The Inconclusive HSG

In June I had an HSG, my first x-ray ever. My RE, Dr. A, performed the procedure and I am thankful for that.

I want to share my HSG experience for those of you who have not had the procedure yet, and who like me, searched every blog I could find to read the HSG posts. Its nice to know what to expect from someone who has actually had one, and not, say, your male RE who can't even imagine what the speculum feels like (and btw they open it extra wide for the these procedures). But I also want to share my HSG experience with those of you who have had the procedure, maybe even multiple times, so that maybe you can offer some knowledge and advice.

I have heard about painful experiences during the HSG (another reason I was thankful that it was being done by Dr. A) so I was kind of expecting the worst, even though I had no reason to suspect any kind of blockage (no symptoms of endometriosis, no previous infections or surgery, no irregular bleeding or pain, etc). I took 2 ibuprofen about 45 minutes before the procedure and I think that helped. I decided that I would do the procedure alone and then F would come in after so that we could all go over the film together.

Dr. A was great at making me feel comfortable, explaining exactly what he was doing... except for a minute or two after he opened up the speculum and inserted the catheter. I think he was expecting the procedure to go fast and easy, for the dye to immediately spill and say "we're done, your clear!" and so he started making small talk as he injected the dye and inflated the balloon. He started to make small talk by telling me about a musical he was producing (what?!!). I was about to ask, "a musical?...about infertility?" when I looked at the x-ray monitor and noticed that the dye wasn't spilling. Dr. A told the radiologist to take an image and then asked how I was feeling. I told him I could feel alot of pressure.


And then no more small talk, no explanation about the musical writing and producing RE, as Dr. A was, as he said later, "really working the balloon up there."

Dye spilled through my left tube (yes!), but not through my right.


Dr A continued to do whatever it is they do to apply more pressure and I was so focused on the image that I didn't really think about the discomfort. Dr. A asked again if I was doing ok and before I could really answer (I was SO focused on that image!) the radiologist said my blood pressure was really low. I took a deep inhale and exhaled because I think I was holding my breath and then, poof, dye spilled through my right tube. The radiologist said, "Yay."


So what does it all mean? I was a bit shaky and light headed after the procedure and was trying to follow everything without getting confused. I was also trying to understand if my tubes were indeed blocked or just spasming or just didn't want dye flowing through them that day. Dr. A put my film up and showed me my uterus, which looked dinky but normal, pointed out some gas in my intestines (thanks, Dr. A!) and then pointed to an area that "might be of some concern, but might not." He explained that there was a proximal tubal blockage, where the tubes join the uterus. Proximal tubal blockage can be caused by something as serious as salpingitis ishmica nodosa (wtf!) and something as hopeful as mucus plugs. The film showed an area on my left tube, right at the opening, where the dye did not make a smooth line in my tube but rather a tiny jagged line (very tiny, I can't really identify it by looking at the film myself), that Dr. A thought could suggest something like salpingitis ishmica nodosa (SIN, try googling that, there's not much). When I asked what could cause SIN, I was told pelvic infection. This was a shock. I asked if I should get tested for STIs and Dr. A said, I guess noticing my alarm, "No, no, your tubes are clear, you're perfect, both of you are perfect. He didn't mention the possibility of endometriosis. Instead, he became very positive, even though I was still very confused. He then went on and on about how my tubes are clear and maybe that's all we needed, and I'll take clomid this cycle and F and I will go to Texas (where we were going the next week), and conceive an oil driller (ha-ha) and to call if I get pregnant so they can arrange for someone in Texas to do an ultrasound, and if I don't get pregnant to call when I get back so we can talk about next steps. Did I mention I was feeling lightheaded?

I wish we talked more about next steps that day. Now I am in Texas without F, working until September, taking a ttc break and I keep looking at my films as if I'm going to be able to figure out what those next steps will be. Another clomid cycle? Another HSG? A laprascopy?

These questions are one of the reasons I wanted to post this, with the images. Has anyone had an inconclusive HSG or an HSG that showed a blockage that was cleared during the procedure? Did you later find a blockage during another procedure? Were you able to do IUI?