HSG is short for the word hysterosalpingography. It means uterine and tube film. It is generally known as “uterine film hsg” for short. It is a contrast X-ray film taken to diagnose whether there is a problem in the uterus and tubes that may prevent conception.
The HSG is usually requested from women who are unable to conceive within the expected period. This period is 1 year for women under the age of 35, 6 months to 1 year between the ages of 35-40. It is recommended that women over the age of 40 who decide to have a child have a uterine film HSG without waiting. Thus, it is possible to prevent loss of time and to have the necessary treatments before the reproductive age advances further.
HSG is increasingly requested by physicians. Because in recent years, thanks to technological developments, HSG has become less costly and accessible.
Uterine Film HSG has been known and made for almost 100 years. It has a bad reputation as it can be quite painful and difficult when done with old equipment and techniques. However, developing technology allows us to take HSG painlessly, and by saving time.
Women are so afraid when they are asked for HSG that they sometimes avoid making this film for months and constantly postpone it.
The uterine cavity and tubes should be viewed from different angles according to the person’s structure. To visualize the uterus in the appropriate position, it should be taken with a C-arm X-ray device. In cases where the tubes are blocked but it is considered possible to open, the tube opening procedure should be continued with selective salpingography. Sonomed Medical Imaging Center has a C-arm X-ray device and tube opening can be performed.
The C-arm X-ray machine makes it unnecessary to attach hooks to expose the uterus. Therefore, the pain that can be caused by hooking the uterus, severe uterine muscle cramps and some false results that these cramps can cause are eliminated.
Soft, thin, special catheters are used to fill the uterus and tubes with medication.
For the tubes, which are blocked due to muscle cramps, plugs and small adhesions, to be opened during HSG, the selective salpingography technique should be used by directly injecting medications. With this technique, we can open almost 70-80% of the blocked tubes in the classical uterine film examination. When the tube is found to be blocked while the uterine film is taken, it is a suitable technique to perform selective salpingography by placing a tube-opening catheter in the same session. It is done in just a few minutes.
Showing that the tube is open is important for the patient’s psychology and to avoid laparoscopy surgery for a simple reason. Also, very importantly, if there is fluid accumulation in a tube that has been blocked from the beginning, it is possible to detect this with selective salpingography and to have the chance to eliminate it before IVF treatment.
When developing technology and appropriate techniques are used, there is usually no pain in the HSG procedure. It is similar to a gynecological examination lasting 1-2 minutes. Therefore, there is no need for anesthesia or the use of painkillers, except in special cases. Sometimes, short and temporary pain similar to menstrual pain may occur, but severe pain does not occur.
The probability of spontaneous pregnancy increases prominently for a few months following the imaging of the uterine film. Many of our patients conceive in the month the film was taken or in the following 4 months.
Before the IVF treatment, a film of the uterus must be taken. It is very wrong to think that it will not matter whether the tubes are open or not in people who will undergo IVF treatment. Some problems in the uterine tubes can prevent the success of IVF. These problems may not always be seen with ultrasonography. MRI is an inadequate and expensive alternative in this regard. These uterine tube problems, which can significantly reduce the probability of IVF success, can be revealed best and most accurately with the uterine film HSG. For example, if fluid accumulation is detected in the tubes, the IVF specialist will take the necessary action to prevent this fluid, which has a toxic effect on the embryo, from reaching the uterus, and then proceed to the embryo transfer stage.
HSG is actually an X-ray film. As is known, bones can be seen on X-ray films. Muscles and internal organs are either invisible or appear in faint silhouettes. The uterus and uterine tubes, which are largely muscular, cannot be seen on plain X-rays. However, when the cavities inside are filled with iodinated liquid that does not pass X-rays, these cavities and channels become visible on X-ray films. HSG is performed by taking X-ray films while the uterus and tubes are filled with iodinated liquid. With HSG, the inside of the uterine cavity and uterine tubes can be seen, but not the uterine muscles.
