A fertility work-up is no walk in the park. It requires getting poked and prodded as well as scanned and surveyed. It’s an involved process. We are not doing this to torture you or to make the experience any more exhausting than it already is. We are doing it because there are a lot of aspects to investigate when trying to see where and why the fertility puzzle pieces are not fitting together. You have ovaries, tubes, and a uterus (in addition to many other non-fertility-specific organs). While they all don’t need to be batting a hundred for pregnancy to occur, they do have to know how to swing the bat and run the bases in order for you to get that coveted home run.
Any test that can do two things at one time is an obvious grand slam. The fertility testing and subsequent treatment takes A LOT of time out of your busy lives; anything we can do to streamline it gets two big thumbs up. The hysterosalpingogram (often referred to as the HSG or that “awful tube test”) can evaluate both the tubes and the uterus at the same time. It is an X-ray that uses radiopaque dye to evaluate these structures.
Not to sound like Google Maps (take a right at the light, and go 4.4 miles), but by infusing dye through the vagina, into the cervix, and hopefully into the uterus, it will find its way out of the tubes and into the pelvis. During the dye’s travels, we can learn a lot about what’s going on inside. So while the test may not be anyone’s idea of fun, it does kill two big birds in the infertility work-up with one stone (not sure where that saying came from…who really wants to kill two birds?).
Despite the information gleaned from the test, we have a breaking news update—the HSG is not perfect. It is limited in its ability to assess function. While it is pretty darn good at telling us if things (a.k.a. the tubes and the uterus) are open, open does NOT equal functional. In other words, while the test may say the tubes are OPEN (liquid can travel through them) that doesn’t guarantee that a sperm and egg can find each other, and as a unit (aka an embryo) make their way back to the uterus. Therefore the results of the HSG should not be assessed in a vacuum–your medical and gynecologic history are important when deciding if the tubes are tunnels that can be easily traveled.
The best time to undergo an HSG is in the early half of your cycle—think day 5 to day 11. This is done to make sure that you are not pregnant; dye and X-rays are not baby-friendly. It’s also important that your doctor KNOWS your medical history before you go; women with a history of pelvic infections or other serious abdominal surgery or disease are in need of some pre-HSG precautionary antibiotics. Additionally, if you have an allergy to iodine, make this well known to anyone and everyone; due to the dye used, an HSG is not right for you.
We all need a complete check-up every now and again; our hearts, our heads, our intestines, our kidneys, and our bones need to be checked out before they can be checked off (at least for that year). Same thing goes for all the structures/organs involved in the reproductive system. Things aren’t always as they seem. For instance, just because you don’t ovulate doesn’t mean you can’t also have a blocked tube. Simply stated, get your tubes checked out before you check the box for what’s causing your fertility problems. Things aren’t as “simple” as they seem.
While some pathology can be what we like to call “incidentalomas” (medical way for saying we found it while looking for something else and are not sure how much meaning it has), if you see it, you should deal with it. You don’t want it to be your deal breaker once treatment starts to progress.
No one looks forward to a dental cleaning. No one looks forward to a colonoscopy, and no one looks forward to a Pap smear (we don’t either!). But they are necessary to get that clean bill of health. Think of the HSG for the tubes and the uterus in the same way; they are necessary to get your fertility clean bill of health. The good news is, if it’s normal, you can check two boxes off of your never-ending to do list. Isn’t that efficient?