Metrosalpingography (diagnosis of fallopian tube patency)

Hysterosalpingography (HSG) is an X-ray diagnostic procedure used to evaluate the uterus and fallopian tubes by injecting a contrast medium through the cervix. The primary purpose of HSG is to assess tubal patency and detect structural abnormalities of the uterine cavity. This examination is a key diagnostic step in the evaluation of female infertility.

Indications for hysterosalpingography

Hysterosalpingography is commonly recommended in the following situations:

• Investigation of infertility. The main indication is assessment of fallopian tube patency, as tubal obstruction is a frequent cause of infertility.
• Suspected uterine abnormalities. HSG allows detection of congenital or acquired abnormalities such as uterine septum, polyps, or fibroids that may affect reproductive outcomes.
• Postoperative assessment. The procedure may be used to evaluate the results of previous tubal or pelvic surgery, including reconstructive procedures.
• Suspected pelvic adhesions. HSG can help identify adhesions that interfere with normal tubal function.

Preparation for hysterosalpingography

Prior to the procedure, several preparatory steps are required:

• Medical consultation. A gynecological examination is performed, and additional tests may be ordered, including vaginal swabs and blood tests to rule out infection.
• Timing of the procedure. HSG is typically scheduled between days 7 and 10 of the menstrual cycle to exclude pregnancy and reduce the risk of infection.
• Infection prevention. In some cases, prophylactic antibiotics may be prescribed to minimize the risk of post-procedural infection.

How is the procedure performed?

Hysterosalpingography is performed on an outpatient basis and usually takes 15–30 minutes. The procedure includes the following steps:

1. Contrast administration. A thin catheter is inserted through the cervix, and a contrast medium is slowly injected into the uterine cavity.
2. X-ray imaging. A series of X-ray images is taken to visualize the uterus and fallopian tubes as the contrast fills and passes through them.
3. Result interpretation. Tubal patency is confirmed if the contrast freely spills into the abdominal cavity. Delayed or absent passage of contrast suggests partial or complete tubal obstruction.

Some women may experience mild to moderate pelvic discomfort or cramping during the procedure, similar to menstrual pain. These symptoms are usually short-lived and resolve shortly after the examination.

Contraindications to hysterosalpingography

• Confirmed or suspected pregnancy;
• Acute pelvic inflammatory disease;
• Recent pelvic or uterine surgery;
• Known allergy to iodine-containing contrast agents.

Alternative diagnostic methods

If hysterosalpingography is contraindicated or cannot be performed, alternative diagnostic options may be considered:

• Hysteroscopy. Direct visual examination of the uterine cavity using an endoscopic device. This invasive method provides detailed assessment and allows simultaneous treatment of certain abnormalities.
• Laparoscopy. A surgical diagnostic procedure that enables direct evaluation of the fallopian tubes and pelvic organs and allows correction of identified pathologies such as adhesions.
• HyCoSy (ultrasound hysterosalpingo-contrast sonography). A radiation-free alternative using ultrasound and saline or contrast agents to assess tubal patency.

Hysterosalpingography in Belarus is a reliable and widely used diagnostic method for evaluating female reproductive health. The procedure helps identify tubal obstruction, intrauterine abnormalities, and pelvic adhesions, allowing physicians to develop an individualized treatment strategy and improve the chances of successful conception.