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Echohysterosalpingography (Echo-HSG)- a method for diagnosing the condition of the uterine cavity and patency of the fallopian tubes based on the ultrasound method.
Echo-HSG should be done as prescribed by the attending physician. This study will help to understand the causes of infertility and miscarriage, assess the patency of the fallopian tubes, and check the condition of the uterine cavity for pathological changes.
Advantages
Echo-HSG has the following advantages over X-ray or laparoscopic HSG:
- no hospital stay required, the procedure lasts 30-40 minutes;
- the possibility of allergic reactions is minimal, because no contrast is used (iodine-containing substances);
- no X-ray exposure.
Another advantage of the method is additional therapeutic effect. During the examination, fluid pressure removes small adhesions located inside the pipes, thereby improving their patency. Therefore, pregnancy after echo-HSG of the fallopian tubes is quite common.
About the procedure
The essence of the study is the introduction of a sterile saline solution into the uterine cavity using a catheter. Once in the uterine cavity, the solution fills it, penetrating further into the fallopian tubes. Using an ultrasound machine, the doctor monitors the movement of the solution. If the solution does not leave the uterine cavity, this picture may indicate obstruction of one or both tubes, which may be the cause of tubal infertility.
During the examination, the woman lies on a couch or is in a gynecological chair. Before inserting the catheter, the doctor treats the genitals, vagina and cervix with an antiseptic. While the catheter is inserted into the vagina and fluid is injected, patients may experience slight discomfort similar to that experienced during the first days of menstruation. If the first days of your period give you serious discomfort or you are very worried, we will administer local anesthesia.
Preparation for Echo-HSG
No special preparation is required. However, you should avoid eating 3 hours before the test. In case of increased gas formation, 2 days before the test, it is necessary to take espumisan 2 capsules 3-4 times a day. If the fallopian tubes are in a state of spasm, it is necessary to take an antispasmodic drug to avoid distorting the results of the study.
Echo-HSG is performed in the first half of the menstrual cycle. For example, with a 28-day cycle, this is from days 6 to 12. From the moment of the onset of menstruation until the day of Echo-HSG, it is necessary to abstain from sexual activity.
There are many reasons why some women fail to get pregnant for a long time. One of them is obstruction of the fallopian tubes. To identify such a pathology, special studies are prescribed. Find out how to check the patency of the fallopian tubes. Understand this diagnostic procedure, preparation and consequences.
What is hysterosalpingography
This difficult-to-pronounce concept refers to a special medical procedure or x-ray. It is carried out to check the condition of the uterus and fallopian tubes, as well as assess their patency. Indications for hysterosalpingography are cases when women cannot conceive a child for a long time or they have already had several miscarriages.
Checking the patency of the fallopian tubes
There are 3 methods used to check the patency of the fallopian tubes. The main one is hysterosalpingography. The procedure involves an x-ray of the fallopian tubes. First, a rubber tip is inserted into the cervix, and through it a thin tube called a cannula is inserted. Through the latter, a coloring substance, often blue, enters inside. Then, using the rays of an X-ray machine, a picture is taken. It shows the structure of the uterine cavity and the tubes extending from it. Other methods for studying these organs include:
Echohysterosalpingography
Assessment of the condition of the fallopian tubes and uterus using ultrasound is carried out using a monitor, and not from an image, as with HSG. Its advantage is the absence of radiation exposure. In addition, echography is also carried out without hospitalization of the patient. The recommended time for the procedure is the day before ovulation. The advantage of this valuable period is that the cervix is relaxed. To prepare for an ultrasound scan, a woman only needs to not eat for 2-3 hours before the procedure. In case of increased gas formation, the gynecologist may prescribe Espumisan, which is taken for 2 days before the test.
To conduct an echography, a woman must pass the following tests: for hepatitis, HIV, syphilis and vaginal microflora. This is necessary to exclude the presence of viruses in the body. During the procedure, patency is indicated by the fact that the contrast medium freely passes through the fallopian tubes and enters the abdominal cavity. Based on reviews from women, we can conclude that after ECHO-HSG there is slight pain that goes away during the day.
X-ray for tubal patency
X-rays or HSG examine the fallopian tubes only in non-pregnant women, because radiation is harmful to the embryo. In such cases, use the previous method, i.e. echography. X-rays are more informative and it is easier to assess the condition of the abdominal organs. The procedure has some disadvantages. Among them are:
- exposure to radiation, albeit in a small dose;
- possible allergic reactions to the contrast agent;
- mechanical damage to the epithelium with subsequent bleeding.
