E1395. Hysterosalpingograms: Tips and Tricks From a Former OB/GYN
  1. Dana Hutchison; University of California, Irvine
  2. Roozbeh Houshyar; University of California, Irvine
  3. Karen Tran-Harding; University of California, Irvine
About ten in 100 (6.1 million) women in the United States ages 15–44 have difficulty becoming pregnant or staying pregnant. Subfertility becomes more pronounced at age 35 and fecundity in females has been found to decrease during the 4th decade of life. Since birth rates have declined for nearly all age groups of women under 40, but rose for women in their early 40s, infertility cases have risen over the years. Therefore, reproductive medicine is becoming more widespread and prevalent in modern times. The hysterosalpingogram (HSG) is a well-known diagnostic procedure in which radiopaque contrast is injected through the cervical canal for radiographic visualization of the endocervical canal, the endometrial cavity, and the lumina of the fallopian tubes. A wide variety of uterine and tubal abnormalities that cause infertility and other reproductive disorders can be shown by this technique. The purpose of this presentation is to describe techniques and tips for HSG to enhance physician performance and maximize patient comfort during the exam.

Educational Goals / Teaching Points
The educational goals of this exam are to: learn the indications and contraindications for a hysterosalpingogram (HSG), understand the steps of the procedure to become comfortable with performing the exam, know trouble-shooting techniques for a smooth and efficient exam, and to be familiar with common and uncommon findings of HSG imaging.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Indications and contraindications of an HSG will be discussed. There will be a review of female pelvic anatomy. The entire procedure will be discussed in detail including patient preparation, steps of the examination, images needed by the reproductive endocrinologists, and precautions for the patient after the exam. Guidelines for troubleshooting procedure will include helping the patient through pain, cannulating past a difficult cervical canal or stenosis, how to use forceps or a tenaculum, and steps to stop cervical bleeding. A pictorial review of HSG imaging will be shown including a normal exam, abnormal exam, uterine anomalies, expected and unexpected findings.

The HSG as a part of reproductive medicine is growing in popularity as rates of infertility in women have increased over time due to more women waiting to have children at a later age. At some institutions, the Obstetricians/Gynecologists perform the pelvic examination for the HSG; therefore, residents and fellows may not attain experience in the technique during their training. Some radiologists may even change jobs where they will have to perform the pelvic portion of the exam for the first time in their careers. This presentation will serve as a guide and pictorial review to enhance the radiologist’s confidence and maximize patient comfort during the HSG procedure.