Techie Tuesday: HSG (Hysterosalpingogram)

Hello folks. Today is techie Tuesday. I am going to spend a few moments providing links to some IF techie things. I want to state pretty clearly that I am not a medical professional.  I am a computer geek/IT professional with over 20 years in the computer and biotech industries. A geeky gal who likes to research her condition/situation/whatever. My supreme computer nerdiness has enabled me to dig up some good places on the net to find info. I have been up many a late night trolling for data and more information on this whole infertility thing. Anywho...

So on 4/2/09 I got to "enjoy" a HSG exam by my excellent RE. Ill call him DocO from now on. DocO is great. He is pleasant, smart and doesn't pussyfoot around (heh...get it) when it comes to his IF diagnosis protocol or recommendations for treatment. He seems very efficient, experienced and confident. He never comes off as arrogant or pushy. I like that a lot. If a RE treated me like dullard, I'd be outta there faster than you can say, "You want to put that WHERE?!?"

Here is a some good description on HSG from my clinic's website:

Hysterosalpingogram (HSG)
The HSG is an imaging test that allows us to evaluate the inside of the uterine cavity and the fallopian tubes. This test involves injecting a small amount of dye through the cervix while tracking the progress of the dye by X-ray as it fills the uterine cavity and traverses the tubes. The structure of the uterine cavity and tubes is reflected in the pattern of dye. By knowing this structure, appropriate treatment can be recommended. Even with IVF, knowledge of tubal status is important. Research has shown that the presence of even one blocked and dilated fallopian tube, called a “hydrosalpinx”, decreases the pregnancy success rate in an IVF cycle. The hysterosalpingogram (HSG) does not tell us everything about the structure of the pelvic organs. It does not show the muscular wall of the uterus or the ovaries. It is possible to have a normal HSG but still have a significant pelvic factor such as fibroids, adhesions or endometriosis. But, vital information on tubal condition is best obtained through HSG .

Why would your Dr. recommend a HSG?

Well the way I see it, your RE clinic should perform this test to determine 2 things:

1. Are you fallopian tube open or blocked?
   If they are both blocked, then sperm cannot meet the egg when released by the ovaries. If both tubes are fully blocked, then you will not be able to get pregnant without IVF or perhaps surgery to fix the fallopian tubes.
   
2. Is your uterus a normal shape?
   If you uterus is of an unusual shape, then there are issues the RE must address. The first time I had a HSG in 2007, they found a submucosal fibroid that severely distorted the shape of my uterus. It was suggested that the abnormal cavity shape acted like an IUD, so while eggs may have been fertilized, when they came to the uterus, they were unable to attach to the uterine lining. HSG can also find if you have a bicornate uterus or a septum that divides the uterus.

Here is a video that shows the HSG xray:
http://www.youtube.com/watch?v=yORqDQKCkX0

Here is a good web article about HSG:
http://www.webmd.com/infertility-and-reproduction/guide/hysterosalpingogram-21590

How does an HSG feel? What is involved from the patient's point of view?

Here is my recent HSG experience. The test was done in the hospital across the way from my RE's office. I checked in to the outpatient area, then was taken to a room and asked to remove all clothing (except my socks) and dress in one of those tie-in-the-back/hey-is-it-a-full-moon-tonight gowns.  I also was given a robe to cover me bum (cheeky monkey). A nurse walked me down a couple of doors to the procedure room. There was a soft exam table with clean sheets and a pillow below a large x-ray machine. DocO was there waiting for me, we shook hands and enjoyed pleasant greetings.

I hopped up on the table and got the old "scoot down...a little more...a little more" routine until I was in the proper location, then the x-ray machine was adjusted over my lower belly. DocO was nice and explained what he was about to do before each step to help put my mind at ease. This article gives a good description in the section, "How is it done". Refer to that for the medical stuff.

How did it feel? Pfffffftttttt...wellsir? The speculum is never, eh...fun. The clamp/tenaculum felt like a rough fleshy pinch. Places know that they are being handled in a manner that does not befit a lady. When the fluid/dye was injected, it didn't feel like much until things are getting quite...ahem...full. And then they seemed fuller and fuller and yowch quite a bit uncomfortable. The x-ray showed both my tubes blocked. Now this can show up because they are truly blocked or  because of a spasm. A spasm?  DocO explained that since the uterus is a muscle, the introduction of the fluid can cause it to contract, therefore blocking the tubes during the test. Sometimes to counter this effect, more fluid/dye is injected which causes more pressure and can either cause the uterus to contract in a different way and allow passage for the dye, or can forcibly clear minor blockages of the fallopian tubes.

So he added more,
and more,
and more,
until it felt like I was going to bust.

I didn't feel pain per se, but I did eventually get quite uncomfortable and crampy. Have you ever needed to pee so much you were on the brink of pain? Yup. Just like that.

DocO and the nurse noted my discomfort and finally stopped the dye injection. This immediately made me feel better and then it was all done. It took about 10 minutes from the time I stepped into the room. We got the information we needed. The tube blockage was a concern, but since we are going on to IVF it isn't too dire.

Here is a page from the Mayo Clinic site that describes different tests that evaluate the uterus.

After the test I went home and worked. It's good to have a pad on when you finish the procedure and for the rest of the day. Some of the dye/fluid will need to clear out of your system and you may notice a tiny bit of spotting. I was generally fine, although I was a little sore inside, kinda like when you know that AF is due any minute. 

The Optimist View:

The good news is that this test is completed and there were no major malformations or anomalies in the uterus that caused DocO great concern. He did notice some shadows on the test that he thought indicated polyps or adhesions. I was so relieved to see no fibroids had returned from the prior year's surgery and that my uterus was of normal size and shape. My next scheduled test was going to determine that in a few days time. That test is called a sonohysterogram or SHG.

Why is the Optimist View section necessary for my blog? The truth is I need to write about the things that keep me optimistic.  I believe in positive energy for my own mental wellbeing.  I don’t choose to focus on the negative things.  I am not a Pollyanna.  I well aware of the fact that “the odds” are not in my favor and if the circumstances  become medically critical, then I promise to admit defeat gracefully and choose a different path for my life that doesn’t involve biological children. 

Please feel free to leave a comment with your experience or information with a HSG test. I may make things much easier for others who need this treatment to know what to expect.