Price of hysterosalpingography
As for the cost of fallopian tube HSG, it depends on the chosen method. In a public clinic, any such procedure will be free. In private institutions, the price for x-rays varies from 1500 to 5000 rubles, and for ECHO-HSG - from 5000 to 8000 rubles. There is variation due to the variety of procedures. The upper bar also includes other services:
- consultation with a gynecologist;
- conducting an examination under anesthesia;
- husband's presence at the event.
How to check the patency of pipes
With any method of studying the patency of the fallopian tubes, everything begins with an examination by a gynecologist and the appointment of the necessary tests. In addition, the doctor must choose the time when it is best for the patient to undergo the procedure. To avoid inaccurate results, the specialist must be sure that on the day of the examination the woman’s uterus will be in a relaxed state, then the risk of spasms is much less. After passing the required tests and proper preparation, the procedure itself is carried out to determine the patency of the fallopian tubes.
What tests are needed for HSG
The first on the list of necessary tests are general studies of urine, blood and its biochemistry. Tests for syphilis, HIV, and hepatitis are mandatory. You also need to take a vaginal smear to study its microflora. When ordering an x-ray of the fallopian tubes, be sure to do a pregnancy test or take a blood test for hCG. This study is a difference between the preparation process for HSG and ECHO-HSG, because the latter can be used for pregnant women.
Preparation for HSG tubes
This procedure requires special behavior from the woman in the several days before the test date. The latter occurs exclusively on days 5-9 of the menstrual cycle. The preparation for tubal HSG includes the following rules:
- 1-2 days before HSG you need to stop having sexual intercourse.
- During the week before the examination, douching procedures and the use of special personal hygiene products are not recommended, i.e. tampons.
- The use of vaginal suppositories, sprays or tablets should also be stopped a week before the examination unless approved by the doctor.
- On the day of the examination, it is better to remove excess hair on the external genitalia.
- Before HSG, be sure to empty your bladder and bowels. If there was no stool, then you need to perform a cleansing enema.
Consequences
Even the safety of the HSG procedure does not guarantee the absence of negative consequences. First on the list is an allergic reaction to the contrast agent. This phenomenon is typical for women who have previously had such “answers” during other examinations. Allergies can also occur in patients suffering from bronchial asthma. Even less common are bleeding, infection, or perforation of the uterus.
X-ray radiation does not pose any danger to a woman at all, because its dose of 0.4-5.5 mGy is much lower than that which could lead to tissue damage. In most cases, the pain and slight bleeding go away on their own after a few days. The main thing is to limit yourself from tampons, douching, and visits to the bath, sauna or bathhouse. If the blood does not go away within a couple of days, and is still accompanied by an unpleasant odor, then consult your doctor.
Pregnancy after having your tubes checked
Doctors do not have an exact scientific basis for why pregnancy develops after HSG. Statistics indicate that this procedure actually increases the percentage of a woman’s ability to conceive a child. This happens especially often when testing for tubal patency is carried out using oil contrast agents. For this reason, some delay in menstruation after HSG may indicate not only the stress the woman has endured, but also a possible pregnancy, which you should definitely check.
Every year the number of women who cannot have children increases. This is often due to pathologies of the fallopian or fallopian tubes. A little-known to non-specialists, but effective method called “hysterosalpingography” will help to identify this problem and cope with it.
Let's find out the features of this method.
What it is
Hysterosalpingography (HSG) is a method for examining the patency of the fallopian tubes. The name literally translates from Greek as “description of the fallopian tubes.” The fallopian tube is the passage between and. Here it is fertilized and then moves into the uterus for development.
If the uterine “corridor” is blocked by something, pregnancy will not take place. Therefore, doctors refer women for an HSG examination.
Hysterosalpingography as a method of female organs is performed to accurately determine the cause of infertility. During the procedure, a contrast liquid is injected into the uterus with a catheter and the cavity and fallopian tubes are filled with it. Using an x-ray or a doctor examines the condition of these internal organs: the patency of the oviducts, the presence of pathological formations, adhesions or inflammation.
