Hysterosalpingogram (HSG) After Tubal Reversal
Patients often ask when they should have a hysterosalpingogram (HSG) to see if their fallopian tubes are open after tubal reversal surgery.
When to Have an HSG
Wait for at least 6 to 12 months after a tubal reversal procedure for this test of tubal patency. An HSG carries a risk of infection and often does not give conclusive results. It is best to give yourself a chance to become pregnant rather than rushing to have an HSG. Most patients conceive within this time frame and will avoid the need for an unnecessary and possibly misleading or harmful procedure.
Preparing for an HSG
To avoid unnecessary risks, an HSG should be performed only after menstruation is over and before ovulation occurs. Having an HSG after the time of ovulation may interfere with a pregnancy - before a pregnancy test can detect that conception has occurred. To minimize the risk of infection, use a betadine vaginal douche the evening before and the morning of the scheduled procedure and ask your doctor for a prophylactic antibiotic prescription. 600 mg of ibuprofen taken one hour before the HSG will minimize its discomfort.
What to Look For in an HSG
You can ask to watch the results on the fluoroscopy screen while the dye is being injected into the uterus.
At first, the dye will fill the uterine cavity. It is essential that the dye actually enter the fallopian tubes up to the point where the anastomosis was performed. Often, this does not occur due to spasm of the sphincter between the uterus and tubes (shown by the arrows) or from mucus or calcium deposits in the proximal tubal segments.
If the dye passes through the anastomosis sites, the fallopian tubes are open. Most radiologists do not consider the x-ray to show tubal patency (openness) unless dye spills into the abdominal cavity. When this happens, the diagnosis of tubal patency is conclusive.
We often see x-rays where dye has passed through the tubal anastomosis site, but has not yet spilled into the abdominal cavity. This is due to an insufficient amount of dye being injected into the tubes. The radiologist may mistakenly believe the tube is blocked when in reality it is open.
Send Your X-Rays To Me
In order to be certain about whether an HSG demonstrates tubal patency, tubal occlusion, or is inconclusive, please instruct the radiologist to send the x-ray films to me to interpret. Having documented the anatomy and measurements of the fallopian tube segments during tubal reversal surgery, I can compare the x-ray findings with each patient’s operative report. This allows me to give the most accurate interpretation of HSG results.
Dr. Berger’s Comment
Hysterosalpingography is a widely available procedure to examine tubal anatomy. Unfortunately, it is often performed or interpreted inaccurately. An HSG also has risks as well as discomfort and cost. It is best to wait for at least 6-12 months after a tubal reversal procedure to have an HSG. Most patients will become pregnant after tubal reversal within a year and can avoid the problems associated with HSGs. Preparing properly for an HSG and sending the x-ray images to me will minimize the risks and errors associated with a hysterosalpingram.
January 13th, 2008 at 2:39 pm
This topic will be very helpful to our patients. Patients often wonder when it is best to have this testing done after surgery. I just wanted to mention that a lot of times the radiology facility faxes their report of the x-ray results, but does not send the actual x-ray images. We want to make sure that Dr. Berger always sees the actual x-ray films. These will have to be mailed to our office. A patient can request this in writing at the facility prior to having the x-ray done to help facilitate the process.
January 13th, 2008 at 3:17 pm
This is an excellent blog topic! We occasionally hear from patients who have been told that their tubes have become blocked following surgery. In many of those cases, the tubes were found to be open when the patient returned for surgery. For the HSG to be helpful, it must be performed and interpreted accurately. As Dr. Berger wrote, it is often better to give yourself 6 - 12 months of trying to conceive before undergoing this testing.
January 13th, 2008 at 7:35 pm
Many patients ask me if HSGs are painful. HSG tests can be uncomfortable for many women. It is important to follow your doctor’s recommendations for pain medication to minimize discomfort. The test is usually performed quickly and the discomfort should be brief. We are happy to talk to our patients about Dr. Berger’s recommendations for pain management. I think this blog is helpful because most women do well when prepared and know what to expect.
January 13th, 2008 at 9:46 pm
This is wonderful information for women who are considering having an HSG. This will help to better prepare them for the procedure. I think that the more informed patients are the better they can understand the outcome of the test. I also think that this information can help alleviate some of the stress that a person might feel.
January 14th, 2008 at 12:38 pm
It seems that some patients become over anxious when trying to conceive after tubal reversal. They want to rush in to having an HSG within two or three months of surgery. The information that Dr. Berger has given makes the point that this is not only unnecessary but in some cases can actually be harmful.
January 14th, 2008 at 2:26 pm
Dr Berger has done it again! Another excellent article giving his patients the education and the tools they need to make informed decisions about their care. This issue is so important for our patients to understand clearly so that at the time of HSG they can ask the best questions and understand the answers given to them.