Hysterosalpingography (HSG) and other tests to evaluate the uterine cavity

An important part of the evaluation of couples or singles that are faced with infertility is an evaluation of the fallopian tubes and/or the uterine cavity. Twenty to thirty percent of cases of infertility are due to abnormalities within the fallopian tubes and/ or the uterus. The presence of abnormalities within the tubes or uterus can dictate the type of fertility treatments that are used as well as the success rate and outcome of a pregnancy.  Here at the Center for Fertility and Gynecology in the Los Angeles area we perform the most advanced fertility testing.

Tests to Evaluate the Uterine Cavity and Fallopian Tubes

The uterine cavity and fallopian tubes are virtual cavities and cannot be assessed with a regular sonogram. A pelvic sonogram can detect abnormalities within the muscle of the uterus or detect abnormalities in the size and/or contour of the uterus but it cannot detect abnormalities that are within the uterine cavity and cannot detect patency or occlusion of the fallopian tubes. The most common tests that are used to evaluate the uterine cavity and fallopian tubes are:

a.Hysterosalpingogram (HSG)

b.Saline infusion Sonohysterography (hydrosonogram)

c.Hysteroscopy and Laparosocpy with chromopertubation.

HSG: Hysterosalpingography (HSG):

Radiographic evaluation of the uterine cavity and fallopian tubes after injection of a radio-opaque medium through the cervical canal. The test is recommended for patients with infertility as well as for patients with suspect uterine or fallopian tube pathology. The HSG allows detection of abnormalities within the uterine cavity and cervical canal such as uterine fibroids, uterine polyps, uterine adhesions and congenital malformations of the uterine cavity. The HSG also provides information on the patency and shape of the fallopian tubes. Added to its diagnostic potential HSG can also increase fecundity rate in the month in which the procedure is done.

Saline Infusion Sonohysterography (Hydrosonogram):

Saline infusion sonohysterography is a procedure in which sterile water is instilled into the uterine cavity transcervically. The uterine cavity is then assessed using a transvaginal sonogram. Hydrosonogram is an excellent test for detection of uterine abnormalities but it cannot evaluate the fallopian tubes. In patients with infertility, a hydrosonogram can be used prior to an In Vitro Fertilization (IVF) cycle when tubal patency does not need to be confirmed. The test is performed at the physician's office by injecting a small amount of sterile water into the uterine cavity under ultrasound guidance.
Hysterosalpingography and Saline infusion Sonohysterography:

Although excellent tests, are not always precise.  It is not uncommon for those tests to detect abnormalities that are then not found during surgery. Due to the significant false positive rate (detecting abnormalities when not there) all abnormal HSG and Hydrosonogram tests are usually followed by surgery in order to confirm and possibly treat the underlying pathology.

Hysteroscopy and Laparoscopy with Chromopertubation:

Surgical procedures used to evaluate the uterine cavity as well as the fallopian tubes. They are called minimally invasive surgeries and are usually done in day surgery, hospitals or surgical centers. These surgeries usually last one to two hours and do not require an overnight stay in the hospital. Recovery from these surgeries is usually very quick.

If you have any questions regarding fertility or testing of the uterine cavity and fallopian tubes please contact Paula at Paula@center4fertility.com