6 Feb 2020

The “Dye Test”

by | posted in: Diagnosis, Starting Out, Testing, The Clinic | 0

Dear Eggsperts–So, I had my first appointment and have lots of tests scheduled. I don’t mind having my blood drawn, and even the ultrasounds are ok, but I’m absolutely terrified about the “dye test.” I’ve heard it really hurts and I don’t know if I can handle it. I mean, I guess I know it’s important, but do I really need it? Can I be sedated for it? Any tips to help me through it?–Terrified in Tahoe

https://www.sciencedirect.com/science/article/pii/S154608431830213X

Dear Terrified–We realize that for many, ‘just’ going to the fertility specialist can be a hard enough first-step to take. The testing itself is all colors of scary too! Yes, the tests themselves can be uncomfortable, but:

  • You know what to expect with a blood test. You may not like a needle in your arm, but you have probably had it done before. 
  • You know what to expect with an internal ultrasound. It’s weird and awkward, but you have probably had gynecology exams before and the ultrasound isn’t all that much different. 
  • BUT, if we had to rank them, we’d probably say that the scariest of the tests is the hysterosalpingogram (the “dye test” or “tube test”.) Even after your nurse explains it, it’s probably safe to say you’re scared because you don’t really know what to expect. Truly, the worry of a receiving a suboptimal result can often feel WORSE! 

Well, friend, we get that.  We hope this post will help.  And, if you’re still with us, here goes….

The hysterosalpingogram (HSG) is an x-ray. Radiocontrast fluid (just a fancy way of saying fluid that shows up on an x-ray) will be flushed into your uterus while various pictures are taken. This allows your doctor to see the shape of the inside of your uterus and fallopian tubes.  We think the coolest part of this test is to watch for the ‘fill and spill,’ as we say, as the fluid fills each fallopian tube and then spills into the pelvis. 

CHECK OUT THIS VIDEO

Without knowing if your tubes are open and your uterus is normal, your doctor won’t have all of the information needed to help you know why it has been hard to get pregnant and therefore unable to make the best recommendation for treatment options to ultimately help you conceive.

So, let’s talk about the HSG so you can have a better idea about the nitty-gritty of what to expect.

  1. Scheduling: 
    • Most of the time, your doctor will want to schedule the test sometime after your period has ended and before you have ovulated. You may have to call when your period starts to schedule the test. The reason for the timing is:
      1. Your uterine lining is thinner right after your period ends, so it is less likely that there will be false results due to a thick lining making it look like there is something irregular in your uterus or blocking the opening to the tubes.
      2. We want to do the test before you have ovulated, because we don’t want to put fluid in your uterus if you might have gotten pregnant and have an embryo developing. 
    • You might be put on birth control pills for a short time just to keep your lining thin and keep you from ovulating, particularly if it is difficult to schedule the test around your period. 
  2. Before the test: 
    • Infections are rare after the HSG, but if one or more of your tubes are blocked, infection risk is higher. You may be prescribed antibiotics to take for a few days before and after the test to prevent infection. Or, you may be prescribed antibiotics after the test only if it looks like you have some tubal blockage.
    • A pregnancy test may be done before the test, just to make sure that you aren’t pregnant before the test is done. 
    • You may be advised to take medicine, such as Ibuprofen or Naproxen, before the test to reduce discomfort. These medicines can be used to help with cramps during your period and can help reduce pain from cramping during the procedure. Ask your doctor if they recommend either of these non-steroidal anti-inflammatory medications, how much, and how long before the test. 
    • If you are really  nervous and scared, and if you have someone who can drive you, your doctor may prescribe an anti-anxiety medicine for you to take before the test. These medicines are usually sedating, hence you shouldn’t drive, nor work until the day after. 
    • Let your doctor know if you have had any allergic reactions to radiographic materials, or seafood, in the past. You may be given medicine to prevent an allergic reaction and/or adjustments may be made to the solutions used for your test. 
  3. The Test: 
    • Location: The test may be done in a radiology suite of a hospital or your doctor may have the equipment to do the testing in their office.
    • Just like a regular gynecologic exam, you will be on an exam table. Sometimes this will be an exam table with foot rests and your bottom is at the edge of the bed. Sometimes, it is a flat radiology exam table and your bottom may be elevated on some kind of pillow and your knees will be bent with your feet resting at the edge of the table.
    •  A speculum will be placed so that your cervix can be seen. Your cervix will then be cleaned to minimize any risk of infection.
    • An instrument will be passed through your cervical opening into your uterus. For some people, cramping may occur. There are a few different types of instruments that can be used. Sometimes a balloon is on the end of the instrument that is inflated in the uterus to prevent the fluid from coming out of the cervix. Sometimes an instrument may hold onto your cervix and hold it tight to an instrument that is on the outside of your cervix to prevent leaking of fluid. 
    • The fluid will be injected into your uterus while x-rays are being taken. This is another time that cramping may occur. You may be asked to roll from one side to another to get a better view of your uterus or tubes. The instrument on your cervix may be manipulated to straighten your uterus for a better view. This all usually takes less than 1-2 minutes. 
  4. After the Test:
    • Cramping should go away within a few minutes. 
    • Depending on who does the test (radiologist, your doctor, another doctor in the practice) you may, or may not, be given preliminary results right away. 
    • You will be asked to schedule a follow-up appointment with your doctor to review the results of this test (and all of your other tests), so that you can talk about your best treatment options after all testing has been completed.
    • If you have blocked tubes, you may be given antibiotics (or antibiotics may be extended.) 
    • You will have discharge from the fluid leaking. It might be pink or even have a spot of blood. It might be kind of sticky. It should be back to normal in a day or 2. 
  5. Call your doctor if you experience any of the following symptoms:
    • Unrelieved pain
    • Heavy bleeding
    • Fever
    • Bad smelling, or a strange-colored, discharge

Still with us?  

Wanna know if there are other options instead of this test. Well, the HSG is the “gold standard,” but there are a few alternative options that you can ask your doctor about. 

  1. If you don’t have any risk factors for tubal problems, you can ask your doctor if they are willing to treat you as if you have open tubes, without doing the test. If you do this, you do run the risk that you spend money and time, only to find out later that there is a tube problem and that the treatment didn’t have much chance of working.
  2. If you are planning on doing in vitro fertilization (IVF), and therefore, bypassing your tubes, your doctor may be willing to do a fluid ultrasound to look at just your uterus instead. Your tubes may not be visible on ultrasound. This is OK, because it means they aren’t dilated and filled with fluid which can hurt your chance for success with IVF. 
  3. There are some clinics that may do a fluid-and-air ultrasound (“bubble test”) to see if your tubes are open. Not all clinics do this as it may not provide quite the same level of  detailed information as the HSG. 
  4. If you have risk factors for endometriosis, or other pelvic conditions, some clinics may offer surgery to look at your uterus and tubes while also looking for endometriosis. 

We hope we met your Eggspectations—An Eggspert

To stay up to date with our content, please bookmark our page www.askaneggspert.com and follow-us on social media. We welcome questions and will answer them in our posts as soon as possible. Please email us at questions@askaneggspert.com

Disclaimer: All of the comments on this page are for basic information only. They are based on the opinions and expertise of the authors and are not meant to provide a substitute for medical care or specific treatment recommendations. Each person is unique and requires individualized diagnosis and treatment plans. Any specific questions should be directed to your personal healthcare provider.