4. HYSTEROSALPINGOGRAM - (HSG)
The HSG is an x-ray of the cavity of the uterus and the fallopian tubes. The Fallopian tubes carry eggs from the ovary to the uterine cavity. It is within the outer one-third of these tubes that actual conception occurs. The purpose of the HSG is to make sure the cervix, uterus and tubes are not blocked or partially impinged upon. A variety of naturally occurring (congenital) and acquired pathologic conditions can cause blockage at various points along the internal reproductive tract. Examples of these conditions are : (1) Tubal blockage due to previous tubal infections or from appendicitis. (2) Blockage of the tubes where they join the uterus or blockage of the uterine cavity due to fibroid tumors (benign muscle tumors) of the uterus. (3) Scarring together of the walls of the uterus or cervix from previous infections, D and C, abortions or cervical conization procedures.
Most gynecologists use a water soluble dye for this test. Our office, in contrast, uses an oil base dye as has been used for some time at the Yale Medical School Infertility Clinic. The reason for this difference comes from clinical research done at Yale which demonstrated a 29% increase in pregnancy in women who had the tubal x-ray done with this type of dye. There was no increase in pregnancy demonstrated with the usual water soluble dye. This beneficial effect lasts for six months following the tubal x-ray. I will do the test myself at Jewish Hospital in the Radiology department. I usually do this test to coincide with the 5th -10th day of the menstrual cycle. The test should not be done if the menstrual period is still flowing.
You will be positioned as for an ordinary internal pelvic exam on a radiology table equipped with an overhead x-ray and fluoroscope machine. The inside of the vagina will be cleansed with a cold antiseptic solution. Then a grasping instrument will be affixed to the cervix. This feels like either a pinch or a small cramp to some women, while many women feel absolutely nothing. A narrow metal tube is then placed about one-third of an inch into the cervical (birth) canal. This may cause a small cramp or two but no significant pain. At this point x-ray dye is injected through the tube. The flow of the dye will be viewed by me through the fluoroscope on a television monitor. At the appropriate time, a quick x-ray will be taken by the technician. The procedure is thus complete and you will then be able to leave.
Either one hour later or occasionally the next day, a delayed x-ray should be taken. For those of you who live far away from the hospital, this film can be taken at a hospital or x-ray clinic close to you as long as you remind me to give you a note to take to that facility. For those of you who live relatively close, this x-ray should be taken at Jewish Hospital. This time, however, you need not check in as you did before; but simply return to the x-ray department and tell the person at the desk that you are there to have your delayed HSG film for Dr. Levin taken. This should only take a minute or two and involves no discomfort. In fact, it is a standing film of the pelvis and if you wear a skirt without any metal, you will not need to even undress. Be sure to schedule the exact time of the follow-up x-ray before you leave the hospital. After the test you may have a brownish or even bloody discharge. This is normal and should be of no concern. Intercourse, tampons and douching should be avoided for twenty-four hours. (You will receive a separate bill from the hospital for the cost of the x-ray materials as well as an interpretation fee from the Radiologist at Jewish Hospital under the name Dr. Tyson, Schwab, Short and Weiss.)