Hysterosalpingogram
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Hysterosalpingography (HSG) is a radiographic diagnostic study of the uterus and fallopian tubes most commonly used in the evaluation of infertility. Uterine abnormalities are thought to be a contributing factor in approximately 10% of infertile women and 50% of women with recurrent early pregnancy loss, while the prevalence of tubal abnormalities in infertility is approximately 20%. [1, 2] Thus, assessment of the uterine cavity and fallopian tubes is a standard practice in the baseline infertility workup.
HSG has long been recognized for its use in detecting tubal patency, polyps, submucosal leiomyomas, synechiae, müllerian anomalies, hydrosalpinges, salpingitis isthmica nodosum (SIN), and peritubal adhesions (see the image below). [3] It does not, however, provide significant information about the ovaries, other areas of the pelvis, or the microbiologic environment of the endometrium, the latter of which may contribute to poor reproductive outcome in approximately 25% of subfertile women. [4]
Known contrast allergy, pregnancy, and active pelvic infection are absolute contraindications to the procedure.
The procedure should be performed in the late follicular phase of the menstrual cycle to ensure that the patient is not pregnant and to prevent false-positive intrauterine filling defects and proximal tubal occlusion due to endometrial thickening. Some facilities perform routine pregnancy tests prior to the procedure, but this practice results in an unfavorable cost–to-benefit ratio.
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Brunham RC, Maclean IW, Binns B, Peeling RW. Chlamydia trachomatis: its role in tubal infertility. J Infect Dis. 1985. 152:1275-82.
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Ryan G Steward, MD Fellow in Reproductive Endocrinology and Fertility, Department of Obstetrics and Gynecology, Duke University School of Medicine
Ryan G Steward, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, American Society for Reproductive Medicine, Texas Medical Association
Disclosure: Nothing to disclose.
Thomas Michael Price, MD Associate Professor, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Director of Reproductive Endocrinology and Infertility Fellowship Program, Duke University Medical Center
Thomas Michael Price, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Obstetricians and Gynecologists, Phi Beta Kappa, Society for Reproductive Investigation, Society for Reproductive Endocrinology and Infertility, American Society for Reproductive Medicine
Disclosure: Received research grant from: Insigtec Inc<br/>Received consulting fee from Clinical Advisors Group for consulting; Received consulting fee from MEDA Corp Consulting for consulting; Received consulting fee from Gerson Lehrman Group Advisor for consulting; Received honoraria from ABOG for board membership.
Vuk P Jovanovic, MD, FACOG Assistant Professor of Obstetrics and Gynecology, Mercer University School of Medicine; Sub-specialist in Reproductive Endocrinology and Infertility, Georgia Center for Reproductive Medicine, Memorial University Medical Center
Vuk P Jovanovic, MD, FACOG is a member of the following medical societies: American Society for Reproductive Medicine, Society for Reproductive Endocrinology and Infertility, American Congress of Obstetricians and Gynecologists, European Society of Human Reproduction and Embryology
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
Richard Scott Lucidi, MD, FACOG Associate Professor of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine
Richard Scott Lucidi, MD, FACOG is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine
Disclosure: Nothing to disclose.
Hysterosalpingogram
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