Hysterosalpingography Examinations Research Articles

Spectrum of Radiological Findings in Hysterosalpingography for Female Subfertility: A Retrospective Cross-Sectional Study in a Tertiary Care Center of Nepal

Introduction: Hysterosalpingography (HSG) is a commonly used diagnostic procedure to investigate the causes of female subfertility. This study aimed to evaluate the range of findings observed in HSG examinations conducted for this purpose. Methods: A prospective cross-sectional study was conducted at the Department of Radiology and Imaging, Tribhuvan University Teaching Hospital, from December 2022 to April 2023. The study included 196 female participants who underwent HSG and met the inclusion criteria. Results: Out of the 196 participants, 127 (64.8%) were categorized as having primary subfertility, while 69 (35.2%) had secondary subfertility. The mean age of the participants was 30.61±5.623 years, with an age range of 20 to 45 years. Among the participants, 142 (72.4%) exhibited a normal uterus, 23 (11.7%) displayed left tubal occlusion, 17 (8.7%) showed right tubal occlusion, 13 (6.6%) had other findings, and 1 (0.5%) was diagnosed with uterine fibroids. Conclusions: This study demonstrated that approximately one out of every five HSG examinations performed to evaluate subfertility revealed tubal occlusion. Consequently, the high detection rate of uterine and tubal pathologies using HSG underscores its critical role as a diagnostic tool for assessing women with subfertility.

When a balloon catheter or tenaculum is required for cervical traction during hysterosalpingography

The aim of this study was to define the actual rate of the traction needed and the balloon catheter or tenaculum requirement for hysterosalpingography (HSG) examinations, and to investigate the correlation between pain scores with the type of traction, operator, parity or the type of infertility. 788 patients undergoing HSG participated in the trial. The HSG examinations were completed in 58% of the patients (458) without any traction. Traction was needed in 42% of patients, those with the balloon catheter in 26.9%, and those with the tenaculum only at 15%. Patients with balloon catheter traction had similar pain scores to those using tenaculum traction. The pain scores changed according to the operator. HSG examinations should be performed step-by-step and the need for traction evaluated during the procedure. IMPACT STATEMENT What is already known on this subject? HSG is a technique to evaluate fallopian tube patency and other potential intrauterine pathology in infertile women. What do the results of this study add? Traction was not needed in more than half of the HSG examinations. The pain due to the balloon catheter and tenaculum is similar. What the implications are of these findings for clinical practice and/or further research? HSG examinations should be performed step-by-step by checking the need for traction. Traction with the balloon catheter prevents the uterine spasm, infection and bleeding complications during or after the HSG.

Diagnostic Value of Hysterosalpingography

Objective: Hysterosalpingography (HSG) is a contrast-enhanced, radiographic examination method of the internal female reproductive organs, which is used in the context of infertility diagnostics for the clarification of uterine malformations. The aim of this study was to investigate the significance of HSG as a diagnostic method in reproductive medicine. Methods: The results of HSG examinations from the Clinic for Reproductive Medicine and Andrology of the University Hospital Halle (Saale) between 2006 and 2020 were retrospectively examined. Results: Normal uterine findings were diagnosed by HSG in 151(51.01%) patients. The most common uterine malformation was uterus arcuatus, which was found in 46 patients (15.54%); 30(10.14%) patients had uterus bicornis unicollis. Uterus bicornis, unicornis, and subseptus were present in 5(1.69%) patients each. A duplex uterus was detected in 3(1.01%) patients, and malformations of a uterus arcuatum unicollis, uterus septus, bicornis subseptus, and uterus corpora in case of sectio bicornis were detected in 1(0.34%) patient each. A comparison of HSG findings with those from initial baseline diagnostics (gynecologic manual examination, sonography, etc.) revealed a correlation of findings in 105 cases (35.84%) and divergence of findings in 79 cases (26.96%). With the assistance of the HSG findings, further specification of the previously collected findings was achieved in 27 cases (9.22%). The diagnostic significance of HSG in reproductive medicine was demonstrated by the fact that findings were obtained and could not be detected in the preliminary examinations. In addition, basic diagnostic findings were confirmed by HSG, and conversely, previously collected findings could be further specified. HSG is a less invasive diagnostic imaging procedure with a short examination time. The fluoroscopy time is usually only a few seconds. Therefore, the radiation exposure is negligible. Conclusion: HSG is a method of radiologic examination that can be used to diagnose and specify uterine malformations. The diagnosis by HSG often opens up new therapeutic options to correct uterine malformations.

