Hysterosalpingography: This Test Can Help You Get Pregnant

The name is a bit complicated, but hysterosalpingography is well known among some women, as it is often asked when a woman is conducting research to see if she has a problem getting pregnant.

Luiz Eduardo Albuquerque, Fertivitro's clinical director, gynecologist specializing in Human Reproduction, explains that hysterosalpingography is an x-ray examination of the female reproductive system (uterus and tubas). It is performed by means of a contrast injection through the cervical canal, which will draw the uterine cavity and the inner part of the tubes. The objective is to evaluate the morphology of the organs, allowing the diagnosis of internal lesions of the uterine cavity, such as adhesions (synechiae), polyps or fibroids; or tubal injuries, such as obstructions, dilations or injuries ?, he says.

Armindo Dias Teixeira, gynecologist specializing in assisted reproduction, videolaparoscopy and gynecological endoscopy, points out that hysterosalpingography is indicated to diagnose causes of difficulty in getting pregnant, malformations of the uterus, fallopian tubes, adhesions, tumors of the uterine cavity, among other cases.

Albuquerque points out that this test is indicated in all women when the couple is being screened for marital infertility.

How is Hysterosalpingography done?

Gynecologist Rogério A. Gomes, from Syrian Lebanese Hospital, explains that hysterosalpingography is performed with an x-ray machine in conjunction with the use of contrast.

Read also: 6 important tips for the woman who wants to get pregnant

• The patient lies on her back with her knees bent (as if taking a Pap smear).
• Contrast (usually iodine-based) is placed inside the uterus by inserting a catheter into the cervix.
• Since x-ray does not cross contrast, it is possible to evaluate the anatomy of the uterus and tubas.
• Throughout the exam, the doctor often asks the patient to change her position, which helps to better distribute the contrast by providing more information.
• After the procedure, the catheter is removed and the patient can go home normally.

"The total procedure time is about 20 minutes," says Gomes.

Albuquerque points out that the test is performed between the 7th and 10th day of the menstrual cycle (counting as the first day of the cycle the first day of menstrual flow). • A gynecological exam (similar to the annual preventive exam collection) is performed, in which a probe will be inserted into the cervix to introduce the contrast. During the contrast injection are several X-rays performed for the documentation of the images ?, adds the expert.

A very common question is regarding the use of contrast. A lot of people are unaware of what it means and even some fear of side effects.

Gomes explains that contrast is a liquid that has the property of not being crossed by x-ray. "The commonly used contrast agent is a 25% iodine-soluble water soluble substance, which is well tolerated and eliminated after 30 minutes," he says.

Albuquerque points out that side effects are extremely rare and are more common in iodinated contrasts such as:

Also read: 12 Factors That Affect Female Fertility And You Didn't Imagine

• Sensation of heat in the body
• Nausea
• Sweating
• Hypotension
• Metallic taste in the mouth

"The risk of using iodinated contrasts is restricted to iodine allergy patients, pregnant women or IUD patients," adds Albuquerque.

Gomes points out that in some cases, contrast allergy may occur. "It is essential for the patient to report to the doctor if she has an allergy to iodine or seafood, and she should return to the doctor in case of swelling, itching in the genital region, itchy skin or shortness of breath," he warns.

Hysterosalpingography pre and post exam care

Meet the prerequisites for the exam, according to doctors:

• The patient cannot be pregnant (there can be neither this suspicion);
• The patient must be between the 7th and 10th day of the menstrual cycle;
• The patient must be in sexual abstinence two days before the exam;
• The patient should not yet have discharge or any vaginal discharge;
• The patient should be sure not to be allergic to iodine.

Exam Preparation

Albuquerque explains that exam preparation may vary from lab to lab. However, it is usually asked:

• Fasting for at least four hours;
• Sexual abstinence of two days;
• Not having menstrual flow present;
• Intestinal and analgesic preparation 30 minutes before the exam.

Gomes stresses that bowel cleansing may be necessary using laxatives the day before. "This is so that gases and feces in the pelvic region do not disturb the visualization of the result."

Also according to Gomes, antispasmodics and anti-inflammatory drugs can be used to avoid discomfort. "It's also important to empty the bladder before starting the exam," he says.

