Hysterosalpingogram and fallopian tube dilatation

COMMENTS?

 

 
Indications: as part of an infertility workup for a woman of child bearing age, the ob/gyne fertility specialist may request this test.

Precautions: Since the hysterosalpingogram involves ionizing x-radiation to the ovaries, it is important that the patient is sure she is not pregnant and cannot be in early pregnancy. To prevent doing the test on an early pregnancy, the hysterosalpingogram test is done within 10 days of onset of the patients last menstrual period.

Pain and discomfort: There may be pain, cramping and discomfort during this procedure. The amount of discomfort varies according to the amount of pre-existing inflammation of the pelvic organs. Normally, no IV sedation is used for this procedure. The patient may benefit form a small dosage of a valium type anti-anxiety drug taken by mouth about one hour before the procedure.

Procedure: The patient is placed on a flouroscopic xray table. The patient’s legs are separated and draped and a speculum is introduced by the radiologist into the vaginal cavity to visualize the cervix. The cervix is swabbed with a Betadine preparation and then a thin catheter is inserted through the cervical canal into the Endometrial cavity. A small balloon at the end of the catheter is inflated in the endometrial cavity to provide a good seal. Under flouroscopic observation, the radiologist injects manually a small amount of water soluble contrast (15 to 20 cc) which fills the endometrial cavity of the uterus and both fallopian tubes. The tubal anatomy and patency can be assessed. Normally, the tubes are slender and spill freely into the peritoneal cavity. In certain diseased states there may be tubal blockage or dilatation. A number of xray spot images of the findings are recorded by the radiologist. The procedure is terminated upon deflation of the retention balloon and removal of the catheter and speculum.

In the event of a mucous plug obstructing the tubes, this procedure usually flushes the mucous plug out of the tube and establishes patency. In these patients, there may be successful pregnancy after the hyterosalpingogram. However, if there is severe underlying pelvic inflammatory disease with tubal occlusion, the hysterosalpingogram will have no therapeutic effect.

Findings: Uterine scarring, adhesions, hydrosalpinx, tubal occlusion, salpingitis, bicornuate uterus.

In the event the radiology hysterosalpingogram procedure is equivocal or for any reason unsuccessful, this procedure might be next attempted by the OB/Gyne fertility specialist in the operating room under general anesthesia. In the OR setting, additional maneuvers can be done to flush the fallopian tubes such as injection of CO2 gas, etc.

Fallopian tube dilatation procedure: Dr. Amy Thurmond from Portland Oregon is probably the best known expert in this area. She is an interventional radiologist who uses the standard armamentarium of catheters and guidewires and gadgets to open up clogged fallopian tubes. Since this is a very sub-specialized procedure, it is best to go to a larger research center or to Dr. Thurmond or a similarly trained specialist for Fallopian tube dilatation.

Hysterosalpingogram shows normal uterine cavity, but both fallopian tubes are occluded.
 
Abnormal Hyterosalpingogram showing bilateral hydrosalpinx. (tubes are blocked and dilated )
 
Normal Hysterosalpingogram showing normal Fallopian Tubes