Serum thyroid-stimulating hormone receptor antibody levels and thyroid dysfunction after hysterosalpingography: a case-control study

Objective Hysterosalpingography (HSG) performed with an iodine contrast media can cause thyroid dysfunction, including thyrotoxicosis and hypothyroidism. We investigated the association between the serum levels of thyroid-stimulating hormone receptor antibody (TRAb), an indicator of Graves’ disease, and abnormal thyroid function after performing HSG. Methods The screening of TRAb was conducted in 362 patients who first visited the Tawara IVF Clinic between April and September 2018. The association between TRAb levels and the effects of HSG examinations on thyroid function were evaluated. Results Of the 362 patients, 2 (0.55%) had high levels (>2.0 IU/L) of TRAb, whereas 18 (5.0%) had intermediate TRAb levels, ranging from 0.3 to 1.9 IU/L. Of the 98 women (including 7 of the 18 women with TRAb level 0.3–1.9 IU/L, and 91 of the 342 women with TRAb level <0.3 IU/L) who had undergone HSG, two women developed overt thyrotoxicosis after HSG, and the frequency was significantly higher (p = .0044) in the group with intermediate levels of TRAb (28.6%, 2 of 7) than that in the group with low TRAb levels (<0.3 IU/L; 0.0%, 0 of 91). Conclusions These findings indicate that increased serum levels of TRAb are significantly associated with the development of thyrotoxicosis after HSG.

Unsuspected Pregnancies in Hysterosalpingography: Implementation and Review of a Multi-Institutional Pre-Procedural Pregnancy Screening Protocol.

Owing to the increasing average age of first-time mothers, as well as advances in assistive reproductive technology, the number of hysterosalpingography (HSG) requests has continued to rise. This increases the likelihood of patients presenting with unsuspected early pregnancies prior to HSG. Currently, there is no standard of practice for the pre-procedural screening of pregnancy prior to HSG, with most institutions using patient-reported pregnancy status and unreliable menstrual cycle dating methods. We implemented a multi-institutional pre-procedural pregnancy screening protocol in order to determine the rate of unsuspected pregnancies prior to HSG and improve the quality and safety of these procedures. Following multi-institutional and multidisciplinary input, a consensus protocol was formulated and implemented across 9 institutions in the Lower Mainland of British Columbia, Canada. Subsequent tracking of pregnancy testing was then performed over a period of 3 years. Pre-implementation review of protocols demonstrated large disparities between institutions. A total of 6333 HSG examinations were scheduled in the review period following implementation. Of these, 10 patients were found to have positive pregnancy tests (0.16%), despite self-reporting that they were not pregnant or had recent menstrual bleeding. Hysterosalpingography is contraindicated in pregnancy, yet we identified 10 unsuspected pregnancies in patients who would have otherwise undergone HSG examinations with existing guidelines. While there remains insufficient data on the deleterious effects of performing HSG on an unsuspected pregnancy, the potential physical, economical, and psychosocial consequences of performing an HSG during pregnancy are sufficient to merit consideration of relatively inexpensive routine pregnancy screening prior to HSG.

The validity of HSG in infertility work up

BackgroundOur purpose was to evaluate the diagnostic accuracy of hysterosalpingography (HSG) in the diagnosis of the uterine cavity and tuboperitoneal abnormalities in infertile women. Reproducibility and consistency were also assessed. Two hundred infertile females underwent HSG, hysteroscopy, and/or laparoscopy as part of infertility workup. HSG examinations were retrospectively reviewed by three radiologists; we compared interobserver variability, and differences between the two results of reading the same examination after 3 months were compared to calculate intraobserver variability.HSG sensitivity, specificity, PPV, NPV, and accuracy were calculated.ResultsThe overall accuracy of HSG in diagnosing tubal, uterine cavity, and peritoneal abnormalities was 95.5%, 95%, and 89%, respectively (P value < 0.04).HSG is reproducible in diagnosing normal versus abnormal examinations. Reproducibility in diagnosing uterine cavity, tubal, and peritoneal abnormalities was (ICC = 0.90), (ICC = 0.70), and (ICC = 0.31), respectively. Best agreement was seen in diagnosing luminal filling defect (sub mucous fibroid/polyp) (ICC = 0.90) (95% CI 0.86–0.98), whereas poorest agreement was found in diagnosing uterine adhesions (ICC = 0.13) (95% CI 0.10–0.13) and pelvic adhesions (ICC = 0.12) (95% CI 0.10–0.13) (P value < 0.03).HSG consistency ranged from moderate to good (K = 0.49–0.79). It was highest in diagnosing normal versus abnormal examination (P value < 0.01); poorest in diagnosing pelvic adhesions.ConclusionHSG has high validity in negative results; it can minimize the use of invasive procedures. Laparoscopy is recommended in patients who had a pelvic disease or showing tubal obstruction on HSG.

