Oil- Based Hysterosalpingogram

Information for patients

A hysterosalpinogram or HSG is an examination to assess the shape of your uterus and fallopian tubes to check whether they are open or blocked. It also shows the shape of the uterus and any other problems with the fallopian tubes. Contrast (x-ray dye) is introduced into the uterus and fallopian tubes which allows them to be seen on x-ray pictures.

An oil-based HSG uses a liquid called Lipiodol to show the shape of your uterus and the patency of the fallopian tubes.
This contrast liquid has been used for HSGs for many years, but a few studies and trials have demonstrated that patients who had difficulty getting pregnant (subfertility/infertility) with no known cause, had a higher chance of natural pregnancy after oil-based HSG than the alternative water-based liquid.

This is a very safe test but due to its higher iodine content than water-based contrast, patient with underlying thyroid disease should not undergo Oil-based HSG.

A HSG is normally performed between day 4 and 11 of the menstrual cycle, after the bleeding stops (at least 24 -hrs post last day of bleeding) and before ovulation. The test however can be done up to day 20 if you have abstained since the first day of your period.

This test cannot be performed if you are pregnant. X-rays can harm a developing fetus therefore you must avoid having sexual intercourse(abstain) from the first day of your last period up until the date the HSG is performed. This includes avoiding protected sex.
If you have irregular periods or no periods, 2 weeks of abstinence is needed prior to the HSG.

Preparation for Oil-based HSG

Unlike water-based HSG, prior to Oil-based HSG, you will need a blood test called a thyroid function test (or TFTs) done within the last 6 months. This is normally done as part of your fertility work up.

If this is abnormal, the oil-based HSG cannot go ahead, however a water-based HSG can still be performed. This test can be arranged by your GP or gynaecologist.

Use of lipiodol is not recommend if you have confirmed blocked tubes (hydrosalpinx). You must have a normal US scan prior an oil-based HSG.

There is no special preparation for this examination other than the timing as described above.

How is the procedure performed?

• You will be asked to change into a hospital gown.
• A sample pot will be given to you for a urine sample for your pregnancy test.
• Our consultant radiologist will take a brief history from you and consent you for the procedure.
• You will be asked to lie on the examination table and the radiologist will insert an instrument called a speculum into the vagina to hold the walls apart so that the cervix can be seen. (The same procedure as having a smear test performed.)
• A small thin soft tube will be will be inserted into the cervix and contrast will then be injected slowly into your uterus.
• The flow of the contrast is monitored with the x-ray machine and several x-rays will be taken of the contrast flowing through the uterus, passing along the fallopian tubes and eventually (if there is no blockages) spilling out at the ends into the pelvis. You may experience some discomfort with mild ‘period’ like cramps as the contrast is injected, this should not be severe and generally settles quickly.
• The procedure takes about 30 minutes.

After the examination:

• The radiologist will explain the provisional findings to you after the examination.
• We will show you to a bathroom where you can freshen up. You will be given a sanitary pad.
• After the examination there may be some blood-stained discharge for up to 48 hours following the test. This is the contrast fluid draining from the uterus and vagina and is completely normal. A sanitary pad) should be worn to allow the fluid to escape. You must not use tampons as this can increase risk of infection
• Most women have no problems following the procedure but some may experience mild period type pain afterwards. Take two of your normal painkillers such as paracetamol/Ibuprofen.
• After the examination you can resume your normal activities.
• You may start having sexual intercourse on the same day as your HSG should unless instructedotherwise on the day.

Risks and Complications

Everything possible will be done to ensure your safety and comfort but, as with all medical procedures, there is a risk of some complications. These are rare, but you should be aware of them before your appointment. They include:

• Infection : Risk of 1 in 100 (1%). You will be given a dose of antibiotics to reduce this risk.
  o If you have a history of pelvic infection, this may be reactivated. If you have any smelly discharge, raised temperature or pain within 48 hours following the examination, pleaseinform your GP so that any infection can be treated – this occurs very rarely.
• Intravasation: On very rare occasions, the oil-based liquid might enter the blood vessels in the uterus. The study will be terminated should this happen. We only inject the liquid under directvisualisation to minimise this risk.
• The oil-based contrast can stay in the pelvis for a few weeks. This is not harmful and iseventually absorbed.
• Granuloma formation: In extremely rare circumstances the liquid may not be absorbed andsomething called a granuloma can form inside the body. This is rarely a problem and very rarelymay require surgery for removal.
• There is an extremely small risk of an allergic reaction to the contrast used. If you experience arash, itching or swelling after the examination, please contact your doctor.
• Some women can feel faint during or after the examination.
• Very occasionally the test cannot provide all of the required information and the findings mayneed to be further evaluated, possibly with laparoscopy or hysteroscopy.
• If possible, when an oil-based HSG cannot be performed, we will perform a water soluble HSGinstead