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

HSG : Risks and Alternatives

If you are allergic to Iodine , sea food or have had bad HSG experience earlier, you can ask your doctor for sonohysterogram procedure.
This is less painful than HSG. In contrast to the Iodine dye , they use saline water to inflate the uterus. This procedure can also detect abnormalities in the Uterus. Also while HSG uses X-Ray , the sonohysterogram uses ultrasound , and is more accurate than HSG.

Common symptoms after HSG test :
Some women have reported bleeding , fever persisting for few days after having done HSG. While this is normal in most cases , but if the symptoms persist , you should meet your doctor.


Other rare symptoms after HSG :
1. HSG might cause inflammation of the lining of the uterus , report if you have persistent fever, lower abdominal pain, and bleeding.
2. HSG might cause cramping ( take ibuprofen before HSG test to reduce the pain ).
3. HSG might cause inflammation of the fallopian tubes ( report if you have vaginal discharge )

These are treatable and your doctor might recommend you antibiotics for the treatment of the above symptoms.

The test must not be done ( or not useful ) for women who have :

1. Pelvic Infection
2. Pregnant
3. Contracted fallopian tube


When should the doctor ask for HSG test ?
The doctor must determine other infertility variables like TSH , Progestrone , LH , FSH , AMH before going for HSG test.
If these variables do not signal a definite cause for infertility , they will ask for a HSG report before determining the future course.

What are the chances for pregnancy after HSG test ?
Some women have reported pregnancy after having undergone HSG test.  It might be because of small obstructions getting cleaned by the iodine dye. However it has only temporary effect lasting for 2-3 months. HSG is only a diagnostic procedure and not a fertility treatment method.

Consent form for HSG.
Some countries have made consent form mandatory for patients undergoing the HSG test. This is to make the patient aware of the risk of HSG treatment.


Precautions before HSG test:
1. Explain you current medication to the doctor. Most of the infertile woman are also suffering from PCOS , and normally take Glyciphage ( metformin ) tablets for decreasing total and free testosterone , as well as increasing the androgens to regularize menstrual cycles.
2. If you are diabetic , since the HSG dye can interfere with kidney functions.
3. Take sanitary pads for possible after leakage of dye
4. If severe cramping occurs , ensure that the diagnostic facility have rest rooms for you to lie down a while.


Another option is to have the HSG test is having it under anesthesia ( to avoid the pain during the procedure ).
You may also want to read some experiences on HSG Procedure with anesthesia  & without anesthesia.


Related Posts : 

Pregnancy after HSG-Myth or Reality
HSG Procedure , The Need , The Pain & Pregnancy
Getting Pregnant is just the starting of a risky and long journey.

HSG Procedure in Manipal vs Sure Fertility Bangalore

I want to give some insight into the HSG procedure that i went across in Bangalore , at 2 different locations
You might also like to read about HSG Risks and HSG Side-effects, HSG Alternatives.
Getting Pregnant is just the starting of a risky and long journey.

--> HSG Procedure @Manipal

The first HSG procedure i had was at Manipal hospital and the second HSG procedure was at Sure fertility.

The difference in the procedure was that the HSG procedure at Manipal was without anaesthesia , while at sure fertility it was with anaesthesia.

  At Manipal hospital Bangalore , the HSG test was performed by a separate department , which handles all the scans , X-rays , Ultrasounds and the HSG as well. While this might sound particularly cool , but at Manipal they treated it just like an ordinary scan only. There is always a huge rush , so even with an appointment the wait tends to be like 1 hour or so , because they need to prepare the dye , which they will then insert into the fallopian tubes , through the vaginal opening. The HSG procedure at Manipal was very very painful . I could not walk , they pressed so hard against me , because they wanted the coloured dye to reach as far as possible to reach both the tubes . The purpose is to take a subsequent X-ray . If the due flows through both the tubes, it will show the color in X-ray . If there is a blockage , the dye will stop , and the point can be detected in the X-Ray. My Doctor had warned me beforehand that any the HSG procedure without anaesthesia will be painful.
I had bleeding till next 7-8 days . Well bleeding is very common , but it is the pain that made it really uncomfortable.


--> HSG Procedure @ Sure Fertility

After my first HSG scan at Manipal, i decided i will take the next HSG test under anaesthesia only. Sure fertility was suggested by my doc only , since Sure fertility do HSG test after administering anaesthesia. It's a small hospital , specialize in infertility treatment . I had to wait an hour until they prepared the room for doing scan and anaesthesia. They called a doctor who administered anaesthesia and another gynaecologist to perform the test. After they put the anaesthesia the lower part of the body did not feel anything. I was completely awake , but during the course of HSG test , I could not feel any thing.

I was happy that the HSG procedure went so well , that i had to ask the doc , if it's really over. The surprise was yet to come. As soon as the anaesthesia effect faded, i had terrible pain , not as much as the first experience in Manipal. But it was there. As usual i bled for next 1 week . Reports were normal this time.

The doctor told me some ladies does get pregnant after doing HSG test , as it cleans the tube and remove some residual stuff , and makes it easier for the egg to travel. Though rare , but some cases have been noticed , where patients have reported pregnancy in next few cycles.

I was very curious to find out the result of my next pregnancy test . It came out negative. But But the very next one came positive and I am very happy having progressed in my pregnancy . I hope to deliver a good baby and wishes all of you would be mom's and dad's all the best. DO share the good news here, and drop any questions. Good Luck !! Bye....   @Laxmi.

--> HSG Procedure Video

Since there was a comment at the end , regarding the kind of anesthesia they administer , I would like to clarify that it was local anesthesia. I was awake during procedure with absolutely no feeling in the lower part.
Thx