What is a hysterosalpingography?

A hysterosalpingography is an examination using x-rays and, as its name suggests, it is used for exploring the uterus (hystero-) and fallopian tubes (salpingo-).

The examination is rather uncomfortable but this is remedied by giving the patient some form of pain relief or muscle relaxant before proceeding. An alternative test called a hysterosonography does now exist, too. It is pain free, does not require the use of x-rays and, furthermore, obtains the same results as a hysterosalpingography. Nowadays, hysterosonographies are the preferred choice over hysterosalpingographies. This technique can be performed at Instituto Bernabeu and the results are provided immediately.

Both examinations are mainly used in women who are having issues getting pregnant so that the uterus, its shape and any abnormalities, as well as the size of the fallopian tubes and any blockages in them, can be examined.

A hysterosalpingography is usually performed on the first few days following menstruation because these are the days on which the patient is least likely to be pregnant. The procedure involves inserting liquid into the vagina that then travels through the uterus and fallopian tubes. It is displayed in white on the x-ray that is simultaneously taken of the abdomen. The process involves filling the uterus and fallopian tubes with the liquid and displaying the liquid on the x-ray.

As mentioned above, the aim is to view the shape of the uterus. In other words, it is possible to diagnose all cases where the patient has a malformation. For example, a bicornuate uterus or a septum or partition situated in the middle of the uterus that makes adhesion difficult and significantly increases the risk of pregnancy loss. The procedure can also be used to view lesions such as polyps or fibroids in the uterine cavity, and even scarred tissue and adhesions. However, the most important information obtained from the examination is an understanding of the condition of the fallopian tubes. In other words, if they are open (permeable) or blocked (obstructed).

The fallopian tubes are the tubes that connect the uterus and ovaries. They make it possible for the oocyte released following ovulation to remain inside until a spermatozoon reaches it.

Blocked tubes stop spermatozoa from reaching the meeting point, making pregnancy impossible. This is why understanding if the fallopian tubes are open or blocked is so important. A hysterosalpingography shows how the liquid travels through the fallopian tubes and is released in the abdomen (permeable) or, alternatively, if there is a blockage along the route and no liquid in the abdomen is observed (obstructed).

As well as obtaining a diagnosis of blockages in the fallopian tubes, it is also possible to view their shape. Enlarged tubes do exist and this can suggest that they are full of liquid (Hydrosalpinx). This happens in particular in women who have had episodes of previous infections or surgery. In cases such as these, diagnosis performed by reproductive medicine specialist is advised. He or she will be able to inform the patient about her prognosis and any treatment that is required.

Blocked or enlarged fallopian tubes are very infrequent in patients who have not had infections in the fallopian tubes or undergone surgical procedures in the abdomen. In fact, some authors do not recommend using the procedure on these patients.

Dr Belén Moliner, gynaecologist at Instituto Bernabeu.