When conception remains difficult for a couple, it becomes essential to identify the precise cause of infertility to determine the most suitable Assisted Reproduction (AR) treatment. Among the causes of female infertility, ovulatory dysfunctions, uterine and tubal factors, such as obstruction of the fallopian tubes, the presence of polyps or fibroids in the uterine cavity, can be determining elements. Precisely to evaluate these factors, a hysterosalpingography is prescribed. 

But what exactly is hysterosalpingography and how is this examination performed in practice? When is it recommended to perform a hysterosalpingography? Are there any contraindications to consider, especially when thinking about pregnancy? All these questions will be answered in this article, which offers a comprehensive view of this X-ray of the tubes and the uterus.

What is hysterosalpingography (HSG)?

Hysterosalpingography, also known as hysterography, is an X-ray procedure to examine the uterus and fallopian tubes, which are the ducts that connect the uterus with the ovaries. This medical imaging examination provides the specialist with the possibility to check the permeability of the tubes, while also allowing inspection of the uterine cavity and the contours of the endometrium, the lining of the uterus. HSG proves to be a valuable diagnostic tool for identifying possible pathologies or anomalies. This X-ray of the tubes and the uterus is usually performed in the radiology department of a hospital or clinic, but it can also be carried out in a specialized imaging center.

How is hysterosalpingography, also called tubal X-ray, performed?

Organs such as the uterus and the tubes are not directly visible on an X-ray due to their radiolucent nature. To make them perceptible, we use an iodine-based contrast agent specially designed for this use. This opaque liquid to X-rays is gently introduced into the uterus through natural channels, using a cannula placed at the level of the cervix. Before this stage, an antiseptic preparation of the vagina and cervix is performed. Once released into the body, the contrast agent spreads into the uterine cavity and the tubes, making them visible in white on the X-rays. The examination itself usually lasts about ten minutes, and the complete consultation lasts about thirty minutes. X-ray images are taken with the patient in a supine and lateral position, gradually capturing the movement of the liquid through the reproductive system.

Hysterosalpingography: When is it appropriate to perform it?

Hysterosalpingography, or X-ray of the tubes and uterus, is often prescribed as part of fertility evaluations, particularly during courses of medically assisted reproduction. Its main objective is to identify possible uterine or tubal factors that may hinder conception, thus explaining the difficulties a couple encounters when trying to conceive a child. Among these factors are partial or total obstruction of a tube, making it difficult for sperm to pass or preventing the fertilized egg from advancing to the uterus for implantation, the presence of fibroids or uterine polyps, or even malformations of the uterus.

However, hysterosalpingography can be recommended independently in other settings. For example, in cases of recurrent miscarriages, excessive menstruation, or bleeding outside the usual menstrual cycle, it can be used to explore the possible origin of these disorders. Thus, the decision to proceed with hysterosalpingography may be motivated by various concerns related to fertility or specific gynecological issues.

Is a tubal X-ray painful?

In most cases, tubal X-rays are a painless procedure. Sometimes, the injection of contrast liquid may cause a sensation of discomfort or abdominal cramps, similar to menstrual pain, which quickly dissipate once the consultation is finished. In exceptional situations, especially in patients with endometriosis, the examination may be more painful. It is possible to take a non-steroidal anti-inflammatory drug or paracetamol before the hysterosalpingography to prevent possible pain.

What happens after the tubal X-ray?

Once the tubal and uterine X-rays are completed, the specialist in charge of the hysterosalpingography can provide their conclusions immediately. Any anomaly or lesion in the uterine cavity or in the endometrium is clearly visible in the X-ray images. If one or both fallopian tubes are blocked, the tube will appear incomplete on the X-ray, indicating that the contrast material could not reach the ovary.

You can resume your normal activities immediately after the consultation, and it is entirely possible to have sexual relations on the same day. It should be noted that there may be some bleeding in the hours or days following the hysterosalpingography. In most cases, this bleeding is of low intensity and is not serious.

Hysterosalpingography and pregnancy: What is the risk?

The radiation used during hysterosalpingography poses a potential risk of causing a miscarriage, making this procedure incompatible with pregnancy. To ensure that the hysterosalpingography is performed outside of a gestational period, your specialist will normally schedule the examination at the beginning of the menstrual cycle, between day 8 and day 12, a few days after the end of the period and before ovulation. As a precaution, it may be necessary to confirm the absence of pregnancy by performing a test the day before the examination. Additionally, hysterosalpingography is not recommended in cases of gynecological infections such as gonorrhea and chlamydia. Before the X-ray, tests may be requested to rule out these pathologies.

What are the complementary examinations to hysterosalpingography?

In the context of Assisted Reproduction (AR), the fertility evaluation usually includes performing a hysterosalpingography, an X-ray of the tubes and the uterus. Other examinations for women are also commonly performed. These include hormonal dosage, a pelvic ultrasound (3D or classical), and a hysteroscopy, which involves exploring the uterine cavity using a mini-camera. These protocols aim to study the internal anatomy of the uterus and ovaries, while also allowing for the analysis of ovarian reserve.

To assess the fertility of the male partner, a semen analysis is generally performed. This may be complemented by hormonal measurements, a testicular biopsy, or even a testicular ultrasound. The goal of the fertility evaluation in Assisted Reproduction is to identify the possible causes of infertility in the couple. The results obtained will guide the medical team in choosing the most appropriate treatment, whether it be classical in vitro fertilization, IVF with ICSI, or even using donor sperm or eggs, among other available options.

In conclusion, performing additional tests, such as hysterosalpingography, hormonal dosage, pelvic ultrasound, and other procedures, is crucial in the context of a medically assisted reproduction process. These investigations aim to identify possible obstacles to the couple's fertility, paving the way for an informed choice of the necessary interventions. If you are facing fertility issues or considering assisted reproduction, it is essential that you take action now.

Contact NatuVitro today for specialized support. Whether you are facing gynecological complications, hormonal imbalances, or other fertility-related challenges, our dedicated team is ready to support you by providing a caring environment, cutting-edge technologies, and solutions tailored to your specific needs. 

Take a step toward making your dream of becoming a mother a reality by contacting us today.

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