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.
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
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 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 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 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 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 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 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 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 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 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).
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
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
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 28th, 2008 at 3:13 pm
Janny - please check with your doctor about your bleeding after the HSG.