Hysterosalpingography – a long fancy word for fallopian tube x-ray. This procedure is used to help determine if the fallopian tubes are open or blocked. An iodine based dye is pushed into the uterus through a thin catheter that is inserted into the cervix. The doctor and radiologist take several radiographic images of the uterus and fallopian tubes for their exam.
This test is usually recommended as part of an infertility diagnosis. My doctor required this procedure to be between day 6 and day 12 of the menstrual cycle. The idea is that bleeding should be subsided, yet ovulation has not occurred, so there is no potential harm to a developing baby. I was still tested for pregnancy before hand. When I arrived they had me pee in a cup, obviously it was negative, just like it has been the past 36+ months but who’s counting.
The nurse/radiologist (I didn’t ask her title) brought me into the room. They wouldn’t/couldn’t allow for Hubby to come in with me, stating that the room was too small (I didn’t even think of the radiation aspect too). Back there she had me sign a consent form, asked me if I had been taking the doxycycline that was RXed to me for the procedure (1 AM, 1 PM pill the day before, day of , and day after). I had, but I forgot to take the 800 mg ibuprofen they recommended before the procedure (*I DIDN’T FORGET THE VALIUM!). She said don’t worry about it, you can take some after if you need it, a lot of people don’t. They had me undress from the waist down, socks can stay on, and sit on the table.
The Dr. came in and introduced himself and described how the procedure would work. Since I had already googled tons of info on HSG I was pretty confident I understood what was going on. It was nice that he was clear and with his information. The Doctor asked me if my RE had told me anything about my uterus. I told them that she said I have a pretty uterus and we can’t say that to everyone! But I also let him know she detected a slight depression on the top side of my uterus, but it was measured to be not significant enough to be considered a septum or abnormal.
Step 1 Lay back butt to the edge of the table, put your legs up into the stirrups. Their stirrups were padded and actually were more like a rest for your legs than say a gyno app just has the metal foot holders. It was strangely comfortable.
Step 2 Dr. Inserts speculum, you know the cold metal thing used at pap smears. I felt no pain at all, but it was cold and a tiny bit of pressure when opening, totally tolerable.
Step 3 Dr. uses antiseptic to clean the cervix 2 or 3 times. This was also cold, but not painful at all.
Step 4 Dr. inserts catheter and inflates something to hold the cervix open. Released/removed the speculum. This was some pressure/cramping but not really pain – more of like a feeling you get when your period or ovulation is going to occur soon (in my experience). Dr. Said that this is usually the most uncomfortable part.
Step 5 Dr. inserts dye into the uterus/fallopian tubes. Nurse exposes radiographs frequently. I felt cramping and moderate intense pressure. I let my Dr. know it was hurting, but tolerable. He had asked me to tell him about anything painful, I think this info can be beneficial to them as the procedure progresses. I was feeling this way because only 1 tube was fully open, the other tube was “slow to fill/spill”
Step 6 Dr. may ask you to rotate your hips to get different angled images or guide dye into slow filling tubes. From my understanding the nurse can help you move if you have trouble. My Doc was surprised when I immediately shifted after he asked me to and said “You’re a good turner” I’ll make a mental note of weird things my Dr.’s say to me.
Step 7 watch the show. My doctor was great and explained the procedure as it was happening on the monitor we both could see. My left tube was more at a low angle, and the dye went right through. The right tube appeared to be at an incline, so naturally its more difficult to push dye up hill, hence the hip turn. Eventually the dye spilled out the other end I felt so relieved.
Step 8 The Dr said he was going to do one more thing, but the catheter had come out so he didn’t do what ever he was going to do he didn’t tell me, I think it may have been just an ending x-ray after they wait a little while, I had read about this part of the exam but I cant remember what it was called.
After the procedure was over he went over his observations and talked about clinical significance. According to him, and he told me multiple times, it doesn’t matter that the tube was slow to fill, the dye did come out the other side, so the tube is open. I felt good about that, but skeptical, if its slow it’s surely not “excellent” so I began my googling once I got into the car.
The nurse had given me a wipe, paper towels and a panty liner and pad. She said there would be about 1 TBS of dye that will come out. She said to refrain from vaginal intercourse for 24 hours (or until you can tell the dye is all out). I was wearing a thong so I put the panty liner in. I should have used the pad.. not fun walking to the car and feel like your about to dye your pants. Being the classy lady I am I shoved some paper towels in my pants once I got in the car.
What I learned about the HSG afterwards is that many women get pregnant shortly after having a HSG procedure. It seems that the pressure of the dye flushes out mild blockages. This information was very anecdotal (TTC forums) but there was hundreds of posts claiming the HSG was the determining factor of their pregnancy. Boy, was I excited when I started reading this. I particularly felt hopeful when hearing this as my tube was “slow to fill” and the pressure I was feeling during the procedure felt significant, once the dye spilled out the Dr. told me that this mean the tubes are open (did he open it?).
I learned that having one tube blocked doesn’t make you infertile either, the eggs can be picked up by the other tube or it may just take longer than typical to get pregnant.
I also learned that tubes may be open, but still not functioning properly. The HSG only tests if the tubes are anatomically normal, it does not test if the villi (finger-like projections that guide the egg down the tube) are working. It is assumed that if the tube are open the villi are functioning normally.
If both tubes are blocked its recommended to do IVF to conceive, or other procedures to help re-open the tubes.
So I’m hoping this procedure cleared out my tubes and this will be the cycle we get out BFP! This cycle we’re also using Pre-seed. I follow a lot of other “regimines” for TTC but to each their own, eating healthy, taking supplements, staying active and avoiding alcohol/caffiene/drugs(obviously) are paramount. I think I’ll also be adding 81 mg baby asprin after ovulation because of my recent MTHFR mutation diagnosis. (more on this next post)
This is my last month TTC before we start actual Medication/IUIs/IVF with my RE. Wouldn’t it be fabulous to get my BFP now… girl can dream right!
UPDATE: Cost – take costs with a grain of salt as every clinic/insurance is different. I have high deductible insurance plan and the out of pocket cost for the HSG was $650.67 for me. This includes a $684.33 write off for having participating insurance. The total billed for the procedure was $1335.00.