When a woman decides that the time has come to get pregnant, the gynecologist will request a series of tests for evaluation, which will determine whether it is possible to become pregnant naturally or if some “extra help” will be needed to facilitate conception. If some difficulty is detected, a specific exam, known as hysterosalpingography, may be recommended.

What is Hysterosalpingography?

Hysterosalpingography is an imaging exam performed with an x-ray machine, but with the help of contrast dye for a more detailed assessment. It is usually indicated to analyze the anatomy of the uterus and fallopian tubes, check for malformations or even possible scars or the presence of something that might prevent the development of an embryo, as well as to see if there is any barrier to pregnancy occurring. Through the contrast injected during the exam, it is possible to analyze the path of the liquid and see if there is any blockage to its passage, including obstructions that could impair the function of the fallopian tubes. It is one of the best exams for diagnosing gynecological issues related to fertility.

IMPORTANT: The hysterosalpingography exam does not cause pain, but it may cause mild discomfort during and after the procedure.

How is Hysterosalpingography Performed?

Hysterosalpingography is usually performed in the gynecologist’s office. If the specialist does not have the equipment in their office, it may be recommended to have it done at a specialized clinic. The procedure should be performed one week after menstruation and before ovulation occurs, to ensure that the woman is not pregnant. With the woman in the gynecological position, a catheter with a small balloon at the tip is inserted, which is inflated once it reaches the uterus, anchoring the probe. Once the probe is in place, the iodine-based contrast is injected. With the help of the x-ray image, the specialist will follow the entire path of the contrast and make the relevant notes, which will be included in the report. It is common during the hysterosalpingography exam for the doctor to ask the woman to change position to facilitate reading the image and help distribute the injected contrast. In the past, thicker and metallic probes were used, which made the exam painful for women. With the modernization of medical instruments, the gauge of the probe was also adjusted to a more flexible and thinner material, which allows for a more comfortable procedure. The exam does not cause pain, but may cause some discomfort both during and after the procedure. For this reason, an analgesic may be recommended before starting, to reduce this discomfort. The discomfort felt by the patient during the exam is similar to mild menstrual cramps, which goes away at the end of the procedure. This is usually felt at the time of the contrast injection.

IMPORTANT: The procedure lasts about 30 minutes on average.

After injecting the contrast, it is necessary to wait for the correct amount of time for the liquid to spread through the reproductive system so that its entire path can be mapped. Immediately after, the x-ray images are taken in sequence, where the path of the liquid will be evaluated and the existence of any abnormalities will be checked.

Precautions for Hysterosalpingography

Some recommendations are given and necessary for performing the hysterosalpingography exam. In addition to the specific timing for the procedure, as mentioned above—which should be after menstruation and before ovulation—it is also recommended to use a laxative the night before the test. The use of the laxative is to ensure that gases or feces in the pelvic area do not interfere with the imaging or provide unsatisfactory results. Before starting the hysterosalpingography exam, if prescribed, an analgesic should be taken to reduce discomfort during and after the procedure.

Hysterosalpingography Results

The results of the hysterosalpingography are provided through a report that accompanies the images taken during the procedure. Based on these results, the gynecologist will analyze the condition of the uterus and tubes and indicate the best treatment. If the report and images show no irregularity in the reproductive system that would cause infertility, other tests will be ordered, including those to investigate male infertility. Many couples spend months or even years undergoing tests on the woman to investigate her infertility, when in fact, the cause of the couple’s infertility lies with the man. Therefore, it is essential that after excluding problems in the female reproductive system, the man undergoes tests to evaluate his sperm. A common finding in hysterosalpingography results is tubal obstruction, which, in some cases, can be resolved during the hysterosalpingography procedure itself.

Advantages of Hysterosalpingography

The exam may intimidate women a little, due to the method used—involving contrast injection and even reports of discomfort during the procedure. Even so, it remains the best method to analyze the female reproductive system, as the contrast allows the path through the uterus and tubes to be checked with precision. Another important advantage is that the hysterosalpingography exam is quick and has a low risk of complications, and any issues can be controlled immediately and easily by the doctor performing the procedure. In addition, it has been proven to increase the chances of a woman becoming pregnant after the exam.

Hysterosalpingography with Sedation

For women who are afraid of the procedure and feel like giving up just hearing about it, there is the alternative of having a sedated hysterosalpingography. However, it is not easy to find clinics that offer this, especially trustworthy ones recommended by your gynecologist. Many specialists believe that sedation is unnecessary for the procedure, so it is not very common. The discomfort during the exam is completely manageable and in some cases, women report not feeling any pain at all.

Does Hysterosalpingography Help with Getting Pregnant?

Due to various reports from women who were able to conceive naturally shortly after the hysterosalpingography procedure, it has been concluded that the method can, in some cases, help unblock the fallopian tubes or remove other obstacles, if present. But we must note that this is not the purpose of the exam. Its sole function is to diagnose problems in the female reproductive system that could be causing infertility.

Recommended Treatments After Hysterosalpingography

Once the diagnosis is confirmed, the gynecologist will recommend the best treatment according to your result. Treatments are usually through medication, ovulation induction, surgical intervention, or even methods like scheduled intercourse or assisted reproduction such as IVF in cases that cannot be solved easily. In the case of a uterine anomaly, where it is impossible for the woman to get pregnant even after any treatment or procedure, including in vitro fertilization, the method known as gestational surrogacy may be indicated. Currently, in Brazil, this method is legal if the surrogate is a relative up to the fourth degree of the couple. In this case, the father’s sperm and the mother’s eggs are fertilized in the laboratory and the embryo is implanted in the uterus of the woman who will carry the pregnancy, so she can gestate the baby. Photo: jemsweb