Which is better: ultrasound or x-ray
In gynecology, two methods of hysterosalpingography are used, so you need to understand what these types of diagnostics are and how they are done:
- GHA echo, or Ultrasound: A sterile saline solution is injected into the uterus, after which ultrasound is directed transvaginally to it. As a result, an image appears on the screen, which the doctor examines in real time. The disadvantage of this method is that there may be inaccuracies: the screen may show a spike where it actually does not exist. But there are also advantages: after the procedure, the woman does not have any unpleasant sensations. In addition, during the diagnostic process, physiological fluid breaks up small adhesions, improving the patency of the tubes and increasing the chances of getting pregnant.
- X-ray: an iodine-containing liquid is gradually introduced into the uterine cavity in small portions, which reflects X-rays, and pictures are taken using the device. This method gives more accurate results. In addition, other doctors can later review the images.
Did you know? The uterus is very elastic. In a healthy, non-pregnant woman, it is small: it reaches 7.5 cm in height and 5 cm in width. During pregnancy, this organ greatly enlarges. At week 20, the uterus reaches the level of the navel, and by week 36 it reaches the lower level of the chest.
Indications
Hysterosalpingography, as the procedure for examining the patency of the fallopian tubes is called, is prescribed in different cases:
- infertility;
- somewhat repetitive;
- preparation for and;
- developmental disorders of the uterus;
- complications after miscarriage or;
- suspicion of tuberculosis of the uterus and tubes;
- intrauterine diseases (hyperplasia, submucosal);
- suspicion of isthmic-cervical insufficiency;
- monitoring the condition of the uterus and tubes after.
Contraindications
HSG is contraindicated in:
- or suspicion of it;
- on, which contains contrast liquid;
- renal and heart failure;
- inflammation of the uterus and;
- infectious and bacterial diseases;
- acute inflammatory processes in the genital organs;
- changes in and .
Preparation
Before performing hysterosalpingography, the doctor will explain to the patient what it is, how it occurs in women and what to do before it. For the procedure to be effective and harmless, you need to carefully prepare for it:
- Be examined to make sure that the woman is not sick with syphilis, HIV, B and C, undergo and have the vaginal microflora checked.
- 7 days before this, you cannot apply creams or use intimate hygiene products that disrupt the microflora.
- Before diagnosis, you need to empty your bowels using an enema or laxatives;
- HSG is done on an empty stomach. 1.5 hours before the x-ray you are allowed to drink no more than 1 glass of water. Before, on the contrary, it is recommended to drink a lot of water so that the bladder is full, which will improve the image.
- To relieve muscle spasms and get rid of nervousness, it is advisable to take and before the procedure.
Methodology
An analysis of fallopian tube patency, as hysterosalpingography is simply called, resembles a routine examination. The patient is located on a special chair. The X-ray machine is above it. When performing an ultrasound, the doctor uses a vaginal sensor.
First, the doctor disinfects the external and internal genitalia. Then, through a catheter, the uterus is filled with warm contrast liquid, and the device takes a picture of the cavity. Then the second part of the fluid is supplied, filling the fallopian tubes and exiting into the peritoneum if the tubes are patent. At this time, 1-2 more pictures are taken. The whole procedure takes 30-40 minutes.
If an ultrasound is performed, a different contrast agent is used, through which ultrasound waves are passed using a sensor. At the same time, the doctor examines the image on the monitor screen. These manipulations last only 15 minutes.
Many women are afraid of hysterosalpingography, believing that it is painful and harmful. But irradiation in very small doses is not dangerous for, and ultrasound analysis is generally harmless. The procedure is usually painless and done without anesthesia. 
A nagging pain, as with, can be felt when a catheter is inserted and the organs are filled with fluid. This feeling goes away soon after the procedure. Nulliparous patients experience particular discomfort. The doctor may give them local anesthesia.
Interpretation of results
The doctor who performed the HSG will give the patient not only an x-ray, but also a conclusion with an interpretation (this is a transcript of the results), which in medicine is no less important than the analysis itself. With normal patency of the oviducts, the uterus on the radiograph looks like a regular triangle with the apex at the bottom and the oviducts in the form of ribbons, from which the injected liquid emerges, similar to smoke in the picture.
If the pipes are impassable, the reason for this should be visible. With an x-ray and a conclusion, you need to contact your doctor, he will explain everything and prescribe treatment. 
