Friday, June 10

HSG Procedure , The Need , The Pain & Pregnancy

-> HSG is just another X-Ray procedure.
-> Under HSG , a catheter is inserted through vagina and cervix.
-> The pain under HSG is caused due to the catheter only.

Catheter used for HSG procedure

-> In HSG , the pain caused due to catheter is like a pap smear, followed by another pain which is like menstrual cramps and occurs for 1-2 days in most cases.
-> After HSG , patients may experience delayed periods,  light bleeding or clots which is quite normal.
-> Generally, after HSG , doctors advices not to have intercourse within 24 hours.

-> HSG procedure will determine :
(a) whether the fallopian tubes are blocked ?
(b) Where the blockage is located ? - at junction , uterus , or end of fallopian tubes.

Pregnancy success rates after HSG :
There is an increased chance of pregnancy after an HSG , but it is controversial to say , whether or not a HSG can improve fertility. Some studies show a slightly increased chance of getting pregnant in the 3 months following the test , but the reason is not clear.

Some of the theories surrounding HSG and Pregnancy are :
(a) Dye flushes out the fallopian tubes , clearing partial or minor blocks in some women.
(b) Iodine Dye used in HSG enhances the endometrium ( lining of uterus) in some way making it easier for an embryo to implant successfully.
(c) Dye solution somehow effect the area surrounding the ovaries enhancing ovulation.

Pregnancy during HSG:
(a) Sometimes the women are not aware that they are pregnant and they undergo HSG procedure , which in turn, harms the embryo and can lead to miscarriage .
(b) I am giving details of 3 such cases of unsuspected pregnancy during HSG :
First case : An ectopic pregnancy :
The patient with regular menstrual cycle had undergone HSG . Her report was completely normal. After a week she suffered from abdominal pain , following which her pregnancy test was done. It came positive , but there was nothing found in uterus . They later confirmed it as an ectopic pregnancy , which ultimately led to miscarriage.
Second case : A healthy pregnancy :
A lady in her early thirties had irregular menstrual cycle ranging from 60 to 90 days , was presented for HSG.
She found herself pregnant 2 months after the procedure .She did not have any intercourse after the HSG. The ultrasound scan showed , a healthy foetus. It was concluded that she was pregnant at the time of HSG investigation. She carried her pregnancy till the 39th week and delivered a healthy baby.
Third case : A miscarriage :
Another lady in her early thirties with menstrual cycles in the range of 45-90 days had undergone HSG test. She had the pregnancy test done before HSG , and it cam negative. 2 days later , the pregnancy test came back positive after she complained of getting vaginal bleeding. On further investigation , no fetal pole was seen and the HCG levels declined , so the pregnancy was considered miscarriage and was terminated by oral administration of misoprostol .
-> The safety of pregnancy after HSG is not well known , given the rarity of this occurence, therefore precaution should betaken prior to the procedure . It is advisable to the patient , to have protected coitus for at least 4 weeks before the HSG procdure and to carry out a compulsory pregnancy test before the procedure.If in doubt , a serum HSG should be considered.

Whether HSG causes ectopic pregnancy ?
Some studies reported that there were ectopic pregnancy following the HSG . This could be due to :
(a) A pre-disposing factor of tubal damage in infertility patients
(b) Possibly a 'flushing effect ' of the amniotic sac by the contrast medium ( dye )

Related Posts : 

Pregnancy after HSG-Myth or Reality
HSG Risks and Alternatives


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