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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