Post Exam

Albuquerque points out that, as with exam preparation, guidelines may vary by lab, but it is generally recommended:

• Rest on exam day;
• Use painkillers if necessary.

Gomes adds that sexual abstinence may be recommended within 5 days of the exam.

Hysterosalpingography Contraindications

Teixeira points out that the main contraindications are:

• Acute pelvic infections;
• Contrast allergy;
• Suspected pregnancy.

Gomes stresses that pregnant women are prohibited from undergoing the test for the risk of miscarriage. "Patients who have had an allergic reaction to iodine while doing other tests or who are allergic to seafood should inform the doctor who will perform the procedure, so that some precautions are taken," he advises.

Risks of Hysterosalpingography

According to Albuquerque, the greatest risk would be the allergic reaction to iodine. • In rare cases, the examination may aggravate an infection when it is pre-existing. In this case, when the radiologist diagnoses a hydrosalpinx (tubal dilation), is it recommended that the patient use antibiotics after the exam ?, he says.

Teixeira points out that all procedures have a certain degree of risk. "But in this test, the most common risks are pain, minor bleeding and eventually some change in blood pressure, and very rarely infection," he says.

Hysterosalpingography Results

But after all, what are the results of the exam? What can they show? Expert Albuquerque explains below:

Uterus Analysis

Normal Results: in the normal uterine cavity, there is a "folding" (pleated) characteristic of the cervical canal, a smooth - walled uterine cavity of generally triangular shape with its base facing upwards, as shown in the drawing:.

Changed Results: Diseases that invade the uterine cavity can be seen on the examination, such as endometrial polyps, submucosal fibroids, and adhesions (synechiae) that cause filling failure at the time of contrast injection into the uterine cavity.

Sometimes we may notice an invasion of contrast into the muscles of the uterus, forming discrete accumulations of contrast. In this case, it is possible to suspect adenomyosis and, therefore, we need more tests to reach the diagnosis ?, adds Albuquerque.

• In alterations of uterine malformation, images may show the presence of double uterine cavity (bicornuate uterus), major filling failure that divides the uterine cavity (uterine septum) or even the design of only half of the uterine cavity (unicorn uterus) )? In the latter, we have to research a little more, because we may be facing a change in uterine malformation that may be accompanied by another cavity or absence of another cavity ?, highlights the Human Reproduction specialist.

Tubal Analysis

Normal Results: a normal tube appears on hysterosalpingography as a linear image from the uterine cavity outlet for approximately two-thirds of the total tube size and then a slight dilation (ampullary region), where a "folding" is noted. (longitudinal) characteristic (pleated), followed by slightly larger dilation preceding the contrast outlet to the abdominal cavity (infundibulum or fimbria).

"The important thing is that the passage of contrast inside the tubes' light is normally not interrupted and, most of the time, does not cause its retention inside," explains Albuquerque.

At the end of the examination, the experienced radiologist waits for the patient to walk and after a few minutes repeats the x-ray examination in order to completely eliminate contrast from the uterine cavity, since once there is no more contrast in the cavity. In the uterine region, there is no more contrast within the fallopian tubes. And so we can conclude that the tubes do not retain contrast, so they are normal ?, adds the expert.

Changed Results: contrast passage obstructions represent a fallopian tube lesion, which may be due to a surgical procedure (tubal ligation) or a sequel to an infectious process.

? In the sequelae of fallopian tube infections, various types of images may appear beyond the obstruction, such as major dilations, showing a breakdown of? tubes (hydrosalpinx) and significant narrowing of contrast output by the infundibulum (paraphimosis) ?, says Albuquerque.

"Small filling defects in the isthmus of the fallopian tubes (thinner segment) may represent polyps inside, but it appears that such disease does not compromise the fertility of the patient," explains the expert.

We may notice an infiltration (small diverticula or nodules) in the tubal wall in the isthmus region, suggestive of salpingitis nodosa, that is, infection of the tube caused by sexually transmitted diseases such as chlamydia, neisseria gonorrhea, ureaplasma and mycoplasma. as causative agent to tuberculosis ?, highlights the expert.