Hysterosalpingographic Findings of Infertile Patients Presenting to Our Reproductive Endocrinology Department: Analysis of 1,996 Cases.

To evaluate the hysterosalpingography (HSG) findings of women with infertility in a tertiary center located in central Turkey. A total of 1,996 patients undergoing the HSG procedure for the investigation of infertility from April 2012 to 2017 were retrospectively evaluated using the archives of the reproductive endocrinology and radiology departments. Demographic and clinical characteristics of patients with normal HSG findings (n = 1,549) and patients with abnormal HSG findings (n = 447) were compared, and the distribution of pathologies on the HSG examinations was evaluated as well. There were statistically significant differences between patients with normal and abnormal HSG findings in terms of age (25.68 ± 4.54 vs. 35.87 ± 2.65, p < 0.001), type (for secondary) and duration of infertility [43.1% vs. 50.6% (p = 0.006); 7 (1-22) vs. 2 (1-12) (p < 0.001), respectively], and baseline follicle stimulating hormone and estradiol levels [7.22 ± 1.38 vs. 7.55 ± 1.42 (p < 0.001); 45.54 ± 9.92 vs. 44.40 ± 9.99 (p < 0.001), respectively]. Among a total of 1,996 HSG examinations, 447 (22.39%) showed abnormalities, of which 237 (11.87%) were associated with tubal pathologies, 163 (8.17%) with uterine pathologies, and 47 (2.35%) with a combination of both. While the most common tubal pathology was one-sided distal tubal occlusion (2.91%), the most common uterine pathology was filling defects (4.16%). HSG is the most commonly used, well-tolerated, low-cost, and safe radiological procedure to use for the investigation of the causes of female infertility.

Patterns of Abnormal Findings in Females Referred for Hysterosalpingography at Private Diagnostic Center, Lagos Nigeria

Background: Hysterosalpingography (HSG) is a special contrast radiographic examination that uses invasive technique for the assessment of the fallopian tubes, uterine cavity and cervical canal abnormalities. This study was undertaken to determine the patterns of abnormal findings in females referred for HSG in Lagos. Materials and Methods: All the HSG examinations were performed with standard protocol. The data used for this study were collected from accumulated radiological HSG reports from the archive of the study center in Lagos. A convenience sample size of 145 patients’ records were retrospectively reviewed based on the inclusion criteria. Data were processed and analyzed using SPSS version 20 and descriptive statistics. Results: Most of the females were within age group 20-30years 53.8% (n=78) and the least were age group 41-50 years 3.5 %(n=5).The commonest indication was infertility 71%(n=103) and the least was Asherman’s syndrome 2.8%(n=4). Tubal anomalies were the most common abnormal finding 41.4% (n=60) followed by uterine 30.3% (n=44). Conclusion: Hysterosalpingography is still the gold standard imaging tool for the evaluation of pelvic structures in females referred for HSG especially in our locality. 21-30 years age group were the most commonly affected population. Infertility was the most common indication and tubal abnormalities preponderance was noted

Effect of menstrual cycle phase and hormonal treatments on evaluation of tubal patency in baboons.

