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A hysterosalpingogram is a diagnostic imaging modality primarily utilized in assessing female infertility. By injecting a contrast dye into the uterus, the procedure enables visualization of the endometrial cavity and fallopian tubes using fluoroscopy and x-ray techniques and assessment of fallopian tube patency. The ability to specifically evaluate fallopian tube patency and endometrial cavity structure is unique to hysterosalpingogram, which is often utilized as a complementary procedure with other imaging modalities (eg, pelvic ultrasonography, hysteroscopy, or magnetic resonance imaging) to assess infertility. This activity for healthcare professionals is designed to enhance knowledge regarding a hysterosalpingogram procedure, including its purpose, indications, and techniques, from patient positioning to contrast media considerations, to ensure clinicians grasp the procedure's intricacies. Ultimately, this activity will provide the competence and skills necessary to effectively utilize this imaging modality in the diagnosis and management of female infertility, thereby improving patient outcomes and quality of care. Objectives: Determine the indications for a hysterosalpingogram. Identify patients who have contraindications for a hysterosalpingogram. Interpret the findings of hysterosalpingograms for both complete and limited results. Apply interprofessional team strategies to improve care coordination and outcomes in patients who undergo hysterosalpingograms. Access free multiple choice questions on this topic.

Hysterosalpingogram (HSG) is an imaging procedure in which contrast dye is injected into the uterine cavity, progresses into the fallopian tubes, and ultimately reaches the fimbriated ends adjacent to the ovaries. Fluoroscopy and x-ray images are taken at various stages of the procedure to assess filling, uterine shape, tubal patency, and peritoneal spillage to evaluate the structure of the endometrial cavity and patency of the fallopian tubes. This diagnostic modality is primarily utilized in assessing female infertility. Structural endometrial cavity and fallopian tube abnormalities contribute significantly to infertility, with up to 60% of cases attributed to such issues.[1] The ability to specifically evaluate fallopian tube patency and endometrial cavity structure is unique to HSG, which is often utilized as a complementary procedure with other imaging modalities (eg, pelvic ultrasonography, hysteroscopy, or magnetic resonance imaging) to assess anatomic infertility etiologies.[2][3] Advancements in contrast agents have improved the safety and tolerance of HSG, with modern nonionic, iso-osmolar agents offering enhanced patient comfort. HSG has some contraindications and associated complications; however, the procedure remains a cornerstone in the diagnostic evaluation of female infertility. Therefore, clinicians should understand how to integrate the HSG procedure into an infertility evaluation, ensuring optimal patient care and accurate interpretation of results.

Overall, severe complications following HSG are rare, with the most common complications being abdominal cramping and vaginal bleeding, which may persist for a few days following the procedure.[21] Other complications include allergic reactions to the dye, pelvic infection, and injury to the uterus or cervix. Rarely, patients may experience a vasovagal reaction due to the manipulation of the cervix. Patients should be advised to contact their OB/GYN clinician if they develop foul-smelling discharge, severe abdominal pain, heavy vaginal bleeding, fever or chills, or syncope. A case report of retained products of conception found during an HSG with associated intravasation of contrast media was published, which resulted in later volume overload during subsequent hysteroscopic procedures.[22]

Interprofessional healthcare teams, including gynecologists, anesthesiologists, radiology technicians, nurses, and additional healthcare professionals, are crucial in ensuring optimal patient care during HSG procedures. Effective communication and collaboration among team members are essential to prevent medical errors and optimize patient outcomes. Meticulous documentation and interprofessional communication enable prompt reactions to patient status changes, including diagnostic test results. This collaborative approach drives improved diagnosis and targeted treatment strategies, enhancing patient-centered care, safety, and team performance. HSG, typically performed by a radiology technician or OB/GYN clinician, requires coordinated efforts among team members to achieve procedural success and patient well-being.