Hysterography

Infertility is defined as the inability to become pregnant for a period of one year. There are exceptions to this definition, in which there is no need to wait a year for the definition of infertility, relating to cases where the menstrual cycle is irregular or absent, where there is a known occlusive defect of the fallopian tubes, presence of endometriosis in the pelvis or in cases where there is low sperm quality. About 15% of couples trying to become pregnant may suffer from infertility. Infertility can be primary if there has never been pregnant, or secondary if there has been a past pregnancy. This definition relates to each partner separately and to the couple together.

Investigation of infertility

Investigation of infertility relates to three main components – normality of the ovulation mechanism; traversability and normality of the uterus, uterine cavity, and fallopian tubes; and normality of the sperm characteristics. For each component, there are tests to assess its normality.

• Investigation of the normality of the ovulation mechanism – Determined first and foremost by the regularity of the menstrual period. Additionally, various endocrine systems are assessed by means of a hormonal “profile” test on Days 2-5 from the beginning of the period. The test includes assessment of the hormonal axis that activates the ovary, including levels of FSH, LH, E2, and progesterone in the blood, as well as other endocrine systems, including the thyroid gland, prolactin, and function of the adrenal. Additionally, the course of ovulation can be assessed by means of a series of blood tests and ultrasound of the ovaries to monitor the growth of the follicle, in which the egg grows, and to monitor the thickening of the endometrium, as evidence of the preparedness of the uterus for pregnancy.
• Mechanical impediment – Meaning occlusion of the fallopian tubes and/or defects in the structure of the uterus and the uterine cavity. Problems of this type can be identified by various methods of imaging, including hysterography, laparoscopy, ultrasound to investigate the presence of fluid (hydrosonography) and hysteroscopy. Each of the tests has its own advantages and disadvantages in the mechanical assessment, and the usual initial examination is hysterography.
• Impaired sperm quality – Determination of male infertility is made by examining the sperm. In the event that the initial examination is not normal, the examination is repeated at an interval of about 4-6 weeks to confirm the diagnosis. In the event that there is a problem with the semen analysis results, an investigation is made into the reason for male infertility by means of hormonal tests, ultrasound of the testicles, an examination by a urologist and genetic tests, depending on the severity of the defect.

Investigation of Mechanical Impediment – Hysterography

Hysterography is an imaging test that shows the uterine cavity and the traversability of the fallopian tubes between the uterus and pelvic cavity. This examination forms part of the investigation of infertility or recurrent miscarriages.

The course of the examination

Before the examination, a personal details questionnaire should be filled out, as well as a consent sheet for the examination, in which the risks involved in performing the examination are detailed. The examination takes about ten minutes and is performed by a gynecologist and a radiographer.

The examination is performed while lying on a bed, similarly to a routine examination by a gynecologist. The vagina is washed and disinfected using polydine solution. A catheter is juxtaposed to the cervix, through which a contrast material, which contains iodine, is injected. The injection allows the uterine cavity and fallopian tubes to be demonstrated, as well as the distribution of the material in the abdominal cavity. While the material is flowing, fluoroscopy imaging is performed, and an image is stored at intervals, to asses the progress of the material in the uterine cavity, traversal of the fallopian tubes and distribution in the abdominal cavity.

When the catheter is juxtaposed and while the contrast material is flowing, there may be a sensation of mild discomfort or pain similar in intensity and nature to period pain, which will pass, if there is any, a short time after the conclusion of the examination. It is rare for there to be pain beyond this. There may also be a mild bloody discharge, at the level of spotting only. The imaging of the course of the examination appears on a television screen in the examination room, and the examination results can be monitored in real-time.
On the conclusion of the examination, the physician will provide an explanation of the significance of the examination results, which are given on a disc and in a written report.

Side Effects

Rarely, there may be increased bleeding, fever above 38 or strong abdominal pain. In these instances, contact the physician who performed the examination immediately in order to receive directions.

Conditions for performing the hysterography examination

The examination is performed shortly after the end of menstrual bleeding. Do not have sexual intercourse between the menstrual period and the hysterography. Bring the negative result of a pregnancy test, performed close to the date of the hysterography in order to ensure that there is no pregnancy at the time of the imaging. In the case of known sensitivity to iodine, this examination cannot be performed. In certain cases in which there are conditions for the development of infection due to the medical background or examination findings, the antibiotic cover will be given after the examination.

Making an appointment for hysterography at Herzliya Medical Center at the Gynecology Department

Hysterography is performed every day between 10:00-13:00 at the Imaging Institute. The availability of appointments is very high.

For advice and further information, contact us at telephone: +972-9-959-4888, or leave your details and we will get back to you promptly.