The uterine film, also called HSG (Hysterosalpingography), is a diagnostic method used to display the uterine cavity. In this imaging method; In the tubes in the uterus, problems such as obstruction, stenosis, and enlargement are detected. Purpose in the film of the uterus; The form of the uterus is the detection of hereditary problems related to the uterine cavity or the problems that develop later and may cause infertility such as fibroid-polyps, especially the detection of adhesions that we frequently see after abortion. With the latest technology devices developed by today’s medicine, this film can be shot painlessly.
This imaging method is also done before IVF or Ovarian stimulation injections treatments are initiated. It is performed by examining the tubes and uterine cavity in the uterus by radiographic methods by giving contrast agents.
When is HSG applied?
Generally speaking, HSG is applied when a blockage in the cervical canal and adhesion in the uterus or a blockage in the Fallopian tubes is suspected.
To be expanded further, the main uses of HSG are as follows:
- Determination of whether the tubes are open during the medical evaluation of non-conception.
- Evaluation of a possible obstruction in the cervical canal or a possible adhesion (Asherman’s syndrome) in case of menstrual bleeding after an intervention applied to the cervix of the uterus (such as an abortion).
- Determining whether there is a congenital developmental defect in the uterus at recurrent miscarriages
What Should Be Done Before Medicated Uterus and Tube Film (Hysterosalpingography)?
For hysterosalpingography, the person does not need to be hungry on the day of application. Anesthesia is not generally required during hysterosalpingography. However, if the doctor decides to perform anesthesia, the person must be fasted for at least 6 hours before the procedure.
Also, the person does not need to use any medication before the procedure. Depending on the doctor’s decision, the patient can use painkillers. However, the doctor who will perform the procedure must know. I decided the patient can take painkillers half an hour before the procedure.
What should I do before filming HSG (Medicated Womb Film)?
- The patient will be protected from sexual pain until the HSG filming date.
- The doctor requesting HSG will write 3 (three) drugs for the uterine film. One of them is antibiotics, the second is a pain reliever, and the third is the contrast agent to be used filming.
- The antibiotic will be used 3 (three) days before the filing date.
- The patient will drink 1 (one) drink from the painkiller at 11:30 on the day of the filming.
- When it comes to filming, it will bring the third drug (contrast agent) with it.
- At around 11:00 am on the day of the filming, HSG entry should be made again from the physician secretary who made the HSG request.
How To Take A Women Hsg Film?
Hysterosalpingography (HSG) or medicated uterus and tube film are applied in a period when menstrual bleeding is finished and in the first half of the menstrual cycle. The reason for this is to prevent the problems caused by the menstrual bleeding filling the tubes through the uterus and into the abdominal cavity from there, on the other hand, not to harm a possible pregnancy in the uterus.
A liquid (contrast agent) seen in the imaging device during the procedure is given into the uterus from the cervix; this fluid is made to make the inside of the uterus and the tubes visible. This liquid is generally water with iodine salt. Iodine is responsible for keeping X-rays. Thus, images can be taken from the inside of the uterus and tubes. It has no smell and is a colorless liquid. It does not cause burning. It has no harm to tissues and organs. It’s called medicine, but it’s not real medicine. Contrast agent in the process; Since it is given by pressure from the cervix, it can also have a therapeutic effect in some cases by removing mucus-like barrier structures in the tubes. This application is completed within a maximum of 15 minutes. Patients do not feel any discomfort that may affect their daily routine after the uterus film procedure. Slight bleeding or spotting after the procedure is normal. The bleeding continues for a few days and ends. However, if the bleeding does not stop, a doctor should be consulted as there may be an abnormal situation.
In some cases, filming of the uterus before IVF injections and IVF treatments can prevent time loss and increase the success rate. Because, if any, detecting negative factors for pregnancy in advance and going for treatment will increase the chance of conception even if indirectly. For example, IVF treatments for a person with a closed tube is nothing but a vain waste of time. The easiest way to find out if the tubes are open is by using a uterus film. With the film of the uterus, not only whether the tubes are open, but also embryo in the uterus can be revealed whether there are congenital or postpartum abnormalities that may adversely affect flour adhesion or its development after attachment.
How to Take Medicated Uterus Film?
During the procedure, the woman lies on the x-ray table and raises her legs towards herself. The doctor inserts the tool called speculum used in the gynecological examination into the vagina. After cleaning the vagina and cervix with a solution, the cervix is held with the help of a tool and pulled to bring the uterus to a flat position. A thin catheter is placed in the cervix. Through this catheter, the liquid is given into the uterus. The passage of the drug through the uterus and tubes is observed under the scope and its films are shot. Then the placed devices are taken back in order and the process is terminated. The whole process takes about 5-10 minutes.
