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 hysterosalpingogram.
January 22nd, 2010 at 4:31 pm
ROSIE – This was a technical problem with the HSG with the dye leaking out through the cervix. It does not mean your tubes are blocked. Often the radiologist tells women their tubes are blocked when they really are not!!
January 22nd, 2010 at 4:07 pm
HI, i had an HSG yesterday, and the doctor wasn’t able to finish it. He said there was something that was pushing it out and he said to go back next month. Should i be worried? Could this be because the tubes are blocked? I mean he couldn’t even get to the point of injecting the liquid? I’m very nervous and sad as well. I’ve been trying to get pregnant for the last 2 years, and I’m only 24 years old. Please someone, is this normal? The Dr said that it could be mucus or anything there, but yet he didn’t really satisfiy me with an answer?
January 13th, 2010 at 6:28 pm
I had my HSG test done back on Nov.24, 2009. The dr that I went to told me that my tubes were closed because there was not any dye spills. I sent everything over to Dr. Berger on December 3rd and he told me that my left tube was still open. Now I have to start on a pill called Clomid to help me ovulate. I can say one thing – Dr. Berger is the best. I hope to have another child soon. Good luck.
January 11th, 2010 at 6:55 am
JULIET – The dye went through your fallopian tubes so they are open. The diagnosis of fimbrial adhesions from an HSG is a presumptive diagnosis. To be definitive, laparoscopy should be performed, at which time the adhesions, if present, should be able to be cleared up if done by a doctor experienced in reproductive surgery.
January 11th, 2010 at 6:24 am
I did my hsg 0n 30/11/09 and the xray showed bilateral partial fimbrial adhesions with forced spill.my gyna recommends laparoscopy to clear the adhesions or ivf.does this mean i cannot have a normal pregnancy without the surgery?pls help am very confused.
December 16th, 2009 at 11:14 pm
I had HSG done one month back. The doctor who conducted the test feels that my left tube is blocked. He also feels its because of TB and feels it needs to be cut since it had hydrosalpinx. They are the same images when I showed to other doctor and he said he feels left tube is not blocked.
Could you look through my images and let me know what you feel? Let me know where I can send the image.
October 8th, 2009 at 7:25 am
I had my tubal reversal March 2009. I was very scared of having the HSG done, but after reading all the information I feel better informed on what to expect. Even with Chapel Hill Tubal Reversal Center being so far away from me I feel like I always have someone to turn to with questions. Thank you for never making me feel silly- no matter how silly the question …Thank You for caring.
July 26th, 2009 at 12:25 am
I had a HSG on 20 July 2009 after trying for nearly 2 years. The test was painful it felt like I was having very bad cramps. The test was quick. I had my results and both of my tubes are open. I hope to be pregnant soon!
June 26th, 2009 at 11:19 am
JARED – Your description of the HSG makes it seem likely that the left tube is blocked at the anastomosis site, but that can best be determined by having the x-rays sent here for examination and comparison with your wife’s operative report. And the answer is, yes, you can have a baby with only 1 tube.
June 26th, 2009 at 10:40 am
Hi,
Yesterday 6/25 my wife had an HSG as a follow-up to the tubal reversal she had in March. The right tube showed spillage, but the left tube showed that the dye stopped in the middle of the tube? Does this mean the left tube is blocked or closed, and if, so can we have a baby with only 1 tube? Thanks!
June 16th, 2009 at 9:56 am
I had a hsg on day 11 of my cycle which was on June 11th and I am experiencing sharp but bearable pains in my lower abdomen. Could this be from an infection from the hsg? No fever though.
June 15th, 2009 at 6:47 am
Bleeding that follows an HSG and continues may indicate some injury or inflammation of the uterus (endometritis), so you should contact your doctor for follow-up evaluation.
June 15th, 2009 at 2:49 am
I had an hsg done on 29thMay. After 3 days from hsmy g I started spotting for 2 days then bled for 3 day like a period, then it stopped. Is it a period that came early?
June 4th, 2009 at 7:19 pm
[...] add this word of caution, Dr. Berger recommends patients wait for at least 6 to 12 months after a tubal reversal procedure before having a HSG. As you say Sandra this is a simple enough [...]
