SCF: 30-31 , SECTOR-11, HUDA, URBAN ESTATE, Panipat, Haryana 132103
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SCF: 30-31 , SECTOR-11, HUDA, URBAN ESTATE, Panipat, Haryana 132103Around 10-15% of the couples are infertile worldwide, making early evaluation and appropriate treatment essential. One of the first investigations performed during female infertility evaluation is hysterosalpingography (HSG).
HSG is a simple imaging procedure for detecting tubal blockage and uterine abnormalities . Although HSG continues to play a valuable role in infertility assessment, newer techniques such as saline infusion sonography (SIS), HyCoSy (Hysterosalpingo – Contrast Sonography),hysteroscopy,laparoscopy with chromopertubation and MRI provide additional information in selected patients and may even offer therapeutic benefits.
This article explains the indications, procedure, advantages, limitations, complications and modern alternatives to HSG.
Hysterosalpingography (HSG) is an imaging procedure that uses fluoroscopy (X-rays) to evaluate the shape and contour of the uterine cavity and patency of the fallopian tubes by introducing a radiopaque dye into the uterus through the cervix. Tubal factors are responsible for almost 30-40% of women’s infertility, making HSG a useful initial investigation.
HSG is a special type of X-ray using a dye that is radio-opaque (will show up on an X-ray film), and is used to determine the shape of the uterus and whether the fallopian tubes are open.
The dye is injected through the cervix under an X-ray that is capable of seeing the dye as it passes through the uterus and fallopian tube.
HSG is usually performed between day 6 and day 10 of the menstrual cycle, after menstrual bleeding has stopped but before ovulation, to avoid disturbing an early pregnancy.
Women at increased risk of pelvic inflammatory disease may be prescribed antibiotics before the procedure
There are a number of modern investigations that are also diagnostic.
Advantages:
HYCOSY uses ultrasound contrast agents to assess the fallopian tubes without X-rays
Advantages:
Hysteroscopy is considered the gold standard for evaluating the uterine cavity.
Advantages:
During this procedure, methylene blue dye is injected through the cervix while the doctor directly visualizes dye spill from the fallopian tubes.
Advantages:
MRI:
MRI is not routinely used for infertility evaluation but is useful in selected patients with:
| Feature | HSG | HyCoSy | Laparoscopy with Chromopertubation | Hysteroscopy |
|---|---|---|---|---|
| Tubal patency assessment | Excellent | Excellent | Gold standard (Excellent) | Not suitable |
| Uterine cavity evaluation | Good | Good | Limited | Gold standard |
| Radiation exposure | Yes | No | No | No |
| Therapeutic intervention possible | No | No | Yes | Yes |
| Invasiveness | Low | Low | Moderate–High | Moderate |
| Diagnosis of endometriosis | No | No | Gold standard | No |
| Assessment of pelvic adhesions | No | No | Excellent | No |
| Requires anesthesia | No | No | Yes | Usually Yes |
| Outpatient procedure | Yes | Yes | No | No |
Hysterosalpingography remains one of the most valuable first-line investigations in female infertility. It is a quick, safe and cost-effective method for assessing tubal patency and identifying abnormalities within the uterine cavity.
However, HSG has limitations, particularly in diagnosing pelvic diseases such as endometriosis and pelvic adhesions. Modern techniques including HyCoSy, hysteroscopy, laparoscopy, SIS, and MRI provide complementary information and, in many cases, allow diagnosis and treatment during the same procedure.
The choice of investigation should always be individualized based on the patient’s clinical history, symptoms, previous treatments, and the suspected underlying cause of infertility.
