of the uterine cavity, fallopian tubes, and adjacent peritoneal cavity following the injection of contrast material through the cervical canal [1,2]. It is performed as a real-time outpatient examination under fluoroscopy with iodinated water-soluble radio-opaque material.

                               

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Literature review current through: Nov 2016. | This topic last updated: Tue Jun 14 00:00:00 GMT+00:00 2016.
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References
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  1. Chalazonitis A, Tzovara I, Laspas F, et al. Hysterosalpingography: technique and applications. Curr Probl Diagn Radiol 2009; 38:199.
  2. Simpson WL Jr, Beitia LG, Mester J. Hysterosalpingography: a reemerging study. Radiographics 2006; 26:419.
  3. al-Badawi IA, Fluker MR, Bebbington MW. Diagnostic laparoscopy in infertile women with normal hysterosalpingograms. J Reprod Med 1999; 44:953.
  4. Roma Dalfó A, Ubeda B, Ubeda A, et al. Diagnostic value of hysterosalpingography in the detection of intrauterine abnormalities: a comparison with hysteroscopy. AJR Am J Roentgenol 2004; 183:1405.
  5. American College of Radiology (ACR). ACR practice parameter for the performance of hysterosalpingography. Amended 2014 (Resolution 39). http://www.acr.org/~/media/b96d79998651431a8bd263017de707a5.pdf (Accessed on March 14, 2016).
  6. McPherson RA, Pincus MR. Henry's clinical diagnosis and management by laboratory methods, 22nd ed, Elsevier Saunders, Philadelphia 2011.
  7. GOLDBERGER MA, MARSHAK R, DAVIDS A. Hysterography and hysterosalpingography. An evaluation of 2,500 cases. N Y State J Med 1950; 50:2697.
  8. Stumpf PG, March CM. Febrile morbidity following hysterosalpingography: identification of risk factors and recommendations for prophylaxis. Fertil Steril 1980; 33:487.
  9. Pittaway DE, Winfield AC, Maxson W, et al. Prevention of acute pelvic inflammatory disease after hysterosalpingography: efficacy of doxycycline prophylaxis. Am J Obstet Gynecol 1983; 147:623.
  10. Møller BR, Allen J, Toft B, et al. Pelvic inflammatory disease after hysterosalpingography associated with Chlamydia trachomatis and Mycoplasma hominis. Br J Obstet Gynaecol 1984; 91:1181.
  11. Meadsday B. An analysis of the complications of hysterosalpingography. Journal of Obstetrics and Gynaecology of the British Empire 1960; 67:663.
  12. Society of Obstetricians and Gynaecologists of Canada (SOGC). SOGC Clinical Practice Guideline. Antibiotic prophylaxis in gynaecologic procedures, No. 275. April 2012. http://sogc.org/wp-content/uploads/2012/09/gui275CPG1204E.pdf (Accessed on March 14, 2016).
  13. ACOG Committee on Practice Bulletins--Gynecology. ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol 2009; 113:1180.
  14. Hindocha A, Beere L, O'Flynn H, et al. Pain relief in hysterosalpingography. Cochrane Database Syst Rev 2015; :CD006106.
  15. American College of Radiology (ACR) Committee on Drugs and Contrast Media. ACR manual on contrast media, version 10.1, 2015. http://www.acr.org/~/media/37D84428BF1D4E1B9A3A2918DA9E27A3.pdf (Accessed on February 28, 2016).
  16. DeCherney AH, Kort H, Barney JB, DeVore GR. Increased pregnancy rate with oil-soluble hysterosalpingography dye. Fertil Steril 1980; 33:407.
  17. Spring DB, Barkan HE, Pruyn SC. Potential therapeutic effects of contrast materials in hysterosalpingography: a prospective randomized clinical trial. Kaiser Permanente Infertility Work Group. Radiology 2000; 214:53.
  18. Perisinakis K, Damilakis J, Grammatikakis J, et al. Radiogenic risks from hysterosalpingography. Eur Radiol 2003; 13:1522.
  19. Radiologyinfo.org. Radiation dose in x-ray and CT exams, 2015. http://www.radiologyinfo.org/en/info.cfm?pg=safety-xray (Accessed on February 28, 2016).
  20. Hall EJ. Hereditary effects of radiation. In: Radiobiology for the radiologist, Hall EJ. (Ed), Lippincott, Philadelphia 1994.
  21. Yoder IC. Hysterosalpingography and Pelvic Ultrasound: Imaging in Infertility and Gynecology, Little Brown & Co, Boston 1988.
  22. Bayer. Guide on HSG evaluation of Essure.
  23. Bayer. Guide on HSG evaluation of Essure. http://www.hcp.essure-us.com/assets/pdf/250-018-0001-13d_ect_process_for_e-use.pdf (Accessed on March 16, 2016).