June 4th, 2009 at 10:16 am
Delayed spill does not necessarily mean tubal blockage.
June 4th, 2009 at 6:24 am
I have been diagnosed with PCOS and my HSG report says delayed spill in left tube while normal spill in right tube. Does that mean my left tube is blocked. I have done 4 IUI but all came out negative. This is the 5th time that IUI was done and I am on waiting period.
May 28th, 2009 at 8:22 am
I had my tubal reversal 5 months ago. My HSG yesterday showed my tubes are open, so that was good news. Let’s hope for a positive pregnancy test soon.
April 21st, 2009 at 1:16 pm
Penny
Many people have the misconception the tubes have reconnected if they become pregnant after a tubal ligation. They almost never reconnect.
When the tube heals often a small opening (termed a fistula) forms. This happens occasionally and it may take a while for a sperm to find its way through the small hole to find and fertilize an egg. It is very hard for a fertilized egg to find the opening. Many patients will end up with an ectopic pregnancy (sometimes these pregnancies act like a miscarrigae). Sometimes the eggs do find their way into the uterus and you will become pregnant- this is very uncommon.
Penny you do have a small opening, hence your positive pregnancy test, but the dye test was not able to find it. Read the next two sentences very carefully:
If anyone becomes pregnant after a tubal ligation then an abnormal opening does exists. If you want to become pregnant then do not count on the opening helping you to become pregnant. If you do not want to become pregnant then talk to your doctor about your options so you do not have an ectopic pregnancy in the future.
April 21st, 2009 at 11:36 am
I had a tubal ligation 11 years ago and became pregnant in Feb/2009. I miscarried in March..I had a HSG done this week to determine if my tubes are reconnected..and the Rad-Tech said that my tubes didn’t looked connected to him.. On the x-ray my right tube didn’t fill up and the dye stopped at my uterus but on the left side the tube was filling up with dye but no spillage showed…The tech had to stop the hsg because I was having pain on the right side..but didn’t feel any pain or pressure on my left ..My question is “Do you think maybe he didn’t use enough dye for it to spill out of my left tube?? Or since I became pregnant once with a tubal would or could it happen again?”
April 6th, 2009 at 6:32 am
Sounds like you have unexplained infertility. You can become pregnant normally but it may take longer. You may have to do assisted reproduction to become pregnant if you are unable to become naturally pregnant.
April 6th, 2009 at 6:23 am
It can be normal to have spotting for several days after an HSG.
April 6th, 2009 at 4:17 am
I had a HSG done on 30th March and on the 2-3rd day after the test I experienced some spotting.. This spotting lasted till today and is still here. Is it normal?
April 5th, 2009 at 5:59 am
I have been married for seven years. My husband sperm report says count and movement is normal. I have regular cycles of 28 days to 30 days and endowments is 10 mm in 13thday and follicle 2.2 mm in 13th day ruptured all are normal. Three times I have done IUI. I have not been able to become pregnant. Laparoscopy result says dye test says delayed spill from both sides and bowel with minimal adhesions to right illiac fossa peritoneum & ligaments no endometriosis. Am I able to become pregnant normally or with an ART method?
Thank you,
Viji
April 1st, 2009 at 4:11 am
Delayed spill shows that the fallopian tubes are open and that pregnancy is possible.
March 31st, 2009 at 10:01 pm
I had a laparoscopy that report says delayed spill. What does meaning of delayed spill? Can you able to become pregnant?
Thanks
VIJI
March 26th, 2009 at 5:58 am
Delayed spills? What does this mean? I am anxious -pregnancy?
March 6th, 2009 at 6:23 pm
MEHREEN – You can have the radiologist send your x-rays to Chapel Hill Tubal Reversal Center for Dr. Monteith or me to examine. If you attach your contact information with the x-rays (such as your name, email address, telephone number), we will contact you to let you know about unblocking your tubes. You can also call Chapel Hill Tubal Reversal Center at (919) 968-4656 to speak with a Tubal Reversal Nurse for further information about unblocking blocked tubes. Chapel Hill Tubal Reversal Center offers a Free Phone Consultation regarding tubal ligation reversal and repairing blocked fallopian tubes.