Factors influencing the result
The purpose of the HSG and its type determine on what day it is done. X-rays are prescribed for the first half of the cycle (preferably between the first day after menstruation and). At this time, the layer of the endometrium (the lining of the uterus) is quite thin, resulting in a more accurate image.
Ultrasound is done on different days of the cycle depending on the diagnosis that needs to be confirmed:
- patency of the fallopian tubes and isthmic-cervical insufficiency are determined in the second period of the cycle;
- installed on day 7 of the cycle;
- submucosal uterine fibroids are confirmed in any phase.
How will you feel after hysterosalpingography?
After HSG of the fallopian tubes, the consequences of this procedure may be felt for several days:
- small;
- nagging pain in the lower abdomen, which can be easily treated with painkillers;
- The stress that a woman experiences during the test can delay the onset for a couple of months.
Complications of HSG
HSG is often used in gynecology because this examination does not cause such complications as may occur after other methods. But sometimes there may be such consequences:
- allergy to contrast fluid;
- bleeding or perforation of the uterus;
- inflammatory process.
Pregnancy after HSG
HSG is a diagnostic method, not a treatment method for infertility. But after this procedure, a long-awaited pregnancy may occur, since the contrast agent often has a therapeutic effect:
- During an ultrasound examination, a saline solution eliminates small adhesions, improving the patency of the fallopian tubes.
- An oil-based contrast fluid increases the activity of the uterine glands and endometrium.
So, hysterosalpingography is a method for diagnosing and establishing the cause of infertility. Its purpose is to confirm the previously made diagnosis. But it should be remembered that this is not the main method; it requires additional analysis. If a doctor orders an HSG test for a specific reason, you need to find out from him what it is, how the procedure is performed and where it is best done.
It is one of the most informative in diagnosing diseases of the pelvic organs. HSG, or hysterosalpingography, is another additional imaging method that allows you to get a more complete picture of the anatomical and functional state of the uterine cavity and fallopian tubes. It is especially widely used to diagnose the causes of infertility.
Preparation for hysterosalpingography
Timing of the procedure depend on the presumptive diagnosis and purpose of the study. To assess the patency of the fallopian tubes, as well as to clarify the presence or absence of internal endometriosis and adenomyosis, HSG is carried out on days 5-8 of the menstrual cycle, if cervical insufficiency is suspected - in its second phase (on days 18-20). Diagnosis of the volume and boundaries of the submucosal (under the mucous membrane) myomatous node is carried out on any day of the menstrual cycle, provided there is no heavy discharge of blood from the genital tract.
Indications and contraindications
Indication to hysterosalpingography is the assumption of the presence of:
- Isthmic-cervical insufficiency - expansion of the cervical canal and its internal os to 5-7 mm.
- Anomalies of the development of the uterus and appendages.
- Submucous fibroids or synechiae (adhesions in the uterine cavity).
- Adenomyosis, endometrioid cancer, polyps, genital tuberculosis.
One of the stages of preparation is examination of the patient by a gynecologist and preliminary studies in order to determine not only indications, but also contraindications for HSG.
Contraindications:
- Assumption about the possibility of pregnancy.
- Pregnancy and breastfeeding.
- Bloody discharge from the genital tract.
- Acute infectious diseases.
- The degree of vaginal cleanliness is below grade II and acute inflammatory processes of the genital organs or urinary tract - bartholinitis, vaginitis, cervicitis, salpingoophoritis, urethritis, cystitis, pyelonephritis.
- Severe chronic somatic diseases.
- stopping the use of vaginal medications and douches 7 days before the study, unless prescribed by a doctor, and within 3 days after the procedure;
- refusal of sexual intercourse or use of contraception during the menstrual cycle during which the examination is planned;
- no sexual intercourse for 1-2 days before the procedure and 2-3 days after the study;
- exclusion from the diet of foods that promote gas formation in the intestines 3-4 days before the test, cleansing enemas the night before and in the morning on the day of the procedure.
Hysterosalpingography is normal
How the research is carried out
The method exists in the form of two options, depending on the equipment used - radiopaque (Rg-HSG) and sonographic or ultrasound (US-HSG). In any case, hysterosalpingography is performed on an empty stomach without the use of anesthesia.
The procedure may cause the patient being examined a feeling of discomfort, discomfort in the lower abdomen and minor pain. Therefore, in case of psycho-emotional instability and high excitability, fear about the procedure and at the woman’s request, it is possible to administer sedatives or conduct adequate general intravenous anesthesia.
