When to Have an HSG after a Tubal Reversal?
HSG is the best method to determine the tubal patency (if the tubes are open). It is not recommended to have a HSG too soon after a tubal reversal surgery. Most will recommended at least 4 to 6 months after a tubal ligation reversal because an HSG relies on increased pressure in the tube, and it the tube is still weak where the tubal ligation reversal occurred, the tube could be damaged. Also, the risk of infection is present whenever a HSG is performed. It is recommended that patients try for a pregnancy first before going straight to an HSG. A good number of patients conceive within this early period and will then not need or desire to have a HSG performed.
Get ready for an HSG:
- An HSG is optimally performed after menstruation and before ovulation. If a HSG is performed after the time of ovulation it may interfere with a pregnancy.
- To diminish the risk of infection, antibiotics and sterile technique are used.
- Gynecologists will mostly recommend a prophylactic pain prescription of 800 mg of ibuprofen one hour before the HSG to minimize discomfort.
What happens in an HSG?
You will be positioned just as if you were having a pap smear performed. The speculum will be placed, and the cervix will be grasped and retracted. A thin tube will be inserted into the uterus and this may cause some cramping. Dye is then injected through this tube and into the uterus. At the start the dye will fill up the uterine cavity. It is necessary that the dye in fact enters the fallopian tubes up to the end where the anastomosis was done. Once past the tubal ligation reversal point, the dye should continue to the end of the tube and be discharged from the end of the tube into the pelvic cavity. Flow through the entire tube may not occur due to a spasm of the muscle at the base of the tubes or a spasm in the tubal segments. As such, some patients who have had a tubal reversal may in fact have a HSG that looks like the tubes are not open. This is very rare.
If the dye passes through the portion of tube that was put back together during the tubal reversal, the fallopian tubes are considered repaired. If the dye spills into the abdominal cavity, the diagnosis of tubal patency is decisive.
Note: Care is taken to note that if in the x-rays show that the dye has passed through the tubal ligation reversal site, but has not yet spilled into the abdominal cavity, this may be due to an inadequate quantity of dye being injected. The radiologist may incorrectly consider that the tube is blocked when it is in fact open. This also is very rare as the gynecologist performing the HSG should be careful to inject a proper amount of dye.