An x-ray (radiograph) is a noninvasive (that does not require surgery) medical test that aids physicians in diagnosing and treating medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. Fluoroscopy is a special x-ray technique that allows the doctor to see internal organs in motion. During a hysterosalpingogram, the uterus and fallopian tubes are injected with a water-soluble contrast material, and the radiologist is able to visualize and assess their anatomy and function.
Hysterosalpingography is mainly used to examine women who have difficulty conceiving; the doctor can evaluate the shape and structure of the uterus, how patent (open) the fallopian tubes are, and detect any scarring within the uterine or peritoneal (abdominal) cavity.
The procedure can be used as part of the investigations of recurrent pregnancy loss that results from congenital (present since birth) or acquired abnormalities (deformities) of the uterus and to determine the presence and severity of these abnormalities, including:
• tumor masses
• adhesions (tissues sticking together)
• uterine fibroids (benign growths inside the uterus)
Hysterosalpingography is also used to evaluate the openness of the fallopian tubes, and to monitor the effects of tubal surgery, including:
• blockage of the fallopian tubes due to infection or scarring
• tubal ligation
• the closure of the fallopian tubes in a sterilization procedure and a sterilization reversal
• the re-opening of the fallopian tubes following a sterilization or disease-related blockage.
Fluoroscopy sends continuous or pulsed x-ray beams to create a series of images that are projected onto a fluorescent screen. When performed with a contrast material, which clearly delineates the area being examined by making it appear dark, fluoroscopy facilitates viewing internal organs in motion.
The procedure resembles a pelvic exam. A speculum is inserted into the vagina, the cervix is cleansed, and a catheter is inserted into the cervix. The speculum is removed and the patient is carefully positioned underneath the fluoroscopy camera. The contrast material then begins to fill the uterine cavity, fallopian tubes and peritoneal cavity through the catheter and fluoroscopic images are taken. The hysterosalpingogram is usually completed within 30 minutes, unless abnormalities are seen in which case the examination may take a longer time.
Hysterosalpingography only exposes the inside of the uterus and fallopian tubes. Abnormalities of the ovaries, wall of the uterus, and other pelvic structures are better evaluated with MRI or ultrasound. Infertility problems may be from causes not evaluated with hysterosalpingography, including, but not limited to, low or abnormal sperm count or the inability of a fertilized egg to implant in the uterus.