March 6th, 2009 at 6:09 pm
I had an HSG x-ray done yesterday and the doctor told me my left tube is blocked as no dye has gone there. How can I get it unblocked?
February 25th, 2009 at 4:50 am
My recommendation would be to ask your doctor for a prescription for antibiotic prophylaxis, such as with doxycyline, and also a medication called Difulan to prevent a yeast infection if this is what you are prone to having. In any event, with your history of prior infections, you should talk with your doctor again before having the HSG.
February 24th, 2009 at 10:35 pm
I am going to have a hsg next week, and my doc never told me the risk, or about taken any pills. Should I be worried. Also I am prone for infections should I go threw with this, and what is the percent in getting an infection.
January 24th, 2009 at 10:38 am
Hi,
I am a 25y/o f and will be getting an HSG test Tues. I am nervous about what the results will be, but I will keep you informed and send the x-rays for a second opinion.
Thanks
January 17th, 2009 at 10:29 am
is 40 to old to have a reversal?what r the main risks how many eggs should i have do i have a better chance if i have eggs and the sperm count is good
January 16th, 2009 at 4:40 pm
MINOKSHI – Discuss redoing your tubal ligation with your doctor if you have had a failure of the original tubal ligation and intend to prevent becoming pregnant.
January 16th, 2009 at 5:42 am
Tubal lagition on 31.10.2008
HSG on 9.01.2009
Tubal lagition failure. Please suggest me what can I do now.
January 12th, 2009 at 4:04 pm
I am going to have a hsg test done next week. I have taken pills to build my system up which worked. I want to know if I take the hsg test will this help with me getting pregnant ?
January 6th, 2009 at 10:30 am
hi i am thinking of going to have a hsg as i had a reversal in may this year and am still trying with no luck as yet do u think i should leave it a yearas its only been 6months ??? after reading all about the test not sure if i want it done as it seems painful and im such a baby …..thanx
December 31st, 2008 at 9:22 am
I had a HSG test done on the day 4 of my cycle. Today is my day 13. i had pain in my lower left and right abdomen for last 2/3 days. i am TTC for a while now and want to ask if my period will be regular after HSG because i took pills for 1 month befor ethe test to regulate my period.Thanks
December 28th, 2008 at 11:26 pm
Thanks Fran M.
December 28th, 2008 at 4:02 pm
i had done my hsg 21st so left tubal is open if possible i will pregnant in next month
December 26th, 2008 at 9:32 am
It is possible for fallopian tubes to be blocked and to still have regular menstrual periods. This happens when you have a tubal ligation or other tubal blockage. If fertilization and implantation do not occur during your cycle, you will shed the lining of the endometrium as your progesterone level falls. The ova does not actually have to make it to the endometrium. It would be helpful to send your HSG films to Dr. Berger for review because he will compare the findings from the images and your tubal reversal operative report to see if the tubal anastomosis site was truely tested.
December 26th, 2008 at 5:35 am
one more question: how come its possible for fallopian tubes to be blocked even if we have regular periods. sorry for being so dumb but i think that regular periods means that we are ovulating and the ova sheds off during menses. am i correct.
December 26th, 2008 at 5:33 am
i had my hsg which was very painful. the x ray is not showing the spillage but i have read that in case of blockage, the fallopian tubes looks fluid filled .my tubes dont look like fluid filled moreover i never had irregular periods. in my report it is written blockage of fallopian tubs in distal 1/3 part bilaterly.
now my doctor is advising me for laprascopy. should i go for it.
December 19th, 2008 at 10:51 am
Do oral contraceptives cause tubal blockage?
October 28th, 2008 at 3:13 pm
Janny – please check with your doctor about your bleeding after the HSG.
October 28th, 2008 at 7:20 am
i did hsg test and since then after 3 days of menses water flow from my vagina for three days at night pls what is the cause. n there is no sign of pregnancy.
