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What to expect: Tubal evaluation can be done in one of two ways: the first involves instillation of X-ray dye into the uterine cavity and fallopian tubes along with imaging using an X Ray machine (HSG), while the second involves instillation of sterile saline (water) into the uterine cavity and tubes along with imaging using an ultrasound machine (SonoHSG). Both techniques allow your provider to assess the shape of the uterine cavity as well as the patency of both fallopian tubes. During the procedure, you may experience mild cramping, which can last from minutes to hours. Your provider may advise that you take pain medications that you may use for menstrual cramps shortly before the procedure and at any time cramping is experienced. This process can be performed in our offices or surgical center and does not typically require anesthesia.

How the procedure is done: For an HSG, you will be positioned under an X Ray imager. Your provider will then place a sterile speculum into the vagina in order to both visualize and clean the cervix. Local anesthesia may also be applied. A small catheter is then placed into outer most opening of the cervix, and through it an iodinated liquid is instilled through the catheter (iodinated liquid can be visualized on an X Ray screen). As the liquid enters the uterus and fallopian tubes, your provider will be able to assess the shape of your uterine cavity along with the shape and patency of your fallopian tubes. The procedure for a sonohysterosalpingogram is also similar, with the exception of instillation of sterile saline into the uterine cavity and visualization of the sterile saline with a transvaginal ultrasound.

What are the risks: Risks of the HSG may include bleeding, infection, and radiation exposure. Typically, bleeding lasts for 1-2 days after the procedure. If bleeding lasts longer, or is heavier than a normal period, your provider should be contacted. The risk for infection is <1%, and you may be given antibiotics before or after the procedure to help to minimize this risk. Radiation exposure from an HSG is very low and would not harm a pregnancy if conception occurs later in the cycle; pregnancy tests are routinely done prior to the procedure to ensure that the test is not performed during pregnancy.

What this test tells you: Abnormalities with the fallopian tube can be seen in up to a quarter of couples with infertility; these abnormalities can be caused by scar tissue, pelvic inflammatory disease or other pelvic diseases, such as endometriosis. In addition to diagnosing tubal factor infertility, HSGs can be used alongside transvaginal ultrasound to identify developmental uterine anomalies, such as septate, unicornuate, bicornuate, and didelphic uteri.