A hysterosalpingogram or tubal flush is a simple, non-invasive way of checking that the fallopian tubes are open (no blockages). It also has the significant benefit of improving pregnancy rates. About 30-40% of younger women who have a HSG will fall pregnant within 6 to 12 months & not require additional treatment. It also far less risky than a laparoscopy. The doctors at Newcastle Fertility Specialists have been performing their own HSGs for over 15 years. Whilst most gynaecologists will refer you to a radiologist we actually do the tests ourselves, on our own patients, offering a level of personalised service & skill unique to our practice.
What does the test involve?
A speculum is inserted into the vagina. The cervix is the neck of the uterus (womb) which lies at the top of the vagina. There is a hole in the cervix, into which a small tube is placed. The doctor then injects x-ray contrast from a syringe into the uterus. Only 5 to 10 mls of liquid are usually required. As the contrast fills the uterus, it passes into the Fallopian tubes, and then out the end of the tubes around the ovaries. X-rays are taken by the female radiographer who is also present. We see an outline of your uterus & tubes.
Are there any risks?
Some people experience some cramps (period like pain) that are self limiting but occasionally intense. Infrequently people feel faint during or after the procedure. Although infection can be introduced into the pelvis it is a very rare complication. For some people the test cannot be performed because of technical difficulties.
What are the benefits of having a laparoscopy instead?
If we suspect you have endometriosis or adhesions we would prefer to do a laparoscopy in order to treat any pathology present. Some people do not tolerate a HSG & would prefer a laparoscopy which is done with a general anaesthetic (asleep). Your doctor will discuss the pros & cons of each approach with you based on your personal situation.
Should I add in Lipiodol?
Usually we do the HSG (tubal flush) using a water based solution which is less expensive. A 2017 New England Journal of Medicine study showed extra benefit if the solution used to flush the tubes was oil based (LIPIODOL) instead of water based. Lipiodol is actually made from poppy seed oil! Live birth rates were 28% with water based solutions & 38% with oil based. Although it is more expensive, many women are now opting to use Lipiodol because of the additional benefit over water based solutions & Newcastle Fertility Specialists have lipiodol available for use at patient request. NEJM2017