How is HSG interpreted?
Above is an HSG image at the top of the page. In this image, the uterus is seen in a triangular shape, under the uterus, the vagina and cervical canal is observed. The right and left capillaries on the sides of the uterus are Fallopian tubes, and the continuation of these structures shows that the fluid spreads in the abdominal cavity and spreads. This film is an example of a completely normal intrauterine film and an open two-sided tube.
- When no liquid reaches the uterus, this indicates a cervical duct obstruction.
- When “spots” are seen in the triangular structure of the uterus, this is a sign of adhesion in the uterus, when the triangular structure of the uterus is impaired, this is a sign of a congenital uterine defect.
- It is a sign that capillaries, that is, when the tubes cannot be seen or when the distribution of the fluid into the abdominal cavity can be observed after these structures, these tubes are clogged.
Is it necessary to withdraw HSG before starting IVF and infertility treatment?
Yeah. HSG must be done before every IVF and infertility treatments. In Betatom, the uterine film is taken with new devices and a painless new method, and selective salpingography is also performed for the clogged tubes.
Is it a painful procedure?
Withdrawing HSG is a partially painful procedure. However, this pain is short-term pain and is not unbearable. The severity of pain differs according to the person. Reactions and contractions against this foreign substance occur in the uterus, especially during drug administration. Due to this pain, sometimes there may be spasm in the tubes and the normally open tubes may appear to be closed. For this reason, there are schools some of the thoughts that recommend HSG under general anesthesia. However, general anesthesia is not required most of the time. Our view is based on the decision to apply general anesthesia according to the patient’s condition. A pain relief that will be taken 30-60 minutes before the procedure in most of the patients provides comfortable and trouble-free operation.
Mild groin pain similar to menstrual pain within a few hours of filming and mild bleeding in the form of spotting for a few days
How are medicated uterine film (HSG) results evaluated?
A normal result means that everything looks normal and is not a problem. Normal value ranges may differ slightly between laboratories.
In medicated uterine film;
Developmental disorders of the structures of the uterus or fallopian tubes
- Wound tissue (adhesions) in the uterus or tubes,
- Blocking the fallopian tubes,
- The presence of foreign bodies,
- If tumors or polyps in the uterus are detected, the result is abnormally defined and requires treatment.
When to get the result of hysterosalpingography (Medicated Womb Film)?
The process of filming the uterus takes approximately ten minutes. It may take approximately fifteen minutes to get the results after the film of the uterus has been made. The results are printed on black x-ray papers. The report is written by the radiologist. No reports are written by the obstetrician. The report, which is written by the radiologist, can be delivered to the obstetrician in about an hour or two. The photographs obtained by the obstetrician during the hysterosalpingography procedure and the report written by the radiologist are evaluated and forwarded to the patient. As a result of the procedures and evaluations, the necessary treatment methods can be applied.
What are the side effects of hysterosalpingography (Medicated Womb Film)?
As with any procedure, some side effects can be found in the medicated uterine film process. It is known that the most common side effects that can be seen are infections and allergies. It is known that after the procedure, infection status is observed in 1 out of every 100 patients. Antibiotic treatment is not preferred by the doctor since the risks are very low. If mitral valve discomfort is observed in the person to whom the procedure will be applied, the patient should start using antibiotics one day before the procedure and antibiotic use should last for four days. In addition, water-soluble contrast agents can prevent allergies from occurring during the procedure. The use of contrast agents in water can be decided by the doctor.
What is done to fix the problem detected in HSG?
Since the fluid is pressurized during HSG, a slightly clogged cervical canal or Fallopian tube can be opened with this pressure. Apart from this, HSG does not have therapeutic properties.
When the Fallopian tubes are found to be obstructed in HSG, IVF can be decided directly, and laparoscopy can be performed to understand the cause of adhesion in the tubes or to treat them if possible.
When adhesion in the uterus is detected in HSG, there are different ways to resolve this adhesion, and hysteroscopy (camera examination of the uterus) is the most commonly used method especially in advanced cases.
Although it is possible to diagnose a structural defect in the uterus in HSG, hysteroscopy and accompanying laparoscopy are usually required to make a definitive diagnosis. Although it is possible to fix the problem during these procedures, open surgery may be required in the treatment of some congenital defects.