by Carolyn (otherwise known as the Heads Up Queen--not to be confused with the Heads Off Queen from Alice in Wonderland)
Why Would You be Having an HSG?
The HSG is one of the first diagnostic tests an RE runs when you’re having trouble conceiving. It is usually given shortly after the first infertility appointment, no later than CD 12 of your latest cycle.
Common problems that can be diagnosed with an HSG include: blocked fallopian tubes, uterine polyps, fibroids, and uterine defects such as a septum or a bicornate uterus.
What You Can Expect
The HSG is performed in the radiology department and is usually administered by a radiologist and an RE. You’ll lie down on the table underneath an x-ray machine, and the RE will insert a speculum as if you were having a PAP smear. The RE will then insert a catheter into your cervix and inject a clear dye into your uterus. For most women, this is the most uncomfortable part of the procedure. To me, the dye felt like sharp, strong menstrual cramps that lasted for a little over a minute. After that, I felt no pain at all.
While the RE is injecting the dye, the radiologist will take pictures of your uterus and tubes. Most of the time you should be able to see what’s happening on a screen somewhere in the room. You’ll be able to see the shape of your uterus, and if your tubes are clear you should be able to see each tube and then the dye as it spills out into your abdominal cavity.
If your tubes aren’t clear, the procedure may be more painful since the dye can’t spill out. The RE may try to force a closed tube open by injecting more dye, and this sometimes works.
After the test is over, you’ll be able to get dressed again and may go over your test results with the RE immediately. If not, your RE should schedule an appointment with you fairly soon to discuss the results. If your appointment isn’t for several days, try to get at least a preliminary report from the RE or radiologist while you’re still in the room.
Make sure to bring your own pad to the hospital or clinic because the dye is very messy and will be leaking out of you for several days. Dye that remains in the abdominal cavity is absorbed into the body. You may also experience some spotting after the procedure, but not heavier than a period.
There is some evidence that suggests that there is an uptick in fertility for the three cycles after the HSG.
Problems That Might Arise
Pain is the most common problem associated with the HSG. Some women experience only mild discomfort, while others experience severe pain. If you have a tight cervix the insertion of the catheter will be very uncomfortable. Occasionally, if you are experiencing severe pain your fallopian tubes may close even though they’re usually open.
If you are allergic to iodine, make sure you tell your RE before the procedure, since the most commonly used oil-based dye contains iodine and can cause an allergic reaction. There is also a water-based dye that can be used if you have an iodine allergy.
There is also a small chance of infection associated with the HSG, so your doctor should place you on antibiotics for several days before and after the procedure. If you feel more pain or experience heavy bleeding after the HSG, contact your doctor immediately.
Since the HSG is usually the first invasive fertility procedure most women go through when they’re having trouble conceiving, it can be overwhelming and emotional. I did an acupuncture session the morning before my HSG, which was a wonderful way to stay calm and focused during the procedure.
Talk to your doctor before the HSG if you can. Ask them to tell you what they’re doing as they’re doing it, and don’t be afraid to tell them when something hurts. In my experience, REs seem to think that an HSG isn’t a very big deal. It’s a VERY big deal to the woman who is lying on the table, both physically and psychologically. Anything you can do to remind your doctor that this isn’t just “business as usual” for you will help.