Friday, October 16, 2009

Hysterosalpingogram or HSG


Infertility can be caused by either male of female factors. Female infertility involves ovulation dysfunctions or abnormalities of the female pelvis. The normal events that occur for successful human reproduction involve (1) sperm is placed within the vagina during intercourse, (2) some of this sperm will move into the cervical mucus (where it can normally reside comfortably for several days), (3) sperm travels from the cervical mucus through the uterine cavity into the fallopian tubes, (4) the sperm fertilizes a mature egg within the fallopian tube, (5) the fertilized egg (preimplantation embryo) continues to develop within the fallopian tube for 4-5 days, (6) the developing embryo enters the uterine cavity and it remains unattached for about a day, (7) the embryo becomes apposed to the uterine lining cells (endometrium) and initiates implantation into this lining, and (8) the implanted embryo continues to develop from nutrients obtained from the maternal uterus (womb). If there is any abnormality in this sequence of events, the success of human reproduction can be severely limited (and may result in infertility).

The hysterosalpingogram or HSG is a radiology test that uses the injection of a radio-opaque distention fluid under continuous fluoroscopy to allow the operator (usually a radiologist but sometimes an infertility doctor) to see the contour of the uterine cavity and the patency of the fallopian tubes. This test is highly informative, relatively inexpensive, generally safe, and quick to perform (mostly under 10 minutes for a skilled operator). The hysterosalpingogram allows the doctor to detect filling defects within the uterine cavity, possibly caused by endometrial polyps (organized abnormal overgrowths of the normal uterine lining cells), submucosal fibroids (smooth muscle tumors projecting into the uterine cavity), or intrauterine adhesions (synechia). The presence of structural abnormalities such as polyps, submucosal fibroids, synechiae, or blocked fallopian tubes can reduce fertility and cause female infertility. The hysterosalpingogram is also commonly thought to remove or “blow out” any material that might be obstructing the inside of the fallopian tubes and thereby the HSG may itself improve fertility.

A sonohysterogram (aka saline ultrasound or hysterosonogram) is a different radiological test that uses the injection of saline (salt water) into the uterine cavity while examining the uterus with a high resolution ultrasound. Sonohysterography is also safe, relatively inexpensive, and informative. A sonohysterogram allows the operator to visualize abnormalities of the uterine cavity (polyps, fibroids, scar tissue) with similar or sometimes greater sensitivity when compared to the hysterosalpingogram. However, the sonohysterogram usually has significantly less reliability when viewing the fallopian tubes, as compared to a hysterosalpingogram. Thus, we usually recommend starting with a hysterosalpingogram and if additional testing is required for abnormalities of the uterine cavity then we consider performing a sonohysterogram.

Many women have apparently had painful experiences with the hysterosalpingogram and therefore the procedure has a blemished reputation among infertility patients. At The NJ Center for Fertility and Reproductive Medicine, LLC, Dr. Daiter offers to personally perform every hysterosalpingogram (HSG) that he suggests for his patients since discomfort with the procedure is truly rare when he performs it. For an appointment to discuss your situation with Dr. Daiter, please call the office at 908 226 0250. Visit us on the web at or

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