BackgroundWe evaluated whether menstrual cycle phase influences the assessment of tubal patency by hysterosalpingography (HSG) in baboons.MethodsRetrospective analysis of baseline tubal patency studies and serum estradiol (E2) and progesterone (P4) values obtained from female baboons used as models for development of non‐surgical permanent contraception in women. The main outcome measure was bilateral tubal patency (BTP) in relationship with estradiol level.ResultsFemale baboons (n = 110) underwent a single (n = 81), two (n = 26), or three (n = 3) HSG examinations. In 33/142 (23%) HSG examinations, one or both tubes showed functional occlusion (FO). The median E2 in studies with BTP (49 pg/mL) was significantly higher than in those studies with FO (32 pg/mL, P = .005). Among 18 animals with repeat examinations where serum E2 changed from <60 to ≥ 60 pg/mL, 13 results changed from FO to BTP (P = .0001). No sets showed a change from BTP to FO with an increase in estradiol.ConclusionIn baboons, functional occlusion of the fallopian tube is associated with low estradiol levels, supporting a role for estrogen‐mediated relaxation of the utero‐tubal junction.

Nnamdi Norbert Jibirigerian Hospitals

Objective:The practice of regular dose measurement helps to ascertain the level of occupational dose delivered to the staff involved in diagnostic procedures. This study was carried out to evaluate the dose exposed to the hands of radiologists and a radiologic technologist carrying out HSG and radionuclide bone scan examinations in several hospitals in Nigeria.Methods:Radiation doses exposed to the hands of radiologists and a technician carrying out hysterosalpingography (HSG) and bone scan procedures were measured using calibrated thermo-luminescent dosimeters. Five radiologists and a radiologic technologist were included in the study for dose measurement.Results:The study indicates that each radiologist carried out approximately 2 examinations per week with the mean dose ranging between 0.49-0.62 mSv per week, resulting in an annual dose of 191 mSv. Similarly, the occupational dose delivered to both the left and right hands of a radiologic technologist administering 99mTc-methylene diphosphonate (MDP) without cannula and with cannula were 10.68 (720.2) and 13.82 (556.4) mSv per week (and per annum), respectively. It was determined that the left hand of the personnel received higher doses than their right hand.Conclusion:The estimated annual dose during HSG is far below the annual dose limit for deterministic effects, however, it is greater than 10% of the applicable annual dose limit. Hence, routine monitoring is required to ensure adequate protection of the personnel. The total annual dose received during the bone scan exceeds the annual dose limit for both hands, and the dose to either left or right hand is greater than the dose limit of 500 mSv/yr. The radiologists monitored are not expected to incur any deterministic effects during HSG examinations, however, accumulated doses arising from the scattered radiation to the eyes, legs, and neck could be substantial and might lead to certain effects. More staff are required to administer 99mTc-MDP in Nigerian institutions to prevent excessive doses to personnel.

Hysterosalpingographic findings among Ghanaian women undergoing infertility work-up: a study at the Korle-Bu Teaching Hospital.

BackgroundHysterosalpingography (HSG) is one of the commonly used radiological modalities for investigating infertility in women. In developing countries such as Ghana it remains the main tool for investigating some of the underlying causes of female infertility. The purpose of this study was to determine the predominance of various hysterosalpingographic results in patients that went through infertility work-up at the Korle-Bu Teaching Hospital between January 2011 and December, 2014. This is to help plan for preventive measures for the communities.ResultsThis study collected retrospectively, 1140 consecutive radiologic reports from January 2011 to December, 2014 from the Department of Radiology, Korle-Bu Teaching Hospital. These reports were reviewed and diagnoses made were evaluated with Microsoft Excel. Secondary infertility was 52.4 % prevalent and primary infertility was 41 % prevalent. While 453 (39.7 %) patients presented with normal findings, 153 (13.4 %) had hydrosalpinx, 498 (43.6 %) had tubal blockage, and 290 (25.4 %) had fibroids. Also there were 10 (0.9 %) cases of patulous cervices, 8 (0.8 %) cases of uterine synechiae, 62 (5.4 %) of irregular uterine outline, 15 (1.3 %) of irregular cervical outline, 3 (0.3 %) of arcuate uteri, and 5 (0.4 %) cases of retroverted uteri.ConclusionTubal blockage which presented in 43.6 % of patients was the most common abnormal finding at HSG examinations carried out between January 2011 and December, 2014 at the KBTH. This was followed by fibroids with 25.4 % and hydrosalpinx with 13.4 %. Factors such as chronic pelvic inflammatory disease or pelvic infection following STIs, mismanaged pregnancies and septic abortions, may have accounted for this since the majority of the women presented with secondary infertility.

