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Hysterosalpingography

INTRODUCTION

Hysterosalpingography (HSG) refers to the radiographic evaluation of the uterine cavity and fallopian tubes after injection of a radio-opaque medium through the cervical canal. Fluoroscopy with image intensification is performed to improve the quality of the radiographic images, as well as help guide the procedure.

Information obtained by HSG includes:

  • The width of the cervical canal
  • The contour of the uterine cavity
  • An outline of the lumen of the fallopian tubes and cornua
  • The presence or absence of spillage of contrast from the fimbriated ends of the tubes
  • An outline of peritoneal structures

In addition to diagnostic information, HSG also has therapeutic effects, which are associated with increased fecundability in the months after the procedure (see "Treatment of unexplained infertility" section on Tubal flushing.)  [1]. Purported mechanisms include:

  • Mechanically dislodging substances (mucus, cellular debris) obstructing the fallopian tubes
  • Enhancing endometrial receptivity
  • Oil media may affect peritoneal macrophages by decreasing in vitro phagocytosis of sperm and altering interleukin and prostaglandin production
  • Breaking down peritoneal adhesions that restrict tubal movement
  • Stimulating tubal cilia, and thus enhancing transport of gametes
  • Improving cervical mucus to enhance passage of sperm
  • Iodine in the contrast medium has a bacteriostatic effect on mucous membranes
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References Top
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  2. Malstrom, T. A vacuum uterine cannula. Obstet Gynecol 1961; 18:773.
  3. Johnson, NP, Farquhar, CM, Hadden, WE, et al. The FLUSH trial--flushing with lipiodol for unexplained (and endometriosis-related) subfertility by hysterosalpingography: a randomized trial. Hum Reprod 2004; 19:2043.
  4. Lindequist, S, Justesen, P, Larsen, C, Rasmussen, F. Diagnostic quality and complications of hysterosalpingography: oil- versus water-soluble contrast media--a randomized prospective study. Radiology 1991; 179:69.
  5. Ahmad, G, Duffy, J, Watson, AJ. Pain relief in hysterosalpingography. Cochrane Database Syst Rev 2007; :CD006106.
  6. Anserinia, P. Strategies to minimize discomfort during diagnostic hysterosalpingography with disposable balloon catheters: a randomized placebo-controlled study with oral nonsteroidal premedication. Fertil Steril 2008; 90:846.
  7. Cengiz, M, Kafali, H, Artuc, H, Baysal, Z. Opioid analgesia for hysterosalpingography: controlled double-blind prospective trial with remifentanil and placebo. Gynecol Obstet Invest 2006; 62:168.
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  9. ACOG Practice Bulletin No. 74: Antibiotic Prophylaxis for Gynecologic Procedures. Obstet Gynecol 2006; 108:225.
  10. Pittaway, DE, et al. Prevention of acute pelvic inflammatory disease after hysterosalpingography: efficacy of doxycycline prophylaxis. Am J Obstet Gynecol 1983; 147:623.
  11. Belt, MM, Rodenko, G, Taylor, K, et al. Use of gadolinium for hysterosalpingography in iodine allergic women: a case-control study. Fertil Steril 2008; 90:835.
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  13. Siegler, A. Hysterosalpingography. In: Reproductive medicine and surgery. Wallach, E, Zacur, H (Eds), Mosby, Baltimore 1986.
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  15. Siegler, AM. Hysterosalpingography. Fertil Steril 1983; 40:139.
  16. Opsahl, MS, Miller, B, Klein, TA. The predictive value of hysterosalpingography for tubal and peritoneal infertility factors. Fertil Steril 1993; 60:444.
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  18. Karande, VC, Pratt, DE, Balin, MS, et al. What is the radiation exposure to patients during a gynecoradiologic procedure?. Fertil Steril 1997; 67:401.
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