Infertility crisis has put quite a strain on some marriages worldwide. Apart from the emotional pain that comes with the experience, there is also the social stigma that depending on the society, tribe, region, or country can be quite prominent and very disheartening.
Science has made tremendous progress in form of both drugs and diagnostics, to ensure that biological conditions or factors that augment the manifestation of infertility are detected early and treated as appropriate.
A Hysterosalpingography (HSG) is a special kind of X-ray that examines a woman’s uterus or womb to check for any deviation from what is considered a normal shape, as well as the fallopian tubes to ensure that there is no blockage of any kind.
Hysterosalpingography uses a type of x-ray called fluoroscopy. It involves the use of contrast dyes or materials that will help give a clear image of the uterus and fallopian tube. A contrast dye is a substance that will help highlight certain organs or tissues in the body after it has been swallowed or injected. It usually gets eliminated from the body either by dissolution or via a process like urination.
Unlike the normal X-ray, fluoroscopy creates a video image and not a still picture.
HSG test is used to evaluate fertility in women and it takes less than half an hour to carry out. It is an outpatient procedure and as such, one does not need to get hospitalized for it unless there is another serious health challenge that prompts otherwise.
HSG Test Cost in Nigeria
The cost of carrying out an HSG test in Nigeria varies based on location and the diagnostic center or hospital in which one intends to do the test. The cost is between N20, 000 to N40, 000. It is cheaper in teaching hospitals compared to private fertility clinics or hospitals. However, the service rendered by private clinics though expensive is always of better quality compared to that of public hospitals in Nigeria.
In Lagos, the test can be done in Lagos University Teaching Hospital, or private fertility clinics like Bridge, Nordica, etc.
In Benin, the test can be done in University of Benin Teaching Hospital, Lily Hospital, Union Diagnostics, St. Bridget, Raytouch, etc.
Before HSG Test
Hysterosalpingography is best carried out after the menstrual period but before ovulation occurs. This is to ascertain that the patient is not already pregnant before going for the test, as the procedure can be very damaging to the fetus.
To properly track the timing, the doctor might have you inform the radiology department the day 1 of your menstrual period. This helps them decide on an optimal date for the HSG test.
HSG test is not a surgical procedure, it is carried out with the patient fully awake and conscious (no general anesthesia is used). The procedure can come with some form of pain or discomfort (cramps or pains) and as such, most doctors usually prescribe Ibuprofen for the patient, to be taken at least an hour before the commencement of the exam.
A sedative might be given to patients that are very anxious about the procedure. Also, there is a risk of infection and as such, the doctor might prescribe antibiotics for prophylaxis.
The patient will be required to take off any metallic item like jewelry, earrings, rings, etc. as metals interfere with the working of an X-ray machine.
How HSG is Carried Out
The patient will be required to lie down on a table under a fluoroscope (an X-ray imager), with the knees bent, feet spread flat on the table, and legs held apart. The doctor will first examine the pelvis by inserting a speculum into the vagina.
An X-ray machine will then be lowered over the abdomen and a swab inserted to clean off the cervix. The swab helps to reduce the risk of infection. After that, a plastic cannula will be inserted into the cervical opening and an iodine-based dye injected through it. The patient may feel a warming sensation when the dye is injected.
The injected dye will flow through the uterus and fallopian tubes if they aren’t blocked and then flow into the pelvic cavity. The patient may feel some discomfort if the fallopian tubes are blocked, at which point she is mandated to inform the doctor.
The doctor then proceeds to take the x-rays. The patient will be asked to hold her breath for a moment or two, for each X-ray picture that is being taken. A change of body position may be necessitated during the procedure. After the doctor has obtained x-ray pictures that he/she deems satisfactory, the x-ray machine will be lifted away from your abdomen and the speculum removed to mark the end of the procedure.
After HSG Test
After the test, the patient may experience some cramps similar to that felt during menstrual periods. This can be taken care of by painkillers taken for normal menstrual cramps or any over-the-counter analgesic. However, if the pain persists or signs of infection such as fever, nausea, and vomiting, severe pains and cramping, foul-smelling vaginal discharge, heavy vaginal bleeding, etc. the doctor should be informed as soon as possible.
HSG helps to check whether the fallopian tubes are open. If they are blocked, sperm cells will not be able to swim towards the eggs for fertilization and conception to occur. Also, it checks whether the shape of the uterus is normal. An abnormally shaped uterus has been implicated as the chief cause of recurrent pregnancy loss in women. HSG test can also detect the presence of polyps or fibroids which could also prevent the implantation or growth of the embryo.
The test results are considered normal if the x-ray shows a normal uterine shape, and the dye which was injected, flowed out freely from the ends of the fallopian tube. A result like this does not imply that the fertility is normal, it could mean that whatever is wrong was not seen on the HSG.
The test results are considered to be abnormal if the x-ray shows an abnormal uterine shape, and the injected dye does not flow out freely from the ends of the fallopian tubes.
- Infection: this is the most serious risk involved with the HSG test. The chances of this happening are usually small (1%) as the doctor is always careful to prevent it. infection is common in women with a history of Chlamydia or who are at high risk of developing Pelvic Inflammatory Disease (PID).
- Fainting: Though rare, the patient may develop lightheadedness during or after the procedure which could culminate in fainting.
- Iodine Allergy: A patient may be allergic to iodine without knowing, only to find out during the procedure.
- Spotting: some women experience spotting 1-2 days after HSG exams. This should be reported to the doctor if it gets heavy and serious.
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