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The Truth About an HSG Procedure for Infertility

A hysterosalpingography (HSG), is an exploratory procedure suggested for unexplained infertility. This will not be the first test your fertility clinic will offer you, first it may be clomid (medicine to help you ovulate) and a round of IUI’s. Then, if you are not successful, they may offer this test to see if your tubes are patent (clear). An HSG involves a dye that is introduced into the uterus and the fallopian tubes which enables them to be visualized using an x-ray. This procedure is not completed in the office, but in the radiology department, or near the lab.

Before my HSG procedure, my RE’s office told me to take Motrin or aspirin for pain. I did not have any Motrin so I took Tylenol, went alone, dressed for work, and planned to visit offices after my appointment. I did not research a ton because I did not want to scare myself or get worked up-I was grossly unprepared. I would like to create a flier that every woman receives when she is scheduled for this procedure, and it would say:

1. Dress in a sweat suit w tennis shoes

2. Plan to take the rest of the day off

3. Go with a significant other/loved one you feel safe with

4. Bring water or snacks if you have not eaten

5. Tell (do not ask) your doctor to prescribe you something stronger to take to alleviate the chance of pain or have another pain relief option present during the procedure (topical anesthetics or intravenous opioids). I am sure that part of the issue is that insurance does not want to pay for additional services to make us comfortable.

I am going to tell you why there is so much conflicting information about his test. Some women say it is a walk in the park, some say it is the most excruciating pain they ever experienced. Here is why! 30-50% of women experiencing infertility have endometriosis, many undiagnosed. That is why they are undergoing this exploratory procedure in the first place-to get more answers. If you are one of those women and you have endo where they are injecting the dye -this could be extremely painful. That was me!

I am not sharing my experience to scare anyone; I just want all women to know the reality of this procedure. I felt uncomfortable right away, entrance into my uterus was not easy. Then, my RE shot the dye through my tubes and I felt such unbearable pain that I nearly passed out. I cried out, and they indicated that my tubes were clear on the left but noted an issue on the right and that it had not passed through the tube. She was going to do it again. Then, 30 seconds to a minute longer she said “oh, there we go, it made it through".

After that I felt like I was not in my body, everything was fuzzy, I felt scared, misunderstood and alone. I went into the bathroom because I was in so much pain, I thought something was wrong and would come out of me. They proceeded to ask me if I suffered from Anxiety because in 10 years, they had never seen someone react like that from an HSG. I was so out of it- I walked down a hallway with my backside out. I then went into a room where they fed me crackers and ginger ale on a cot. I laid down and called my dad, he was wonderful. He was in healthcare, and I thought he would know just what to tell me, he did.

The RE that asked me if I suffered from anxiety did call that night to check on me, but after the procedure, did not try to connect any dots as to why my procedure was so painful, even after explaining that for 6 months I felt consistent pain on my right-side during yoga and running. I ended up leaving that clinic and by the suggestion of my acupuncturist (because my temps stayed high during my period) I told my RE surgeon at the new hospital to look for endo when they went in for a uterine resection.

Sure enough I had stage 4 Endo, both tubes were adhered to other neighboring organs. My left fallopian tube was clear, but my right fallopian tube was in fact blocked with endometriosis (bloody lesions). There lies the problem. The first clinic said my right tubes were patent, but just because the dye eventually went through, did not mean they were clear.

RE’s need to be talking about endometriosis more, this cannot go on! Since they stopped doing as many laparoscopies as they used to in years past, endo is being overlooked and can take up to 10 years to diagnose. They are missing this disease not only in OBGYN clinics but also Fertility clinics, whereby that time they should certainly be aware that endometriosis can be the cause of unexplained infertility. Oftentimes, women are getting all the way to IVF without knowing if they have endometriosis, which will significantly reduce their chances of conceiving, even with IVF.

So, since we have a disease that is present in 30-50% of this population that is profoundly underdiagnosed, I would strongly recommend taking something stronger than Motrin to ensure you are comfortable. What exactly that should be, I do not know, but I would love to see more research as to what medicines may be effective.

In the study “Drug treatments for pain relief in hysterosalpingography” from the National Library of Medicine, PubMed Health. They concluded that women struggle to tolerate this procedure and there is no consensus on the best pharmacological interventions for pain relief. Only topical anesthetics and intravenous opioids were found to be of benefit in reducing pain during the procedure. Of course, there is no evidence that these pain relievers are beneficial post procedure. There is insufficient evidence for other drug treatments in reducing pain during an HSG. Another area of women’s health research that needs attention.