Hysterosalpingography: This test can help you get pregnant

The name is somewhat complicated, but hysterosalpingography is well known among some women, as it is a test that is often requested when a woman is conducting research to see if she has any problems getting pregnant.

Luiz Eduardo Albuquerque, clinical director of Fertivitro, a gynecologist specializing in Human Reproduction, explains that hysterosalpingography is an X-ray examination of the female reproductive system (uterus and tubes). “It is performed through an injection of contrast through the cervical canal, which will draw the cavity of the uterus and the inner part of the tubes. The objective is to evaluate the morphology of the organs, allowing the diagnosis of internal lesions of the uterine cavity, such as adhesions (synechia), polyps or fibroids; or injuries to the tubes, such as obstructions, dilations, or injuries,” he says.

Armindo Dias Teixeira, a gynecologist specializing in Assisted Reproduction, Videolaparoscopy and Gynecological Endoscopy, points out that hysterosalpingography is indicated to diagnose causes of difficulty in getting pregnant, malformations of the uterus, changes in the tubes, adhesions, tumors of the uterine cavity, among other cases.

Albuquerque points out that this test is indicated for all women when the couple is being investigated for marital infertility.

How is Hysterosalpingography performed?

Gynecologist Rogério A. Gomes, from Hospital Sírio Libanês, explains that hysterosalpingography is performed with an X-ray machine in conjunction with the use of contrast.

The patient lies on her back with her knees bent (as if she were going to take a Pap smear).
Contrast (usually iodine-based) is placed into the uterus by inserting a catheter into the cervix.
As the X-ray does not pass through the contrast, it is possible to assess the anatomy of the uterus and tubes.
During the exam, the doctor often asks the patient to change her position, which helps to better distribute the contrast, providing more information.
After the procedure, the catheter is removed and the patient can go home as usual.

“The total procedure time is about 20 minutes”, says Gomes.

Albuquerque points out that the exam is performed between the 7th and 10th day of the menstrual cycle (counting as the first day of the cycle the first day of menstrual flow). “A gynecological exam is carried out (the same as the annual preventive exam), in which a probe will be inserted into the uterine cervix so that the contrast is introduced. During the injection of the contrast, several X-rays are performed to document the images”, adds the specialist.

A very common question is regarding the use of contrast. Many people are unaware of what it means and even fear of side effects.

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Gomes explains that contrast is a liquid whose property is not to be traversed by X-rays. “The commonly used contrast product is a water-soluble substance with 25% iodine, which is well tolerated, being eliminated after 30 minutes”, he says.

Albuquerque clarifies that side effects are extremely rare, being more common with iodinated contrast agents, such as:

Feeling of heat in the body
nausea
Sweating
hypotension
metallic taste in the mouth

“The risk of using iodinated contrast agents is restricted to patients with iodine allergy, pregnant women or patients using IUDs”, adds Albuquerque.

Gomes points out that, in some cases, allergy to the contrast can occur. “It is essential for the patient to report to the doctor if she has an allergy to iodine or seafood, and she should return to the doctor in case of swelling, itching in the genital region, itchy skin or shortness of breath”, he warns.

Care before and after Hysterosalpingography exam

Meet the prerequisites for taking the exam, according to doctors:

The patient cannot be pregnant (there cannot be even this suspicion);
The patient must be between the 7th and 10th day of the menstrual cycle;
The patient must be in sexual abstinence for two days before the exam;
The patient must not have any vaginal discharge or discharge;
The patient must be sure that she is not allergic to iodine.

exam preparation

Albuquerque explains that preparation for the exam can vary from laboratory to laboratory. However, you are usually asked:

Fasting for at least four hours;
Two-day sexual abstinence;
Not having menstrual flow present;
Bowel preparation and analgesic 30 minutes before the exam.

Gomes reinforces that bowel cleansing may be necessary, using laxatives the day before. “This so that gases and feces in the pelvic region do not interfere with the visualization of the result”.

Also according to Gomes, antispasmodics and anti-inflammatory drugs can be used to avoid discomfort. “It’s also important to empty your bladder before starting the exam,” she says.

post-exam

Albuquerque points out that, as in preparing for the exam, guidelines may vary depending on the laboratory, but generally, it is recommended:

Rest on the day of the exam;
Use analgesics if necessary.

Gomes adds that sexual abstinence can be recommended for 5 days after the examination.

Contraindications of Hysterosalpingography

Teixeira points out that the main contraindications are:

Acute pelvic infections;
Allergy to contrast;
Suspected pregnancy.