  24. Wittmer MH, Famuyide AO, Creedon DJ, Hartman RP. Hysterosalpingography for assessing efficacy of Essure microinsert permanent birth control device. AJR Am J Roentgenol 2006; 187:955.
  25. Veersema S, Vleugels MP, Moolenaar LM, et al. Unintended pregnancies after Essure sterilization in the Netherlands. Fertil Steril 2010; 93:35.
  26. Khati NJ, Parghi CR, Brindle KA. Multimodality imaging of the essure permanent birth control device: emphasis on commonly overlooked abnormalities. AJR Am J Roentgenol 2011; 196:W648.
  27. Conceptus. Essure physician training manual: HSG protocol. San Carlos, CA: Conceptus; 2002
  28. Siegler AM. Hysterosalpingography. Fertil Steril 1983; 40:139.
  29. Yoder IC, Hall DA. Hysterosalpingography in the 1990s. AJR Am J Roentgenol 1991; 157:675.
  30. Horwitz RC, Morton PC, Shaff MI, Hugo P. A radiological approach to infertility--hysterosalpingography. Br J Radiol 1979; 52:255.
  31. Winfield AC, Pittaway D, Maxson W, et al. Apparent cornual occlusion in hysterosalpingography: reversal by glucagon. AJR Am J Roentgenol 1982; 139:525.
  32. Rezvani M, Shaaban AM. Fallopian tube disease in the nonpregnant patient. Radiographics 2011; 31:527.
  33. Benjaminov O, Atri M. Sonography of the abnormal fallopian tube. AJR Am J Roentgenol 2004; 183:737.
  34. Essure [package insert]. Milpitas, CA. Bayer Healthcare; 2002. http://www.hcp.essure-us.com/assets/pdf/Link%20Essure%20IFU.pdf (Accessed on June 06, 2016).
  35. Hopkins MR, Laughlin-Tommaso SK, Wall DJ, et al. Hysterosalpingography After Radiofrequency Endometrial Ablation and Hysteroscopic Sterilization as a Concomitant Procedure. Obstet Gynecol 2015; 126:628.
  36. Karasick S, Goldfarb AF. Peritubal adhesions in infertile women: diagnosis with hysterosalpingography. AJR Am J Roentgenol 1989; 152:777.
  37. Karasick S, Karasick D, Schilling J. Salpingitis isthmica nodosa in female infertility. J Can Assoc Radiol 1985; 36:118.
  38. Kim SH, Kim SH, Yang DM, Kim KA. Unusual causes of tubo-ovarian abscess: CT and MR imaging findings. Radiographics 2004; 24:1575.
  39. Chavhan GB, Hira P, Rathod K, et al. Female genital tuberculosis: hysterosalpingographic appearances. Br J Radiol 2004; 77:164.
  40. Varma T. Tuberculosis of the female genital tract. The Global Library of Women's Medicine, 2008. http://www.glowm.com/section_view/heading/Tuberculosis%20of%20the%20Female%20Genital%20Tract/item/34#20361 (Accessed on March 22, 2016).
  41. Steinkeler JA, Woodfield CA, Lazarus E, Hillstrom MM. Female infertility: a systematic approach to radiologic imaging and diagnosis. Radiographics 2009; 29:1353.
  42. Capella-Allouc S, Morsad F, Rongières-Bertrand C, et al. Hysteroscopic treatment of severe Asherman's syndrome and subsequent fertility. Hum Reprod 1999; 14:1230.
  43. Sadow CA, Sahni VA. Imaging female infertility. Abdom Imaging 2014; 39:92.
  44. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions. Fertil Steril 1988; 49:944.
  45. Kaufman RH, Adam E, Binder GL, Gerthoffer E. Upper genital tract changes and pregnancy outcome in offspring exposed in utero to diethylstilbestrol. Am J Obstet Gynecol 1980; 137:299.
  46. Goldberg JM, Falcone T. Effect of diethylstilbestrol on reproductive function. Fertil Steril 1999; 72:1.
  47. Troiano RN, McCarthy SM. Mullerian duct anomalies: imaging and clinical issues. Radiology 2004; 233:19.
  48. DeCherney AH, Cholst I, Naftolin F. Structure and function of the fallopian tubes following exposure to diethylstilbestrol (DES) during gestation. Fertil Steril 1981; 36:741.
  49. Maheux-Lacroix S, Boutin A, Moore L, et al. Hysterosalpingosonography for diagnosing tubal occlusion in subfertile women: a systematic review with meta-analysis. Hum Reprod 2014; 29:953.
  50. Preutthipan S, Linasmita V. A prospective comparative study between hysterosalpingography and hysteroscopy in the detection of intrauterine pathology in patients with infertility. J Obstet Gynaecol Res 2003; 29:33.
  51. Uzun O, Findik S, Danaci M, et al. Pulmonary and cerebral oil embolism after hysterosalpingography with oil soluble contrast medium. Respirology 2004; 9:134.
  52. Liao YH, Lin CL, Tsai PP, et al. Subsequent Cancer Risk of Women Receiving Hysterosalpingography: A Nationwide Population-Based Retrospective Cohort Study. Women Health 2015; 55:613.
Topic Outline

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