A critically important step in the infertility evaluation is a detailed examination of the inside of your uterus.
There are two non-surgical options that can accomplish this evaluation – a hysterosalpingogram (HSG) or a sonohysterogram (sometimes called a saline infusion sonogram or SIS). These tests are usually performed in order to investigate possible uterine abnormalities, including intrauterine adhesions (scar tissue), endometrial polyps (an overgrowth of the uterine lining), or uterine fibroids (benign solid tumors of the muscular uterine wall).
The HSG is performed by one of the radiology groups in town. We will give you a requisition as well as contact information for the group approved by your insurance carrier. You will then call their office when your period begins in order to schedule the procedure. HSGs can be performed anytime from the end of your menstrual bleeding until shortly before ovulation. You will go to the radiology office at your appointed time and a speculum will be placed into your vagina. A very small catheter or plastic tube will be gently guided through the cervix into your uterus and a small balloon will be inflated to keep the catheter in place. A radio-opaque dye (a fluid detectable by X-ray) will then be slowly injected through the catheter into your uterus and hopefully out into your fallopian tubes while a large camera attached to the ceiling takes pictures.
You may experience mild cramping during this procedure as well as for 30-60 minutes afterward, so we recommend that you take some ibuprofen or other mild analgesic shortly before the procedure. You are welcome to return to work after the procedure, as any cramping that you experience should resolve rapidly. A radiologist will interpret the findings of your examination, and they will also send the actual X-ray pictures to us for our interpretation. Our staff will then call you with our findings and suggestions.
An advantage of an HSG over a sonohysterogram (see below) is that the HSG also provides a very good picture of your fallopian tubes. This is important, as the fallopian tube is the pathway that essentially connects the ovary to the uterus. When an egg is ovulated, it is picked up by the fallopian tube. Sperm (either through intercourse or intrauterine insemination) then swim out of the uterus into the tube where they hopefully bind to and then fertilize the egg. The fertilized egg (early embryo) then travels down the tube into the uterus where it hopefully implants and starts its development into what – under the right conditions – will become your new baby. In addition to providing evidence that your tubes are patent (open) and of a normal size and shape, the HSG also has therapeutic benefit, as many studies suggest that pregnancy rates are elevated for 3-6 months following the performance of an HSG.