Gomes reinforces that pregnant women are prohibited from performing the test due to the risk of abortion. “Patients who have had an allergic reaction to iodine when undergoing other tests or who are allergic to seafood should inform the doctor who will perform the procedure, so that some precautions are taken”, he guides.

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Risks of Hysterosalpingography

According to Albuquerque, the greatest risk would be an allergic reaction to iodine. “In rare cases, the exam can worsen an infection when it is pre-existing. In this case, when the radiologist makes the diagnosis of a hydrosalpinx (tubal dilatation), it is recommended that the patient use antibiotics after the exam”, he says.

Teixeira highlights that all procedures have a certain degree of risk. “But on this test, the most common risks are pain, minor bleeding, and eventually some change in blood pressure, and very rarely infection,” he says.

Hysterosalpingography Results

But what are the results of the exam anyway? What can they show? Specialist Albuquerque explains below:

uterus analysis

Normal results: in the normal uterine cavity, there is a characteristic “ruffle” (ruffle) of the cervical canal, a uterine cavity with smooth walls in a generally triangular shape with its base facing upwards, as shown in the drawing: ▼.

Altered results: diseases that invade the cavity of the uterus, such as endometrial polyps, submucous fibroids and adhesions (synechia), which cause filling failure, at the time of injection of contrast inside the cavity can be seen in the exam. of the uterus.

“Sometimes, we can notice an invasion of the contrast in the musculature of the uterus, forming discrete accumulations of contrast. In this case, it is possible to suspect adenomyosis and, therefore, we need more tests to reach the diagnosis”, adds Albuquerque.

“In malformation alterations of the uterus, the images can show the presence of a double uterine cavity (bicornuate uterus), a large filling defect that divides the uterine cavity (uterine septum) or even the drawing of only half of the uterus cavity (unicornuate uterus). )… In the latter, we have to research a little more, because we may be facing an alteration of uterine malformation that can be accompanied by another cavity or the absence of another cavity”, highlights the specialist in Human Reproduction.

tube analysis

Normal results: a normal tube appears on hysterosalpingography as a linear image from the exit of the uterine cavity for approximately two thirds of the total size of the tube and then a slight dilatation (ampullary region), where a “ characteristic longitudinal pleat (pleat), followed by a slightly greater dilation that precedes the exit of the contrast to the abdominal cavity (infundibulum or fimbriae).

“The important thing is that the passage of the contrast inside the lumen of the tubes is normally not interrupted and, in most cases, it does not cause it to be retained inside”, explains Albuquerque.

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“At the end of the exam, the experienced radiologist waits for the patient to walk and, after a few minutes, repeats the X-ray exam with the aim of completely eliminating the contrast from the interior of the uterine cavity, because, once there is no more contrast in the cavity, uterine tube, there is also no need for more contrast inside the tubes. And so, we can conclude that the tubes do not retain contrast, therefore they are normal”, adds the specialist.

Altered results: obstructions in the passage of contrast represent an injury to the tubes, which may be due to a surgical procedure (tubal ligation) or a sequela of an infectious process.

“In the sequelae of infections of the tubes, several types of images can appear in addition to the obstruction, such as important dilatations, showing a derangement of the normal ‘folding’ of the tubes (hydrosalpinx) and significant narrowing of the contrast output through the infundibulum (paraphimosis)”, says Albuquerque.

“Small filling failures in the isthmic region of the tubes (thinnest segment) may represent polyps inside, but it seems that such a disease does not compromise the patient’s fertility”, explains the specialist.

“We can notice an infiltration (small diverticula or nodules) in the wall of the tubes in the isthmic region, suggestive of salpingitis nodosa, that is, tube infection caused by sexually transmitted diseases, such as chlamydia, neisseria, gonorrhea, ureaplasma and mycoplasma, and may also have as the causative agent of tuberculosis”, highlights the specialist.

“Even with apparently patent tubes, we can notice images suggestive of infection, such as: tube tangling, lack of tube mobility during the examination (fixed tubes) and sequestration of a moderate amount of contrast in certain peritubal regions”, highlights Albuquerque.

Where to do Hysterosalpingography

Albuquerque says that labs that do X-rays usually do hysterosalpingography. The vast majority of health plans cover the exam.

Gomes reinforces that this exam is normally covered by health plans (for that, consult your operator) and is also available in the Unified Health System (SUS). “The exam can be done in laboratories or even inside the Hospital according to the patient’s peculiarities”, she says.

Teixeira also explains that the examination is usually performed by a radiologist with experience in gynecological diseases.