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Hysterosalpingography is a hundred-year old diagnostic radiological technique which is used primarily to investigate female infertility. It is based upon the use of fluoroscopic screening of the uterus and the fallopian tubes as a radio-opaque contrast medium is flushed through them.
It is a widely-used and generally safe procedure if done under the right conditions. Following the introduction of fluoroscopic screening, complications have been drastically reduced. The controversy over whether to use oil-based or water-based contrast media for injection continues.
Oil-based media such as ethiodized oil were initially quite popular due to the finding that they improved fertility rates and brought down the time to conception. This research was not, however, duplicated by other studies, and as a result water-based and oil-based media were held to be of equal efficacy in hysterosalpingography.
Oil-based contrast did carry a certain risk of causing tubal granuloma formation in women who had damaged tubes, which led to its gradually falling out of favor. Water-based agents were held to be less caustic to the tubal mucosa. They do, however, cause more irritation to the peritoneal cavity following spillage, and distends the uterine cavity more rapidly, causing greater pain.
Furthermore, water-based contrasts are cheaper than the oil-based media, and they spread over the uterine and tubal contours more smoothly providing a better view. In addition, they are more likely to travel down the patent tubes fast, and are removed promptly from the peritoneal cavity. Also, they are less likely to be intravasated and, hence, to cause acute hypersensitivity reactions.
Very recent research reports that 40% of patients who had this procedure conceived within 6 months when ethiodized oil was used, compared to 29% with water-based media. This may change the approach to hysterosalpingography, especially since the use of fluoroscopy has led to the elimination of mortality connected with the procedure.
The mechanisms of improved fertility include:
With all this in mind, this procedure is likely to be used still more widely for the diagnosis and treatment of female infertility. It can detect endometrial polyps, submucosal fibroids, tubal occlusion or peritubal adhesions, salpingitis isthmica nodosa, hydrosalpinx and tubal inflammation or infection, among others.
The procedure is used to assess the internal contour of the endometrial cavity and the fallopian tubes in: