Hysterosalpingography: all you need to know about this exam

THEhysterosalpingography, often called hysterography, is an X-ray examination of the fallopian tubes (“salpingo”State relating to the tubes) and uterus (the prefix“hysterical”Referring to it). Hysterosalpingography, or hysterography, is therefore an x-ray of the tubes and uterus.

Concretely, this examination makes it possible to visualize the uterus as well as the fallopian tubes thanks to the injection of a product of contrast via a probe, by vaginal route.

Why and when to have a hysterosalpingogram?

Hysterography is in practice systematically offered to a couple where infertility has been diagnosed, or at least to a couple who have been trying to have a baby for a while.

This radiological examination is an integral part of the infertility assessment of the couple, after the usual examinations such as taking temperature, spermogramme, hormonal assessments, etc. It aims to make sure the fallopian tubes are not blocked, because this would prevent fertilization, but also that the uterus does not contain anything that could hinder or prevent implantation of the fertilized egg.

Note that it is however possible to observe the patency of the fallopian tubes directly via a laparoscopy, or laparoscopy, surgery “mini-invasive”Often performed in cases of endometriosis.

On the other hand, hysterography is not useful when the infertility is of male origin and it requires in vitro fertilization with Intracytoplasmic Sperm Injection (ICSI). Because in this technique, an oocyte is taken from the woman by puncture, then the embryo (developed in the laboratory) is reimplanted in the uterus, which “bypasses” the tubes. Their condition is then irrelevant.

Blocked tubes, endometriosis… What can a hysterosalpingography reveal?

In the best case, the hysterography does not reveal any abnormality, neither at the level of the uterus, nor at the level of the tubes. What reassure the couple about their chances of pregnancy.

In other cases, hysterosalpingography may allowexplain repeated miscarriages, the origin of unexplained uterine bleeding (metrorrhagia), and to highlight a uterine malformation (bicornuate uterus for example, or septate), the presence offibroids or polyps, or blockage of one or both fallopian tubes. Solutions to overcome these difficulties can then be offered to the couple to increase their chances of conceiving.

Before or after ovulation: on what day of the cycle should you do this tubal test?

Hysterosalpingography, or hysterography, should be performed in the first part of the menstrual cycle, after menstruation and before ovulation. The goal is to complete this review when the uterine lining, or endometrium, is thinnest.

To avoid any infectious complication, the prescribing doctor may want to ensure the absence of Chlamydia infection and the good condition of the uterine cervix, via a smear. Antibiotics are sometimes prescribed for prevention to avoid any genital infection due to the exam. It is not no need to be fasting to perform a hysterosalpingogram.

Pregnancy or allergy: when to do it is contraindicated

Also, as the hysterography is not at all suitable for pregnancy, a dosage of the hormone beta-HCG may be prescribed to ensure that the patient is not pregnant.

Note also that the contrast medium used contains iodine, therefore allergy to iodine products is a contraindication to hysterosalpingography. However, this radiological examination can still be performed in women who are intolerant to iodine thanks to premedication.

How is a hysterosalpingography performed?

The exam takes place in gynecological position, preferably with the bladder empty, under an x-ray machine, as for a basin radio. The doctor introduces a speculum into the vagina, then a probe into the cervix, with which the contrast product is injected. Gradually, it spreads into the uterine cavity and into the tubes, allowing visualize the progression of fluid in the organs. A small balloon is inflated to prevent the contrast medium from falling back into the vagina. Several X-rays are taken during the examination.

It is recommended to wear hygienic protection during the day following the examination, as residue of the contrast agent may leak out. In case of blood loss or pain during the following days, it is recommended to consult quickly, because it may be an infection.

Potentially significant pain after the X-ray

Finally, note that hysterosalpingography has a bad reputation because it can sometimes cause more or less severe pain, especially during the introduction of the probe or when the product spills.

These pains depend, among other things, on the type of infertility the patient suffers from and the experience of the doctor performing the examination.

Price and reimbursement: how much does a hysterosalpingogram cost?

The exam costs on average more than a hundred euros but is reimbursed by Social Security if you have called on a caregiver categorized in sector 1. If this is not the case, the excess fees can sometimes be taken into account by your mutual insurance company.