Hysterosalpingogram

Hysterogram, hysterosalpingography, uterography, uterotubography, and uterosalpingography.

• To diagnose tubal obstruction as a cause of infertility.
• To detect suspected fibroids, polyps, or developmental abnormalities in the uterus and fallopian tubes.
• To evaluate the fallopian tubes before or after sterilization reversal surgery.
• To evaluate incompetent cervix in women with a history of miscarriage.

Contrast dye is used to highlight the areas in question for the X-ray machine.

• The test will be scheduled during the early part of your menstrual cycle (between menstruation and ovulation), when pregnancy is unlikely.
• You undress from the waist down and don a hospital gown.

• You lie on your back on an examination table with an X-ray machine suspended over your abdomen. Your legs will be placed in special stirrups that go behind your knees.
• A speculum is inserted into your vagina to hold open the vaginal walls. Then a thin, grasping instrument called a tenaculum is inserted to hold the cervix in place.
• A thin catheter is inserted through the cervix into the uterus. A small balloon inside the catheter is inflated to keep it in place, and radiopaque contrast dye is instilled through the catheter. This usually causes several minutes of cramping and may result in spasm.
• The gynecologist and radiologist watch the dye on a fluoroscope screen as it enters the uterus and spreads through the fallopian tubes, looking for abnormalities.
• Four to eight X-rays are taken at various intervals as the dye travels through your reproductive tract.

• If you suspect that you have a pelvic infection or may be pregnant, ask your doctor to reschedule the test.
• Tell your doctor if you are prone to pelvic infections. You may be given prophylactic antibiotics to take before the test is done. It may also affect the choice of dye since water-based dyes are believed less likely to spread infection.
• Be sure to take an analgesic such as ibuprofen about 30 minutes before the test to lessen the effect of the cramps.

Sonohysterogram, a test in which a catheter is inserted into the uterine cavity to instill fluid to distend the uterus, which is then examined via transvaginal ultrasound for space-occupying structures.

• You will remain on the examination table until any cramping subsides and to be sure that you do not experience any adverse effects from the dye.
• You may be asked to stay until the X-ray films are developed to be sure that no others are needed.
• Then you are free to dress and return to normal activities.
• If you experience severe cramping, you should not drive home.
• Wear a sanitary napkin for 24 hours after the procedure.
• Notify your doctor if you experience or notice excessive bleeding, fever, or unpleasant vaginal odor.

None.

The radiologist will study the X-rays for a final report, but certain diagnoses can be made by watching the progress of the dye on the fluoroscope to see whether the shape of the uterine cavity appears normal or has apparent protrusions that might indicate a fibroid tumor or scar tissue; whether the dye leaks, indicating a tear in the uterine lining; and whether the dye flows through and out the fallopian tubes, indicating that they are patent (open).

• It's relatively noninvasive.
• Negative results (showing that the fallopian tubes are open) are highly reliable.
• It shows the internal contours and patency of the fallopian tubes (ultrasound does not).
• The test itself may open small blockages.

It may produce false-positive results: what appears to be a tubal blockage close to the uterus may only be a spasm in that area.

• If the tubes appear to be open, and the uterine contour is normal, no further testing is necessary.
• If they appear to be closed, or the uterine cavity is irregular, additional tests (laparoscopy or hysteroscopy) or surgery may follow.