If you’re new to having an HSG, it might feel a bit daunting. However, our fertility specialists are here to support you throughout the entire process. The procedure is quite similar to a pelvic exam, so you can expect familiar steps.

• Personnel

At Netcare IVF I Fertility Centre, Hysterosalpingography (HSG) is typically conducted in the radiology suite by our specialist radiologist and a radiology technician. In certain situations where accessing the entrance to the womb is challenging, an OB/GYN clinician may also be present to assist the radiologist and technician during the procedure.

• Preparation

At Netcare IVF I Fertility Centre, Hysterosalpingography (HSG) is best scheduled during the first half of the menstrual cycle, specifically between days 7 and 10, to minimize the risk of unintended pregnancy. To manage pain, patients may be advised to take over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen sodium or ibuprofen about an hour before the procedure.

Prophylactic antibiotics are generally not given, although they may be considered for patients with a history of pelvic inflammatory disease or prior infections, at the clinician’s discretion. Additionally, the antispasmodic medication hyoscine-N-butyl bromide may help reduce pain and prevent proximal tubal spasms during and after the HSG.

Most patients are able to drive themselves home after the procedure, but they should be encouraged to arrange for assistance if needed, depending on their individual recovery and comfort levels.

• Hysterosalpingogram (HSG) Procedure

    The HSG procedure involves several key steps:

1. Patient Positioning: The patient is positioned on the examination table in the dorsal lithotomy position.
2. Speculum Insertion: A speculum is inserted into the vaginal vault to visualize the cervix. The cervix and vaginal area are cleansed using a betadine solution or an equivalent antiseptic.
3. Cervical Stabilization and Cannula Introduction: The cervix is stabilized using a tenaculum, and a metal cannula with a rubber acorn tip is gently inserted through the cervical os. It’s important to create an adequate seal. Alternative catheters, such as plastic ones with inflatable balloons or thin catheters with shallow acorn tips, may also be used. Prior to catheter placement, contrast media is injected to remove any air from the endometrial cavity, as air can compromise imaging quality.
4. Uterine Manipulation: The tenaculum may be used to adjust the position of the uterus for optimal visualization during radiographic imaging.
5. Scout Radiograph: A preliminary scout radiograph of the pelvis is taken before injecting the contrast medium.
6. Contrast Injection: The contrast agent is injected slowly to minimize discomfort. The uterine cavity is filled with 1 to 3 mL of radiopaque media, and multiple pelvic X-rays are taken to observe the flow of the contrast from the uterine cavity into the fallopian tubes, ideally reaching the fimbriated ends.

• Possible Side Effects of a Hysterosalpingogram

At Netcare IVF I Fertility Centre, our specialists know that is always best to discuss clients’ concerns before the HSG procedure. While HSG is generally safe, there are some possible side effects to be aware of:

1. Slight vaginal discharge or Bleeding: Light vaginal discharge or spotting can occur after the HSG, but heavy bleeding is uncommon.
2. Allergic Reactions: If a contrast dye is used, there’s a small risk of an allergic reaction. Inform your doctor if you have any known allergies.
3. Infection: There’s a slight risk of infection in the uterus after the procedure. It’s important to monitor for any unusual symptoms, such as fever or severe pain. To minimize the risk of infection, it’s recommended to use a pad instead of a tampon during this period.
4. Dizziness or Nausea: Some women may feel dizzy or nauseous, but these symptoms typically resolve quickly.
5. Radiation Exposure: An HSG uses X-rays, so there’s a small amount of radiation exposure, but it’s generally considered safe.