The study is carried out on a gynecological chair. After a preliminary examination and induction of anesthesia (if necessary), a special balloon catheter about 35 cm long and with a lumen diameter of 0.2 cm is inserted into the cervical canal. It is equipped with a cone-shaped balloon that ensures tightness in the area of the external os of the cervix.
Through the outer end of the cannula, 2.5-3 ml of a radiopaque or echo-contrast solution is injected into the cervical canal with a syringe, and an X-ray or on-screen examination (in the case of ultrasound-HSG) of the inner surface of the uterine cavity is taken. Then about 4 ml of contrast solution is injected, thereby achieving tight filling of the uterine cavity and exit of the solution through the fallopian tubes into the pelvic cavity (to check the patency of the tubes). This is also recorded by photograph or inspection. If necessary, control is carried out by repeated administration of another 3-4 ml of solution. The total amount of the latter is 10-20 ml.
In order to diagnose isthmic-cervical insufficiency and determine its cause, adrenal progesterone test . When performing HSG on the 18th day of the menstrual cycle, a sharply narrowed cervical canal and its internal os are normally detected. If they are dilated, the named test is performed.
It helps to determine whether the disorders are organic or functional. The essence of the test is the subcutaneous injection of 0.5 ml of 0.1% adrenaline. 5 minutes after this, a control HSG is performed. If narrowing of the cervical canal has not occurred, then in the evening of the same day, oxyprogesterone capronate (0.125 g) is injected into the muscle, followed by repeating the previous procedure after 4 days.
With functional cervical insufficiency caused by insufficiency of the corpus luteum, after its correction with oxyprogesterone, a sharp narrowing of the canal occurs, but in the case of an organic reason for its expansion, it remains the same.
Thus, ultrasound hysterosalpingography and X-ray HSG are almost no different in technical implementation. They are also equivalent in terms of information content. The main difference between the methods is:
- Contrast solutions used. In the case of ultrasound-HSG, an echo-contrast solution is used that does not cause allergic reactions - a 10% glucose solution or echovist, which is galactose granulate in a bottle. It is dissolved immediately before the study to a 20% suspension with a solvent added to the preparation. For X-ray HSG, iodine-containing X-ray contrast agents are used - Verografin, Triombrast, Urotrast or Cardiotrast. Their administration should be preceded by a sensitivity test, since any of these drugs can cause a severe allergic reaction.
- Degree of exposure to physical factors (radiation). US-HSG is based on the use of the effect of ultrasonic waves, which do not have a negative effect on the genitals. Despite the fact that a small dosage of X-ray radiation is used for Rg-HSG, nevertheless, with repeated images it has a cumulative biological effect on the ovaries. Therefore, trying to become pregnant is recommended only after menstruation following the study.
Consequences of hysterosalpingography
In some women who have undergone HSG, the onset of the first menstruation after the procedure occurs at a later date than usual, followed by the restoration of the previous cycle. Such a delay after hysterosalpingography, usually not exceeding several days, is apparently associated with psycho-emotional stress and mechanical interference with the function of the genital organs.
HSG is solely a diagnostic method and not a therapeutic method. However, many patients who were examined for infertility note the onset of pregnancy in the next 3 months after the examination.
There is no scientific explanation for this. Some doctors associate pregnancy after hysterosalpingography with the introduction of an oil solution of a radiopaque substance, which supposedly improves the function of the villous epithelium of the tubal mucosa and destroys “loose adhesions,” which is unlikely.
The assumption of mechanical washing with a solution of a contrast agent of mucus that forms on the mucous membrane of the walls of the fallopian tubes in the presence of a sluggish inflammatory process that has not been previously diagnosed seems more convincing. As a result, the patency of the tubes and the function of the villous epithelium are restored for some time.
Another assumption is a short-term correction of the function of the corpus luteum with oxyprogesterone during an adrenal-progesterone test.
After HSG, discomfort in the lower abdomen may persist for 1-2 days, and minor bloody and/or mucous discharge may appear. If the procedure was performed against the background of a chronic inflammatory process, an exacerbation of the disease is possible.
At the same time, hysterosalpingography in most cases does not cause any serious consequences and is a highly informative additional method in diagnosing a number of diseases and causes of infertility in women.