"Even with apparently patent tubes, we can see images suggestive of infection such as: tubal folding, lack of tube mobility during the examination (fixed tubes) and moderate contrast sequestration in certain peritubarian regions," says Albuquerque.

Where to do Hysterosalpingography

Albuquerque says labs that do X-ray exams often do hysterosalpingography. The vast majority of health plans cover the exam.

Gomes emphasizes that this exam is usually covered by health plans (for this, consult your carrier) and is also available in the Unified Health System (SUS). "The exam can be done in laboratories or even inside the hospital according to the patient's peculiarities," he says.

Teixeira also explains that the exam is usually performed by a radiologist with experience in gynecological diseases.

Common Hysterosalpingography Questions

Below, the gynecologists consulted clarify the main questions about the exam:

1. Does hysterosalpingography hurt?

Luiz Eduardo Albuquerque: hysterosalpingography is not a pain-free examination, however, anesthesia is not required. In the hands of caring professionals who are concerned about using the right equipment, using preheated contrast and pre-examination pain reliever, the procedure becomes virtually painless. Of course, pain is a subjective condition and each patient may report more or less pain, varying its intensity.

Armindo Dias Teixeira: The test may cause discomfort and may be minimized by administering painkillers prior to the procedure. It is still a test that causes a lot of fear in women, because in the past, rigid and thick cannulas were used to introduce contrast, which caused a lot of pain. Today flexible and thin cannulas are used, but the stigma of the past still persists. Fortunately the technique is less painful. Another important point is the pain tolerance that differs from person to person.

2. What is the approximate price?

Luiz Eduardo Albuquerque: The price may vary widely, but should be around $ 500.

3. Does hysterosalpingography help you get pregnant?

Luiz Eduardo Albuquerque: We cannot state that performing hysterosalpingography could help a couple to have children, because infertility is often multifactorial, but some patients report spontaneous pregnancy after the exam.

Armindo Teixeira: Some women get pregnant after the exam. A likely explanation would be some partial obstruction in the fallopian tubes with the contrast injection.

Rogério Gomes: You can't say that. It is a tool to diagnose possible factors that are hindering the woman becoming pregnant and, from the results, correct uterine or tubal abnormalities observed during the examination.

4. Will every woman who has difficulty getting pregnant have to have hysterosalpingography?

Armindo Teixeira: not necessarily. It depends on each case and the patient's report of any problems, but it is undoubtedly a very useful test in the diagnosis of a number of problems that lead to difficulty in becoming pregnant.

Luiz Eduardo Albuquerque: If the couple is starting their marital infertility research, it is very important to request this test. If the cause of infertility is already known and the indication for treatment is in vitro fertilization, hysterosalpingography may be dispensed with, as tubal function will not be used because oocytes (eggs) will be fertilized in the laboratory and the embryos will be transferred directly to the uterine cavity and thus acting as the tubas.

Testimonials from those who made hysterosalpingography

Housewife Glaucia Teves, 42, says she had been trying to get pregnant for over a year, until her doctor recommended the test. Researching a little on the subject I was a little scared, but decided to face it, because I had to know if I had a problem with the tubes. On the day of the exam, did I take anti-inflammatory about an hour and a half before? The doctor reassured me, and I tried to relax as much as possible. At the time, I felt a little colic, even a little like menstruation and very fast ?, reports.

Ana Maria de Fátima Pereira, a 38-year-old physiotherapist, says she was afraid of taking the exam because she thought it would hurt a lot.? I faced my fears? I took the exam in February and, in March, I got my positive! In the end, I found it easy? I felt a little colic and nothing more. I was very well attended by the doctor and the nurse, who asked me all the time if I was ok. In my case, it was worth the exam! My doctor said I had no problem with my fallopian tubes, so should I have any interruptions? that with hysterosalpingography was resolved ?, reports.

Now you have probably answered your main questions regarding hysterosalpingography. It is worth noting that if this examination is requested by your doctor, it is worth leaving aside fears and / or anxiety and perform it quietly.

After all, hysterosalpingography is an important tool to diagnose possible factors that are hindering the woman to get pregnant. And it will allow, from the results, correct possible uterine or tubal anomalies.

Use oil-based contrast for HSG fertility boost (May 2024)