Medical Contribution By Jason G. When beginning the infertility treatment process, diagnostic testing will be the first step you take before your clinical plan can be created. Infertility is diagnosed based on the results of three main tests: Each test looks at a different component significant to conception: Day 3 hormone bloodwork: Determines the condition of the fallopian tubes and uterus. Prior to starting diagnostic testing, many patients have already had their blood drawn and know what to expect regarding hormone evaluation.
Most patients, though, have not experienced a hysterosalpingogram HSG. Fear of the unknown can make many patients nervous or apprehensive about this aspect of their diagnostic work-up. However, learning all that SGF does to make the test more manageable is hopefully reassuring.
After ovulation, a current in the body pushes the egg into the fallopian tubes where the sperm and egg will meet and fertilization can occur. Once an egg is fertilized, an embryo will develop and continue through the fallopian tubes until it reaches the uterus, where it will implant into the uterine lining.
It can also make sure the cavity is not affected by fibroids, polyps or scar tissue. This is an important step as it allows the practitioner to be sure that the patient is not unknowingly pregnant prior to starting the HSG. Should a patient be pregnant, the dye used to fill the uterus can harm or displace the growing fetus, resulting in an increased risk of miscarriage. At the start of the procedure, a speculum is inserted into the vagina in order to view the cervix, similar to a Pap smear.
The cervix is cleaned with an antiseptic solution; then, a thin, plastic catheter, generally about the size of the tip of a pen, is placed inside the cervix. Once placed, a small amount of contrast dye, usually two to three teaspoons, is passed through the catheter into the cervix, filling the uterus and fallopian tubes. The tubes are considered open when the dye is able to move completely through the length of the tube, spilling the dye out on the other side.
Immediately following the HSG test, patients will receive preliminary results from their practitioner. When spotting or discharge occurs, we encourage patients to use sanitary napkins or pads as opposed to tampons. We also encourage our patients to speak with their physician about taking some over-the-counter pain reliever following the test to reducing any cramps or discomfort.
While uncommon, a risk associated with HSG is infection. Patients that have a diagnosed or suspected problem with their fallopian tubes — such as a history of ectopic pregnancies or a hydrosalpinx — will likely be prescribed an antibiotic to be taken in advance. An HSG will not bring on menses, so if you experience a full menstrual flow, develop a fever, or continue to feel pain for more than a few days, you should speak with your physician.
Shady Grove Fertility places high value on patient safety and comfort and goes out of our way to minimize discomfort. We encourage taking a pain reliever 30 to 60 minutes prior.
Many women feel some cramping for about 2 minutes when the dye is filling the uterus. Therefore, we strongly encourage taking an over-the-counter pain reliever such as ibuprofen 30 to 60 minutes before the test to reduce feelings of pain or discomfort. This will help tremendously. Also, speak with your doctor about taking pain medicine 30 to 60 minutes before the procedure especially if you have a history of ectopic pregnancies or a hydrosalpinx. We have very experienced clinicians who perform HSGs.
The clinicians at our practice who perform HSGs perform thousands each year and have the experience and expertise to help make your experience as comfortable as possible. We encourage you, if you are feeling any discomfort during the test, to communicate with your clinician performing the test, let us know if it hurts, and we may be able to make some adjustments to make you more comfortable.
We are selective about dye and instrument type. We select a dye that is known to cause the least amount of cramping and an instrument that is known to cause the least amount of discomfort.
We care about your comfort. We perform this procedure on a GYN table, which makes patients more comfortable, compared with a hospital table common in other locations. It was nothing at all. Like a regular OB exam, but a little bit longer. I only felt a little pinch when they inserted and inflated the catheter. When they injected the dye it just felt like a very dull menstrual cramp and then it was over before I knew it! While the actual procedure takes about 5 minutes, you should plan to arrive for your HSG 30 minutes prior to your scheduled appointment.
You can also expect to be with us for minutes after the scheduled HSG start time. Is it okay to drive home by myself after the test? The standard operating procedure for an HSG does not call for sedation. You are unlikely to have pain following the procedure, but you may feel crampy or achy. The majority of our patients are able to drive after an HSG and even immediately return to work. When is the best time during my cycle to schedule the HSG?
The test should be scheduled after your period ends, but before you expect to ovulate — usually between days 5 to 12 of your menstrual cycle. To figure out the days of your cycle, count day 1 as the day your period begins. Where can HSGs be performed? HSGs can be completed in many healthcare environments, including hospitals, radiology labs, or other free-standing centers. No, Shady Grove Fertility physicians routinely make diagnostic and treatment decisions based on HSGs performed at facilities other than our own.
Occasionally, however, the information on an HSG done at an outside facility may be inconclusive or not provide all of the information needed for the best medical recommendation.
In these situations, your Shady Grove Fertility physician may recommend repeating the HSG to obtain necessary information. Because we take great pride in the lengths to which we are able to go to make sure women are as comfortable as possible during an HSG, many physicians refer their patients to SGF for an HSG. Who can administer an HSG? HSGs can be performed by infertility specialists, obstetrician-gynecologists, radiologists, physician assistants and other health care providers.
Health care providers performing HSGs should be trained in performing pelvic exams and be technically proficient with the HSG technique. They should also be able to evaluate its findings and report them comprehensively. Will I have insurance coverage for my HSG? Patients whose insurance policy does not extend HSG benefits at Shady Grove Fertility will incur a charge for the procedure and will be responsible for its payment.
The cost versus the benefits can be discussed with your primary Shady Grove Fertility physician, as well as other questions you may have about the HSG. How soon after the HSG can I resume intercourse? Generally, we want patients to abstain from intercourse until after vaginal spotting or discharge stops, usually 1 to 2 days after the HSG.
The HSG, though not commonly known, is a beneficial way that your physician can determine the best path to help you on your journey to reproductive success.