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Hysterosalpingogram

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What is the test?

The hysterosalpingogram is an x-ray test that takes a picture after dye has filled the inside of the uterus and fallopian tubes. It is a useful test in helping determine the cause of infertility. It is sometimes also used to evaluate patients who have had several miscarriages or patients with an IUD (intrauterine device) that cannot be seen on regular examinations. This test can show areas of scarring inside a fallopian tube or changes in the uterine cavity, as might occur with a polyp or other growth in the uterus.

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How do I prepare for the test?

Tell your doctor if you have ever had an allergic reaction to x-ray dye or if you have had a recent infection in the pelvis. Definitely tell your doctor if there is a chance you might be pregnant. If you have regular periods, it is best to have this test done in the week right after your period ends. This is before ovulation occurs in your cycle, so there would be the least risk of exposing an early pregnancy to the dye used in this test. Some doctors will require you to have tests for pelvic infections before having a hysterosalpingogram.

Some doctors recommend that you take antibiotics before the test. If this is your doctor's practice, he or she will give you a prescription for this medicine.

You will need to sign a consent form giving your doctor permission to perform this test.

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What happens when the test is performed?

This test takes place in the x-ray department. You lie on your back on a table with your knees bent and your feet in footrests, as you would for a pelvic examination. Most doctors feel your uterus to determine its size and shape by pressing inside your vagina with two fingers and pressing down on your lower abdomen with the other hand. A speculum (a device that looks like a duck-bill that can be opened and closed) is used to open the vagina so that your doctor can see inside. You may feel slight pressure from this.

Your vagina and cervix (the part of your uterus that the doctor can see inside your vagina) are cleaned with an antibacterial soap. A thin clamp might be clipped onto your cervix to hold it steady while the dye is put into your uterus. The doctor pushes a small bendable plastic tube gently through the opening in your cervix into your uterus. A tiny balloon on the end of the tube is filled with air to hold it temporarily in place.

The speculum is then removed, but the thin tube is left in place, with one end (about 6 inches of tubing) remaining outside of your vagina. Your doctor might have you change position at this time, so that you are lying more comfortably. A small amount of x-ray dye (about a tablespoon) is injected through the tube into your uterus, and several x-ray pictures are taken that may show up on a video screen for your doctor to see. Your doctor might ask you to move your pelvis slightly or roll from side to side to provide the clearest view of your uterus and tubes. When the x-rays are done, the balloon is emptied of air from the outside and the tube is gently pulled out.

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What risks are there from the test?

It is common for patients to have a small amount of bleeding from the vagina and some pelvic cramping for a few days after the procedure. If you have heavy bleeding, fever, or increasing pain in the pelvis, you should call your doctor. Some women experience an allergic reaction to the contrast dye. The most significant risk from this procedure is infection, which happens in close to 3 out of 100 patients. Most doctors use a water-soluble dye when they do this procedure; there are some risks associated with oil-based dyes that are still used in some centers, including rare scarring problems in the uterus or (rarely) breathing complications if the oil moves into a blood vessel.

As with x-rays, there is a small exposure to radiation. In large amounts, exposure to radiation can cause cancers or (in pregnant women) birth defects. The amount of radiation from a hysterosalpingogram is too small to be likely to cause any harm. However, since the x-ray exposure is directed right at the pelvis and ovaries, it is very important to be sure you are not pregnant at the time of the test.

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Must I do anything special after the test is over?

You may be watched for 30 minutes or so to make sure you do not have an allergic reaction to the x-ray dye and do not have any worrisome bleeding.

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How long is it before the result of the test is known?

Your films can be reviewed by the doctor immediately after the test. Usually this allows your doctor to give you an early idea of how the films look. Sometimes it takes a day or two for a radiologist to review the films thoroughly and give a formal report to your doctor.

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