Congenital uterine anomalies, fibroids growing into the uterine cavity, and fleshy protrusions called polyps in the uterus can be detected with HSG. Uterine wall adhesions that may occur in the uterine cavity after miscarriage, abortion, hysteroscopy, and other uterine surgeries can be clearly diagnosed with HSG.
With HSG imaging, where cornual catheterization (selective salpingography) is also available, whether the uterine tubes are open or not can be detected as accurately and reliably as laparoscopy. If there is an obstruction in the uterine tubes, which are approximately 10-12 cm long, HSG can also detect the distance of the obstruction from the uterus. This is very important because a blockage in the middle of the tube or away from the uterus prevents conception from the other tube, which is intact, or holding the IVF due to the flow of the fluid produced in the tube into the uterine cavity.
Finally, HSG allows us to get an idea about the condition of the ovaries and the abdominal cavity around the tube. Intra-abdominal adhesions, which can occur in many cases such as abdominal surgeries, peritoneal infections, and chocolate cysts, may make it difficult or prevent the egg from coming out of the ovary from reaching the mouth of the tube, even if the tubes are open.
HSG has become a simple, easy, very useful and relatively cost-effective examination that allows us to detect all these within 1-2 minutes. There is no longer any justification for patients or obstetricians to recommend an HSG to avoid it.
No special preparation is required before HSG imaging. In the past, painkillers, antispasmodic drugs or suppositories were recommended before the examination. Thanks to new techniques, they are no longer needed. Taking a bath during the day before the examination is beneficial in terms of hygiene.
Yeni tekniklerle yapılan HSG çekimi sonrasında istirahate gerek yoktur. İşe veya sosyal programa devam edilir. Araç kullanılabilir. Doktorunuz aksi bir uyarıda bulunmadıysa korunmasız ilişki serbesttir. Bazı risk gruplarında birkaç gün sürecek koruyucu antibiyotik önerilmektedir. Hangi hastaya antibiyotik kullanılması gerektiğine kadın doğum uzmanı veya HSG çeken radyoloji uzmanı karar verir.
There is no need to rest after HSG imaging with new techniques. The work or social program is continued. Vehicles can be used. Unprotected intercourse is permitted unless your physician has warned you otherwise. In some risk groups, prophylactic antibiotics are recommended for a few days. The obstetrician or radiologist who performs the HSG procedure decides which patient should take antibiotics.
The uterine muscles are involuntary muscles, like the heart muscle or the intestinal muscle. Uterine muscles cannot contract voluntarily like arm and leg muscles. It has independent contraction mechanisms that work on their own. For this reason, patients cannot cause the uterine film to come out wrong by contracting their arms, legs, and chin with fear and anxiety.
Whether the tubes are blocked or open, severe pain never occurs in the imaging made using new techniques and a C-arm X-ray machine. In the old technique, when the tube was partially blocked, it was necessary to administer the medication with high pressure and therefore severe pain could occur. Thanks to selective salpingography, this is no longer necessary. Because giving medication by reaching directly into the tube with the catheter does not cause tension in the uterus, so it does not cause pain.
The radiologist decides whether it is possible to open the tubes that are blocked during HSG with selective salpingography in the continuation of the examination. If the tubes are permanently blocked and there is no possibility of opening, the examination is terminated. The radiologist who evaluates old HSG films or watches the images on the screen during imaging will interpret the findings and decide whether selective salpingography can be beneficial.
Selective salpingography is not performed for tubes that are permanently blocked, surgically connected or found to have fluid accumulation.
HSG is an X-ray examination and X-rays, electromagnetic waves, are used. X-rays cause some ionization as they pass through the tissues. For this reason, it should be used in limited amounts. New generation x-ray machines work with detectors like digital cameras. Just as advanced digital cameras can take clear pictures even in dark environments, so advanced X-ray devices can take very clear X-ray films with very few X-rays. For this reason, there is tens of times lower radiation in HSG examinations performed with new-generation advanced X-ray devices. This is very important not only for the patients but also for the physicians and other health staff who perform this examination next to the patient and who are exposed to some amount of radiation with each patient.
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