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Infertility Investigations

Hysterosalpingogram (HSG)

Failure to adequately test the uterine cavity occurs commonly and patients often undergo a laparoscopy and Curettage and are incorrectly told that "their uterus is normal", even though non of the following tests have been undertaken!

A HSG is an X-ray of the cervical canal, uterine cavity and interior of the tubes as well as a test (not absolute) of whether the tube(s) is open or not (tubal patency). It requires injection of a radio-opaque dye through the cervix, and is performed as an outpatient procedure. It does not require general anaesthesia. A great deal of useful data can be obtained with this test, provided it is performed by someone with a lot of expertise, and your own practitioner should discuss the results with you.

It should be noted that this is a test of the interior of the reproductive pathway, and as such is complemented by the following tests, which include fluid sonohysterography, hysteroscopy and laparoscopy.

The diagnosis of "blocked tubes" should never be made by hysterosalpingography alone, as they have a 10% false negative rate. The additional tests are mandatory
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Fluid Sonohysterogram

This procedure involves viewing the cavity of the uterus and the walls of the uterus by ultrasound but the image is vastly improved by filling the cavity of the uterus with certain fluids which includes saline (a balanced salt solution) via a thin plastic tube placed in the cavity of the uterus. It is causes no more discomfort than a speculum examination of the cervix. Unfortunately this test does not provide sufficient information about the internal anatomy of the Fallopian tubes. A variant of this test is the HyCoSy, which may show if the tubes are open but gives no other information about the state of the tubes.