October 19th, 2008 at 8:48 am
im about to go for a hsg on tuesday. i started a period on 9th oct very very light and its now the 19th oct still having a period what do i do? i understand i cant have it done unless i have finished my cycle, also what will happen if they find my tube(s) are blocked will they try to open the tube(s) there and then or will i have to go for surgery and have them opened?
many thanks
September 1st, 2008 at 7:29 pm
2006 I had a tubal pregnancy.Although , I think it was a miscarriage.I had a tubal legaition done at the age of 17 reversal in 1992, which states my right tub mite not work but my leftis open, i have had 2 pg since then one misscarriage in 2001 and 2006 tubal pg. I had a HSG IN 2006 AND it states thread like spillage in the left tube none in the right. but not a complete spillages does this mean my tubs are compleltly blocked thats what the radiologist says. thanks EA
July 30th, 2008 at 7:41 pm
Thanks. My new doctor knows about my experience, so hopefully he will do what he can to make sure the procedure is not painful (I’ll still be nervous, though).
July 30th, 2008 at 6:33 pm
An HSG should not have to be painful. This usually has to do with the techniques used by the doctor performing the procedure. I think you should discuss your previous experience with your doctor to see how it can be made comfortable for you. You may require a prescription medication for pain control, but if so, that would need to be prescribed in advance by the doctor who will perform the HSG.
July 30th, 2008 at 9:54 am
I had an HSG in 2006, and got pregnant. I am trying to have another baby, and my doctor wants to perform another HSG. The problem is, the first one was horribly painful. Is there any medication (stronger than Advil, which I took the first time around) that I can take that will make the procedure less painful?
July 29th, 2008 at 6:24 pm
Cristina – In the case of tubal ligation by fimbriectomy, an HSG can determine if there is sufficient ampullary segment of tube remaining for the procedure of ampullary salpingostomy – that is what is done for fimbriectomy reversal. If you do not have an HSG performed, then I advise starting the procedure with screening laparoscopy to see if the tubes are repairable. If so, then the salpingostomy procedure is performed at the same operation.
July 29th, 2008 at 6:16 pm
I am the exception to the rule. I have 2 healthy boys and after had a tubal ligation in 1999 that failed within the first year. Then the same MD went back in through larger incision and took my fimbria. My husband to be and I desperately want to have a child together and I have read where an x-ray HSG should be done prior in some cases before the surgery before the fimbria re-build is done? But I am also reading don’t do it until after the reversal, which of course my surgery would be a little more than a reversal with a fimbria rebuild… Help?
Should I have an HSG prior to scheduling the procedure with you and at 30 years old what are my chances of getting pregnant? Both prior children were conceived while taking oral contraceptives and first tubal failed.. MD says I am very fertile. or was…
Christina
July 16th, 2008 at 6:11 pm
The egg drops into the abdominal cavity and the right tube may catch it. Once you feel fully recovered from your surgery and have had a normal menstrual period, you can begin trying to become pregnant again.
July 16th, 2008 at 4:01 pm
thx for the answer. my left ovary will still work after left tube removal. does the egg drop inside the stomach after left ovary produce it? or can right tube catch it? how long should I wait for next pregnancy trial?
July 15th, 2008 at 6:36 pm
An HSG will be able to determine if your right tube is open and looks normal, but it cannot predict whether or not an ectopic pregnancy may occur in the future.
July 15th, 2008 at 2:11 pm
yesterday I had an operation. my baby grow in my left tube near ovary. they took the tube with the baby. now I do not want to have that experience again, so I want to check out my right tube.do you advice me to make hsg?
July 7th, 2008 at 2:55 pm
Dear Alison -
The risk of a complication (infection)from HSG is low, so you probably don’t need to worry. But if you develop pain or fever after the HSG, you need to contact your doctor right away to be treated with antibiotics. If your doctor scheduled the HSG for cycle day 4 when you were still menstruating, it sounds like he/she is not fully informed about the potential risks of the hysterosalpingogram.
July 7th, 2008 at 2:43 pm
I recently read somewhere that it should be done on 7-10 cycle days. However, my Hysterosalpingogram was done on the 4th day of my cycle (I had almost stopped menstruating by then.
I am now worried if this will have some consequences on my reproductive system and fertility.
Will appreciate your response.
Thanks,
Alison
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.
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 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 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 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 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.