Effective and ovarian dose in PA conventional and rotational 3D hysterosalpingography examinations

The purpose of this study was to compare effective and ovarian doses (E and OD, respectively) in hysterosalpingography (HSG) examinations performed with conventional posterioanterior (PA) projections and rotational 3D (3D) techniques. 29 HSG examinations (11 conventional and 18 3D), were performed using a digital C-arm angiographic system. In the conventional technique, we used posterioanterior (PA) instead of an anterioposterior (AP) projection normally used according to the international literature. All information concerning exposure conditions for each patient, were recorded. Thermoluminescent dosimeters (TLDs) were attached on the skin of each patient over the ovaries. In conventional HSGs, average values were for Dose Area Product (DAP) 0.41 Gycm2, for Effective Dose (E) 0.15 mSv and for Ovarian Dose (OD) 0.24 mGy. In 3D-HSGs, they were 14.4 Gycm2, 2.29 mSv and 3.96 mGy correspondingly. Patient doses in 3D-HSGs are of the same order of magnitude with those reported in the literature for conventional technique. However, they are larger compared to the conventional HSG performed with the technique we use in this specific X-ray system. E and OD are much lower with our technique where PA projection and the specific C-arm system are used in comparison with the corresponding values published in the literature for the conventional technique where the AP projection is used.

Hysterosalpingography in the workup of female infertility: indications, technique and diagnostic findings

ObjectivesTo evaluate the spectrum of diagnostic findings in hysterosalpingography (HSG) examinations performed at our institution between 2006–2010 and their prognostic significance for treatment decisions and fertility outcomes.MethodsPatients were filtered from our PACS. Pathological HSG studies were re-evaluated. Indications for referral, technical success and diagnostic findings were analysed. Pathological findings were correlated with further diagnostic workups, treatments and fertility outcomes.ResultsOf 411 HSG examinations, 226 (55 %) were normal, 94 (23 %) showed minor abnormalities and 5 (1.2 %) were not diagnostic. Eighty-six (21 %) examinations were pathological. Twenty-nine patients underwent subsequent laparoscopy, during which proximal tubal occlusion diagnosed at HSG was ruled out in 9/23 cases. Follow-up information was unavailable for 20 patients. Nineteen of 66 patients with follow-ups after pathological HSG had at least one subsequent successful pregnancy. Forty-one patients had no further treatment and no pregnancies.ConclusionsThe detection rate for pathologies at HSG was low (21 %). There was a high false-positive rate (39 %) for proximal tubal occlusion, most likely because of spasms, demonstrating the importance of delayed imaging after injection of antiperistaltic agents. HSG remains a valuable diagnostic tool. Our results, however, indicate that this technique should be more selectively indicated.Main Messages• Good acceptance of HSG by the patients. No complications with antibiotic prophylaxis.• Low detection rate (21 % pathological exams) for pathologies in our study.• High false-positive rate for proximal tubal occlusion.• This demonstrates the importance of waiting longer after injection of buscopan.• High pregnancy rate in pathological cases: Indication too broad or even a therapeutic effect of HSG?

Hysterosalpingography with use of mobile C-arm fluoroscopy

To review radiation exposure during hysterosalpingography (HSG) examinations with use of a mobile C-arm fluoroscopic imaging system with advanced features including pulsed fluoroscopy and last-image-hold capability. Retrospective clinical study. Freestanding outpatient radiology office. Two hundred consecutive patients who were referred for HSG examinations to evaluate fertility or status of tubal ligation. Pulsed fluoroscopy (eight frames per second) and continuous fluoroscopy were used with automated exposure control and last image hold for static image capture. Fluoroscopy time (seconds), field of view (12 in., 9 in., 6 in.), mode (continuous, pulsed), and dose area product (mGycm(2)) were recorded for each patient. The total estimated surface dose then was calculated. One hundred forty-seven patients had normal results on hysterosalpingograms, and 57 patients had abnormal results on hysterosalpingograms. Selective salpingography was performed in 26 of the 38 patients with fallopian tube occlusions. Mean fluoroscopy time for normal, abnormal, and selective catheterization was 4.17, 14.3, and 56.1 seconds, respectively. Mean estimated surface dose for normal, abnormal, and selective catheterization was 2.6, 6.9, and 46.7 mGy, respectively. A mobile C-arm fluoroscopic imaging system with pulsed fluoroscopy and last-image-hold capability may be a desirable alternative for HSG to achieve lower radiation exposure with improved operator convenience and patient comfort.