The HSG is an X-ray of the uterus and fallopian tubes. It is an unduly neglected test that some doctors believe has been superseded by telescopic inspection under anaesthetic. In fact, it provides information that it is difficult to get in any other way. Moreover, it is easy to do and less expensive than those requiring an anaesthetic.
The X-ray is done following a simple internal examination. The doctor inserts a thin tube through the cervix. The instrument that fits inside the cervix is no larger than a ballpoint pen refill. A small amount of dye is injected into the uterus, and its progress is monitored on a television screen. About six X-rays may be taken. The whole procedure takes about ten minutes and photos are taken during an injection, revealing whether the tubes are open. The quality of the shadow on the X-ray can give a very good outline of the inside of the uterus, and the shadows which the inside of the tubes produce can show if there is tubal blockage. Often, with a carefully taken film, the presence of scarring in the wall of the tube can be detected. With very modern X-ray equipment , especially using digital enhancement , great detail can be revealed and invaluable information obtained.
Many clinics organise an HSG as soon as possible after the first visit to the clinic. By the time the couple returns for their follow-up appointment this means there will be a detailed assessment of the quality of the tubes and the uterus.
With digital enhancing equipment a computer image is used which makes the whole procedure simpler for the patient and more informative. HSG used to have a reputation for causing discomfort, but this is now largely unjustified. Most women in our hospital do not even realise that the test has started or finished. Sometimes the insertion of the tube can cause a little discomfort, but it is no worse than a period pain. Persistent pain after the HSG can indicate infection and is not normal. Any woman who experiences this should contact the hospital no matter how late at night it might be.
HSG can be good at revealing adhesions inside the uterus, as well as fibroids, scarring of the uterine muscle and polyps. It can also outline congenital abnormalities of the uterus, which are not such uncommon causes of infertility. In the area where the tubes join the uterus, the internal plumbing is extremely delicate and small. The HSG reveals far more effectively than a laparoscopy whether there is any scar tissue here or polyps in the tube itself. A good X-ray also clearly reveals any scarring in the tubal lining and its folds. This is very important because so often there is tubal disease even though the tubes are not blocked and knowledge of this kind of damage helps you make a decision about treatment. Also, this kind of scarring can make an ectopic pregnancy (implanting in one or other tube) more likely.
Despite countless breakthroughs in medical science, we still do not understand why some pregnancies will end in tragedy. For most of us, having a child of our own is the most fulfilling experience of our lives. All of us can imagine the desperation and sadness of parents who lose a baby, and the life-shattering impact that a disabled or seriously ill child has on a family.
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