When Should You Opt for a Hysterosalpingogram?

In the realm of infertility diagnosis, many patients often request a hysterosalpingogram without realizing that not every infertile woman needs this examination. Moreover, even when necessary, a hysterosalpingogram should not be the initial diagnostic choice.

For couples who have been trying to conceive for over a year without success, a systematic examination at a hospital is essential. Given the wide array of tests available for infertility, the examination process should follow a structured approach: starting from simple to complex, non-invasive to invasive, and inexpensive to more costly procedures. This approach is akin to building a house; you must lay a solid foundation before constructing the upper floors.

A hysterosalpingogram (HSG) is a procedure where a radiopaque dye is injected into the uterus and fallopian tubes, and X-rays are taken to evaluate the shape of the uterine cavity and the patency of the fallopian tubes.

Four-Step Examination Method

Based on years of standardized diagnosis and treatment of infertility, the following four-step examination method is recommended for initial screening of infertility causes:

1. Semen Analysis for the Male Partner

2. Ovulation Monitoring (including assessment of ovarian function) for the Female Partner

3. Pelvic Examination (gynecological tests) for the Female Partner

4. Fallopian Tube Patency Test

When to Perform a Hysterosalpingogram

1. Male Factor Asthenozoospermia

If the male partner has severe asthenozoospermia, direct Intracytoplasmic Sperm Injection (ICSI) treatment is needed, making a fallopian tube check unnecessary. However, if the male partner has mild asthenozoospermia and the female partner's ovulation function and ovarian reserve are normal, a fallopian tube examination can be considered. If the tubes are unobstructed, intrauterine insemination (IUI) can be performed to assist conception.

2. Female Ovulation Disorders

In cases of female ovulation disorders, especially in primary infertility with no abnormalities in ovarian reserve or male semen, ovulation induction therapy should be attempted first. If ovulation does not occur after 3 to 6 cycles of treatment, a fallopian tube patency test may be warranted.

3. Gynecological Examination

For female patients with suspected pelvic endometriosis or ovarian cysts affecting fertility, based on medical history and ultrasound results, laparoscopic examination and treatment should be the first choice. This procedure allows for visual assessment of the fallopian tubes, any damage, the degree of injury, and their relationship with surrounding organs, providing a comprehensive evaluation of tubal patency and function.

In cases where ultrasound indicates uterine lesions such as endometrial polyps, intrauterine adhesions, or abnormal endometrial hyperplasia, hysteroscopy should be considered. This procedure allows for the treatment of uterine cavity issues and bilateral tubal catheterization with fluid infusion to evaluate tubal patency.

4. Female Ovarian Reserve Function Assessment

For women with diminished ovarian reserve and declining natural fertility, in vitro fertilization (IVF) should be considered without delay. The tubal check should be the last step due to the following reasons:

- The initial steps are non-invasive and relatively simple. The tubal patency test is invasive and carries infection risks, so it is reserved as the final step.

- If any of the initial tests show abnormalities, specific treatment options are available. In primary infertility without high-risk factors for tubal obstruction, a trial of guided conception for 3-6 months can be attempted without the need for a tubal test, thus avoiding the pain and risks associated with the procedure.

Preparation and Aftercare for Hysterosalpingogram

Because some patients may experience pain during the imaging procedure, and pain stimulation combined with fasting may lead to hypoglycemia, dizziness, and other discomforts, it is not advisable to undergo imaging examinations on an empty stomach. Instead, it is recommended to eat a light, high-protein, and regular meal. Additionally, remember to empty your bladder and bowels on the morning of the imaging to avoid any influence from feces and intestinal gas on the images.

During the imaging procedure, some patients may experience abdominal pain, which usually subsides within 30 minutes. Bringing a warm compress to place on your lower abdomen after the procedure can help alleviate the pain. There may also be a small amount of vaginal bleeding after the procedure, so it's advisable to bring a few sanitary pads to avoid soiling your clothing.

If abdominal pain persists or worsens, or if vaginal bleeding is heavier than menstrual bleeding and lasts more than seven days, seek prompt medical attention. Although imaging procedures carry some risks, they are generally performed on an outpatient basis. Discomfort may occur during and within 30 minutes after the procedure, so it is recommended to have a family member accompany you.