Hysterosalpingography (HSG), also known as medicated uterine film, is a diagnostic method used to examine the tubes and the inside of the uterus with radiographic methods by administering contrast material.
HSG can be taken in imaging centres or hospitals and is not taken in our centre.
A liquid seen on the radiograph is injected into the uterus from the cervix during the procedure. This liquid makes the inside of the uterus and the tubes visible. Since the contrast agent is given under pressure from the cervix, in some cases, it can also have a therapeutic effect by clearing the mucus-like barrier structures in the tubes.
Classically, there is an increase in pregnancy rates in the first six months after the uterine film is taken. As the uterine film shows the condition of both the tubes and the inside of the uterus, it is a technique commonly used in infertility cases.
How is HSG (Medicated Uterine Film) Taken?
It should be taken within 3-4 days of the end of the menstrual bleeding. During this period, the intrauterine tissue is thin, and the probability of pregnancy is low. Thus, both the quality of the films increases and the possible damage to pregnancy is prevented.
It is recommended to take a pain reliever half an hour before taking HSG (medicated uterine film) to prevent cramp-like pain.
The woman lies on the x-ray table and pulls her legs towards herself during the procedure. The doctor places the speculum instrument, which is used during the gynaecological examination, into the vagina.
After cleaning the vagina and cervix with a solution, the cervix is held with the help of an instrument and pulled to bring the uterus to a flat position. A thin catheter is inserted into the cervix. Through this catheter, fluid is given into the uterus. The passage of the drug through the uterus and tubes is observed under a scope, and films are taken. Then, the placed devices are taken back in sequence, and the process is terminated. The whole process takes 5-10 minutes.
In Which Situations is HSG (Medicated Uterine Film) Used?
The most common reason for use is infertility. Despite advances in imaging techniques, HSG is still the best way to show the permeability of tubes.
What Are The Side Effects?
Complications include infection and allergy. The infection rate is around 1%. Therefore, systemic antibiotic treatment is not required. However, in risky cases such as mitral valve disease, it is recommended to start antibiotics one day before filming and continue for four days afterwards to prevent infection.
Despite the possibility of allergy, water-soluble contrast agents have been used in recent years, which have a very low allergy-causing features.
Is It a Painful Procedure?
HSG withdrawal is a somewhat painful procedure. However, this pain is short-term pain and is not unbearable. The severity of pain varies from person to person. Especially during drug administration, there is a reaction and contractions in the uterus against this foreign substance. Due to this pain, sometimes there may be spasms in the tubes, and the normally open tubes may seem closed.
Therefore, additional methods recommend the withdrawal of HSG under general anaesthesia. However, general anaesthesia is not required most of the time. In our opinion, the application of general anaesthesia should be decided according to the patient’s condition. A pain reliever to be taken 30-60 minutes before the procedure in most patients ensures a comfortable and trouble-free procedure.
Within a few hours after the film is taken, mild groin pain similar to menstrual pain and light bleeding in the form of spotting may occur for a few days.
What Does It Mean If The HSG is Normal?
A normal detection of hysterosalpingography shows us:
- The shape of the uterine cavity is normal, and there is no formation such as septum, polyp or myoma that can prevent pregnancy.
- There is no adhesion due to previous surgical interventions or infections in the uterus.
- The fallopian tubes are open to allow the passage of sperm and eggs.
However, the normal presence of HSG:
- Whether the endometrium layer, which covers the inside of the uterus and where the pregnancy settles, normally develops every month, and has the characteristics to carry a pregnancy,
- Whether a possible pregnancy can continue without any problems until delivery,
- Whether the open tubes adhere to the surrounding organs in a way that affects the potential for pregnancy,
- It does not give any information about the condition of the ovaries.
Hysteroscopy has replaced HSG in recent years to examine pathologies inside the uterus.
A slight increase in pregnancies occurs spontaneously without treatment after HSG (medicated uterine film). The reason for this is that the very slight adhesions in the tubes are opened due to pressure and the germicidal properties of the drug given. It is not surprising and expected for a couple with a long-term infertility problem to become pregnant spontaneously after HSG.
If any pathology is detected in HSG, appropriate treatment is performed.
What Happens After The HSG is Taken?
- There may be spotting or a small amount of vaginal bleeding. Call your doctor if bleeding increases or lasts longer than a few days.
- There may be mild or moderate back and groin pain. Call your doctor if the pain gets worse.
- If you have a fever, it could be an early sign of infection; call your doctor right away.
After the procedure, it may be inconvenient to have sexual intercourse and use a vaginal tampon. Your doctor will give you the necessary warnings about this issue.
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REFERENCES:
https://pubmed.ncbi.nlm.nih.gov/25769434/
https://pubmed.ncbi.nlm.nih.gov/23768623/
https://pubmed.ncbi.nlm.nih.gov/26986742/
