Hysterosalpingogram

Excerpt

Hysterosalpingogram is a test imaging procedure commonly the second step in the diagnostic approach for female patients presenting with infertility. Pelvic ultrasound is generally the first.

Infertility in females is a complex workup assessed from a hormonal, structural, and partner-based approach. Disorders of the fallopian tube can account for up to 60% of the reasons for infertility, depending on the population.

One of the easily diagnosable causes of infertility is structural and developmental abnormalities. The primary role of hysterosalpingography is to assess the patency of the fallopian tubes and the structure of the endometrial cavity. The fallopian tubes generally carry the oocytes, which are released from the ovaries. The fallopian tubes are the patent structures that attach to the uterus at the interstitial space. The fallopian tube structures start with the fimbria at the ovarian end, infundibulum, ampulla, and isthmus. Hysteroscopially, the connection of the fallopian tube to the cavity is referred to as the ostia.

During the procedure, a radioopaque media fills the uterine cavity, continues into the fallopian tubes, and eventually reaches fimbriated ends next to the ovaries. Typically 1 to 3 mL of media is introduced into the uterine cavity. During the filling process, multiple pelvic X-rays are taken to visualize the spread of the media.

The exact number of the images is institution-dependent. The filling is continued until media are flowing from both the fallopian tubes. The hysterosalpingogram has limited visualization to areas that have patency to the cavity for which the contrast medial is deposited. In the setting where at least one fallopian tube is not showing contrast spillage, intravenous anticholinergic medication can be given to rule out the possibility of fallopian tube smooth muscle spasms. The contrast media appears hyper-dense on imaging, thus allowing for visualizing the media’s pathway.

Guidelines include HSG as part of a standard fertility evaluation. Laparoscopy and dye are more appropriate in women with a history of pelvic inflammatory disease (PID), previous ectopic pregnancy, or endometriosis. This allows assessment of both tubal and other pelvic pathology.