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The HSG provides information about the internal architecture of the fallopian tubes and the uterus. Dye is passed through a small tube through the cervix and into the uterus. The dye is “radiopaque” meaning that it can be visualized on X-ray.
The dye fills the uterus and flows through the fallopian tubes into the abdominal cavity if the tubes are open. Sequential x-rays are taken during the procedure and if there is a tubal obstruction, or complete blockage, the dye is  stopped at that point and is seen on x-ray. If the dye does not enter the fallopian tube it may be due to scarring or to spasm of the musculature of the proximal tubes. Likewise, abnormalities in the uterus such as fibroids and polyps can often be seen as a “filling defect”. A “filling defect” is an area that does not fill with dye in the uterine cavity. Congenital abnormalities of the uterine cavity can also be evaluated with an HSG.
The HSG is an outpatient procedure and is accompanied with only minimal discomfort if the tubes are open. If the tubes are blocked, the procedure can be painful as increased pressure is usually applied in order to try to “force” dye into the fallopian tubes. It is recommended that 600-800 mg of Ibuprofen be taken 30 minutes prior to the procedure to decrease the likelihood of significant cramping.
The hysteroscope is a small tubular “telescope” like device that is inserted through the vagina and into the uterus. The uterus is filled with carbon dioxide or another media such as sterile saline causing it to expand. The physician can often clearly visualize conditions such as fibroids, polyps, or congenital uterine abnormalities. If hysteroscopy is performed in an operating room, treatment can usually be performed at the same time (operative hysteroscopy).
3D Saline Sonogram (SSG)
In the saline sonogram (also know as a hysterosonogram or sonohysterogram) the uterus is filled and expanded with saline (salt solution) using a catheter passed through the vagina and cervix into the uterus. Ideally 3D (three dimensional) ultrasound vaginal probe is then inserted into the vagina and abnormalities such as fibroids and polyps can usually be seen.
We believe that 3D ultrasound technology is critical for saline sonograms. It allows the fertility specialist to obtain over 400 ultrasound pictures of the internal architecture of the uterus in less that 2 seconds while saline is simultaneously being injected. The pictures can then be analyzed in all three dimensions after the probe has been removed. Most importantly, the 3D ultrasound provides a coronal view (3rd dimension) that is not typically seen with 2D ultrasound equipment. The coronal view allows for visualization of the typical triangular view of the uterine cavity as seen at the time of hysterosalpingogram (HSG).
Ultrasound pictures also provides information about the wall of the uterus (myometrium) that is not seen at HSG. This may include fibroids. The size of the fibroids as well as their proximity to the uterine cavity can be determined.
3D ultrasound technology has revolutionized our ability to easily and accurately evaluate the uterine cavity.
Ultrasound has many uses in the fertility evaluation, especially the vaginal probe ultrasound. Using the vaginal probe, sound waves are “bounced” from the transponder and picked up by a receiver. Internal organs and structures such as the uterus and ovaries are seen as ultrasound “shadows”.
Vaginal probe ultrasound is used extensively to monitor follicles during ovulation induction cycles. If daily monitoring is performed until the follicle “ruptures” it can also determine when and if ovulation occurs . Another use is to measure the thickness of the endometrium to confirm that it is developing properly.
Ultrasound is also used to document pregnancy, by visualizing the fetus, as well as detecting early fetal heart motion. It can be used in many different types of abdominal evaluations for fertility such as for ovarian hyperstimulation syndrome (OHSS) and other conditions.
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