Tube Test: All you need to know about Hysterosalpingogram

Introduction

A hysterosalpingogram (HSG) is also known as a Tube Test. It is an X-ray dye test, which helps in diagnosing fertility-related problems in women. With the help of a Tube Test, the doctor can study the reproductive anatomy of a woman that is hindering her to get pregnant. These problems include fallopian tubes that are blocked and an irregularly shaped uterus.

The procedure of HSG is such that an X-ray machine captures the images of the woman’s uterine cavity and fallopian tubes, which are filled with a special type of dye.

The doctor plans the HSG test with such a timing that it falls during the first two weeks of a woman’s menstrual cycle. It is after the last period has ended, but before she ovulates. It is because this period has less chance of pregnancy for the female or menstruating during the test. It is important to note an HSG shouldn’t be done if a woman is pregnant or there is a pelvic infection.

Why is an HSG performed and when?

An HSG is an important diagnostic technique that helps the doctor to ascertain whether the fallopian tubes are blocked or they are open. This will give the physician an idea about any fertility problems in the patient.

When the fallopian tubes are open it provides a clear path for the woman to conceive because sperm make their way through fallopian tubes to fertilize an egg. The fertilized egg (embryo) then travels through the fallopian tubes to the uterus. The embryo then grows there and develops into a healthy fetus.

So, when the fallopian tubes are blocked it prevents these processes from happening naturally, which is the main reason for infertility.

An HSG helps the doctor to confirm the success of a tubal ligation or tubal reversal.

As a test, HSG can predict whether a tubal ligation procedure managed to successfully close the fallopian tubes so that the woman can’t get pregnant. It is also helpful in determining if the procedure was reversed as desired.

It helps in planning for further imaging. An HSG is a great way to learn about any irregularities in a woman’s uterus (fibroids, abnormal shape). It aids the consulting doctor to make any plans for further imaging, such as hysteroscopy and sonohysterography. A sonohysterography is more sophisticated in further defining the results of an HSG while also providing a final diagnosis. On the other hand, hysteroscopy is beneficial in intervening in specific conditions of the uterus.

These days, HSG is mainly used to determine whether the fallopian tubes are open. There exist numerous alternative tests that are less complicated and also offer a more comprehensive evaluation of the uterus.

An HSG is performed by a gynecologist, a radiologist, or a reproductive endocrinologist. After the test, the X-rays are assessed by a radiologist who writes a report and communicates the results to the consulting doctor.

The procedure of HSG and what to expect

For the HSG procedure, the technician fills the uterine cavity and fallopian tubes of the female with a dye. The dye forms an outline of the uterus and the fallopian tubes making them distinct on an X-ray. When the X-ray depicts the free flowing of the dye through the fallopian tubes, it is an indication that they are open. Contrarily, when the dye stumbles upon a barrier preventing the flow, it means the fallopian tubes are choked or blocked.

What you can expect before an HSG

The doctor, in the beginning, reviews the medical history of the patient to make sure that the woman can successfully undergo an HSG. If a patient is tracking the luteinizing hormone (LH) levels, the doctor may examine the results of the LH test. It will ensure that the woman is not pregnant. The doctor will also make sure that the patient is not allergic to any parts of the dye solution that is used during the procedure of HSG. Apart, the physician will also deliberate on any risks with the patient, which is very minimal with the HSG process.

Preparing for an HSG

The patient should strictly follow the instructions of the doctor and technicians available during the procedure. Following are some of the recommendations usually made by the doctor:

To take OTC (over-the-counter) medicine for pain an hour before the process
To take antibiotics beforehand to curb infection
To bring someone along to drive the patient home after the HSG

The patient may have difficulty in driving back home because she may experience cramping making it difficult to drive. Hence, it is advisable to have someone to assist, in such a scenario.

The whole HSG procedure gets over in less than five minutes and the patient can leave for home the same day once it is over.

For the procedure, the doctor or technician will inject a solution with dye into the uterus and fallopian tubes while an X-ray captures the images, as mentioned above.

Taking the dye injection

The patient will have to lie on the examination table with her knees bent and legs open, akin to having a pelvic exam. The X-ray machine (fluoroscopy machine) will be positioned above the table.

The provider then inserts a tool called a speculum into the vagina with the purpose to widen it, facilitating the doctor to gain access to the patient’s cervix.

After that, the provider will clean the cervix and insert a small catheter in the cervical canal and into the patient’s uterus. The catheter resembles a thin plastic tube, which is called a cannula. It is also possible that the provider may use a thin plastic tube that has a balloon at the end. The use of the balloon is that it inflates once inside the body to hold the tube in place so that the dye could be injected properly and safely.

Is HSG painful?

It is worthwhile to mention that HSG can be mildly painful or there could be slight discomfort for the patient, both during the process and once it is over. The patient is likely to experience mild cramping when the provider inserts the dye solution into her uterus. The cramping may be more in the case of blocked tubes.

Once the process is over, the cramping may remain from five minutes to a few hours. The cramps may be moderate and mild, so nothing to worry about. It is helpful if one takes over-the-counter NSAIDs to assuage the cramps.

Conclusion

After the procedure, one may have to put on a pad to catch the leaking dye solution from the vagina, which is often sticky and contains a small amount of blood. There could be some side effects as well such as cramps, dizziness, an upset tummy, nausea, a small amount of vaginal bleeding for a couple of days, etc. The patient can resume normal activities based on the comfort level immediately after the HSG.

As for risks, an HSG utilizes radiation to capture X-ray pictures, but the radiation is very minimal. So it is not considered risky. There may rarely appear a few complications including infection, injury to the uterus, an allergic reaction to the dye solution, etc. If you want to know more about an HSG or tube test price in India, contact your healthcare facility or laboratory for an exact quote on this.

FAQs

What is the HSG or tube test procedure?

Hysterosalpingography or HSG, also known as a tube test, is an X-ray process aimed at viewing the inside of the uterus and fallopian tubes. It is often helpful to examine if the fallopian tubes are partially or fully blocked. It can also reveal the inside size of the uterus, whether it is normal in size and shape.

What are normal HSG results?

The HSG test results are considered normal if the liquid dye flows freely through the fallopian tubes and spills out. It is an indication that there are no blockages. The spilled dye, which flows into the abdomen, gets absorbed by the body.

How many times HSG should be done?

HSG always remains valid until the advent of a new situation such as an operation or an infection or a pelvic injury. When infertility is prolonged, sometimes the patient may get frustrated and proactively ask for a repeat HSG.

Which injection is given before the HSG test?

A device called a speculum is used to insert into the vagina, ensuring it remains open. The cervix may be numbed for the process. Next, a catheter is carefully directed through the cervix and into the uterus. To proceed with the process, the radiologist will align the X-ray machine over the abdomen while a contrast dye is injected through the catheter.