UNDERSTANDING DIAGNOSTIC PROCEDURES IN A FERTILITY CLINIC:  HYSTEROSONOGRAM (HSN) Part3

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This week we shall be concluding this topic emphasingthe role of HSN as a diagnostic procedure.

When not done by specialists, HSN may cause abnormal cramping, spotting, and vaginal discharge. Some women have cramping for several hours after the procedure. It is often recommended to take pain reliefsbefore this test. Some doctors may also prescribe stronger pain medication and/or antibiotics before the procedure. The woman can visit the doctor again if some other pains or discomfort arises in the 1-2 days.

The physician will determine the best test(s) based on the medical history.  Some patients who have undergone Hysterosalpingogram (HSG) will also need an HSN based on the results of the HSG.  Some irregularities that may not be identified by the HSG can be detected by this test. Vice versa, some patients who completed an HSN will also require a HSG if there are unanswered questions regarding the fallopian tubes.

Testing & Diagnostics

Hysterosonogram (HSN) is sort of a combination of a HSG and ultrasound. However, instead of using radio-opaque dye and x-rays to view the uterus, sterile saline (salt water) and high-resolution ultrasound technique is used.

The result is a very sensitive method for displayingabnormalities inside the woman’s uterus. It is less painful and more comfortable compared to HSG,which sometimes causes abdominal pain. HSN, however, cannot replace HSG when it comes to evaluations of fallopian tubes.

Diagnosis of infertility requires comprehensive testing on both the female and male partners. On the female side, infertility testing usually involves hormonal testing to determine the patient’s ovarian reserve, diagnostic imaging to see if there are any blocked fallopian tubes, patent tubes or uterine fibroids.However, immunological testing is advised to rule out any maternal autoimmunity. Knowing the root cause of a couple’s infertility is the first step toward successful fertility treatment.

What are the limitations of HSN?

This procedure may likely have certain limitations in clinical situations. In women with stenosis of the cervix, it may be difficult to insert the catheter into the cervical opening for the sterile saline to be injected. If the uterine cavity is unable to go through proper expansion, then the saline injection may also prevent good-quality ultrasound images from being obtained. This can occur especially with uterine scarring or large fibroids, which may partially hinder the expansion uterine cavity, a hysteroscopy may be required.

In such cases where an abnormality of the fallopian tubes is suspected, a procedure such as Hysterosalpingography might be recommended for further exams.

Benefits of this procedure

• This procedure is short, provides image if the cervix and the uterus lining. It can be considered less harmful and well tolerated by patients with a very few or in most cases no complications.

• It is widely available, easy-to-use and less expensive than most other imaging methods.

• The ultrasound-scanning machine gives a clear picture of soft tissues that do not show up well on x-ray images.

• Many uterine abnormalities that may not be seen adequately with routine transvaginal ultrasound may be viewed in detail with HSN.

• This procedure can prevent unnecessary surgery, and it can ensure that all abnormal growths are removed at surgery.

After a hysterosonogram is performed, it is common to see some spotting or bleeding. You can use pads or tampons. It is probably best to abstain from intercourse until the bleeding has stopped.

Pelvic / abdominal cramping is to be expected in some patients. Pelvic pain not alleviated by analgesic medications should be reported.

A fever is not normal. A fever may be an indication of an infection in the uterus or abdomen. Any temperature elevation should be reported. A woman may return to work or other normal activities immediately after having a Hysterosonogram. She may drive to the appointment and may drive afterward. Pelvic / abdominal cramping is to be expected.

In conclusion, once the couples have had a fertility profiling, it is time to start considering treatment options. However, treating infertility goes beyond fertility treatments. Infertility treatment can also include surgical interventions, lifestyle changes, weight loss, or treatment of an underlying medical condition.

Usually, infertility treatment plan will depend on the reason both partners are unable to have children.

Sometimes, after a woman completes aHysterosonogram procedure, she may able to conceive all by herself alongside her partner because the fallopian tubes are now blockage free and also noabnormalities are detected in the endometrium. Treating infertility can either be my medications use, surgery or by assisted reproductive technologies like IVF. It is important to visit a fertility expert if you are attempting pregnancy.