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Hysterosalpingography (HSG) is a radiologic procedure performed to image the uterine cavity and demonstrate tubal patency by injecting a radiographic contrast media through the cervix. HSG is one of the basic infertility tests. HSG is still the first-line approach for excluding anatomic defects of the uterus and to document open tubes in the presence of female infertility. HSG is also performed in patients with recurrent miscarriage since uterine abnormalities can be detected in 15-25% of such patients. There is strong data showing that HSG procedure itself may also enhance fertility during the first 3 months of the test.
HSG should not be performed while you are menstruating or you are in the second half of your menstrual cycle. Therefore proper scheduling of the procedure immediately after menses during the first half of your menstrual cycle is important. In patients with unpredicted cycle lengths a urine pregnancy test may be required shortly before the procedure.
HSG should be considered as a screening test. This means that if abnormal you may need other approaches to confirm a specific diagnosis. These may include saline infusion sonography, hysteroscopy and/or laparoscopy. For example tubal blockage seen on HSG may require laparoscopy which may confirm or rule out presence of tubal disease.
HSG is contraindicated in the presence of any acute pelvic infection or any cervical infection with sexually transmitted organisms like Gonorrhea and/or Chlamydia. That’s why UF Health Reproductive Medicine physicians may recommend screening tests to rule out such infections before your HSG. Severe iodine allergy is another contraindication; although if laparoscopy or hysteroscopy cannot be initial options, there is a protocol involving premedication with corticosteroids and anti-histaminic agents to prevent severe allergic reaction which is called anaphylaxis.
Although HSG itself lasts about 3-4 minutes from start to finish and the discomfort resolves rapidly at the end of the procedure, our physicians recommend a non-steroidal anti-inflammatory agent like ibuprofen or naproxen 1 hour before your scheduled HSG to minimize uterine cramping during the procedure.
Saline Infusion Sonography (SIS)
This is a quick and almost painless office procedure performed by injecting sterile normal saline solution into the uterine cavity through a pliable catheter also used for intrauterine insemination, while performing transvaginal ultrasound. It is an excellent test to evaluate uterine cavity and used to rule out any presence of polyps or fibroids within the cavity of distorting the cavity which may at times challenging with HSG. SIS is required before any assisted reproduction to ensure that uterine cavity is normal before upcoming embryo transfer.
Ovarian Reserve Assessment
The age-related decline in female fertility is partly due to progressive regression of egg quality and quantity. Ovarian reserve tests are usually geared towards estimating the quantity of eggs in the ovaries. Although some implications can be made for egg quality from these test results, the egg quality is best reflected by female age. Advanced reproductive age is one of the most important parameter predicting having a child, with or without fertility treatment. We believe that quantification of ovarian reserve furnishes some clinically important information especially before assisted reproduction and females with advanced reproductive age and in couples with otherwise unexplained infertility. Both low and high ovarian reserves need specific treatment approaches to optimize fertility treatment outcome.
UF Health Reproductive Medicine physicians assess ovarian reserve with multiple tests to optimize clinical decision-making. Briefly we use Clomiphene Citrate Challenge test (CCCT) along with antral follicle count with transvaginal ultrasound and serum anti-Mullerian hormone levels. The testing starts on the second, third or fourth day of your menstrual cycle when a baseline ultrasound to count small antral follicles in your ovaries and a blood draw for serum FSH, estradiol and AMH levels are needed. Then typically patients used Clomiphene Citrate between days 5 to 9 of their cycle for five day at 100 mg daily dose. They return on day 10 for another serum FSH level. Some other tests like SIS, HSG, and sexually transmitted disease screening tests can also be scheduled during the same cycle so that all test results for fast decision making for treatment regimens and protocols can be made.
Using Donor Sperm – Contacting Cryobanks
Donor sperm may be opted by some patients to be used for intrauterine insemination with or without ovulation induction or for assisted reproduction. The document below can assist you in finding more information about some FDA approved donor sperm banks around the nation. Please note that this information may change without our control without notice. Our patients should make sure that the cryobank they are contacting is still FDA approved and they should also verify billing and payment information with these companies.
Obtaining Sample for Semen Analysis
Semen analysis is an essential part of an infertility investigation. In order to obtain an accurate result, you should abstain from having intercourse or ejaculations for 48-72 hours prior to the semen collection. Do not abstain longer than 5 days prior to collection.
Be sure to wash your hands and cleanse your penis before collection but do not use any chemical antiseptic agents. Use no lubrication. The specimen must be obtained by masturbation into a clean collection container obtained from the laboratory. Collection in a condom or by interrupting intercourse is not an acceptable substitute. The specimen should be collected in the office or be received by the laboratory within 30 minutes from the time of collection. Do not allow the specimen to be exposed to cold or hot temperatures in transport. The specimen will be examined under a microscope to determine the number of sperm present and their movement as well as any abnormalities in their shape. Normally, there can be substantial fluctuation in the parameters in all men over time. Because of these fluctuations, more than one semen analysis may be necessary over the course of several weeks or months.
Lab hours at UF Health Reproductive Medicine at Springhill for semen analysis are 9:00 AM – 3:00 PM Monday – Friday excluding holidays. By appointment only.
Resources & Links
- American Society for Reproductive Medicine
- Endometriosis Association
- Fertile Hope
- National Institute of Child Health and Human Development
- Polycystic Ovarian Syndrome Association
- Reproductive Facts
- Society for Assisted Reproductive Technology
News & Media Releases
- 3 Commonly Used Medications to Treat Unexplained Infertility
- The miracle makers
- Celiac disease and infertility: Is there a link?
- Pesticides And Sperm Quality: Can They Make Men Infertile?
- Researchers find new fertility drug to be more effective than one used for the past 40 years
- UF Health Shands Hospital first academic health facility in Florida to receive national Baby-Friendly designation
- Researchers uncover genetic and hormonal origins behind the evolution of sex organs
- Medical specialty one-stop shop at new UF&Shands at Springhill practice in northwest Gainesville