A hysterosalpingogram, or HSG is an important test of evalution of women with fertility problems.. The HSG test is a radiological procedure usually done in the Radiology Department of a hospital. During HSG, radiographic contrast (dye) is injected into the uterine cavity through the vagina and cervix. The uterine cavity fills with contrast  and if the fallopian tubes are patent , contrast fills the tubes and spills into the abdominal cavity

 Figure 1: Hysterosalpingogram

HSG will be able to tell whether the fallopian tubes are patent or blocked and whether a blockage is at the junction of the tube and uterus (proximal) or at the other end of the tube (distal).

     Figure 2: Normal HSG

   Figure 3: Distal blockage of fallopian tubus, lending to distension of tubes.

Besides assessing the patency of the fallopian tube, HSG could also assess the uterine cavity for the presence of congenital uterine anomalies, polyps, fibroids or uterine scar tissue

Figure 4: Congenital uterine anomaly

The hysterosalpingogram procedure only takes about 5 minutes to perform. However, the test is usually done in the Radiological Department of a hospital . Following are step by step procedure of HSG:

• The woman lies on the table on her back and brings her leg up into a “frog leg” position.
• The doctor places a speculum in the vagina and visualize the cervix.
• A tube or cannula to be inserted into the uterine cavity is either a plastic or a metal tube. To stabilize and counter tract the uterus, an instrument known as tenaculum is used to grasp the cervix. Contrast is slowly injected through the cannula or catheter into the uterine cavity. An x-ray picture is taken as the uterine cavity is filling and then additional contrast is injected so that the tubes should fill and begin to spill with contrast into the abdominal cavity. Series x-ray pictures are taken during HSG.
• When both tubes are spilles with contrast, the woman is often asked to roll to one side or the other slightly to give a slightly oblique x-ray image which can further delineate the anatomy.
• The procedure is now complete. The instruments are removed from the cervix and vagina.
• The woman usually remains on the table for a few minutes to recover from the cramping caused by injection of the contrast.
• The results of the test can be obtained immediately. The x-ray pictures can usually be reviewed with the woman several minutes after the procedure

There were several studies reported of spontaneous pregnancy within four months after the HSG.. This could be done to the flushing of the tubes or cleaning out some debris that was preventing the woman from conceiving.

Complications associated with a hysterosalpingogram include the possibility of an allergic reaction to thecontrast , which is uncommon. This usually causes a rash, but can rarely be more serious. Pelvic infection or uterine perforation are also possible complications, but these are very uncommon.

If a woman has multiple sexual partners or is otherwise at risk for sexually transmitted diseases, she will be screened with cervical cultures before doing an HSG. In patient with high risk of infections, several days of antibiotics taken prior to the procedure reduce the risk of infection after HSG.