The HSG

This... is not my uterus.

If your OB or RE has suggested this test as your next step, punch them in the face... then sign yourself up!  It is an invaluable tool to helping you along your TTC journey but, as it hurts like the dickens, it also sucks ass.

The HSG (or HysteroSalpingoGraphy) is a procedure used to determine whether or not your uterus and/or fallopian tubes are blocked and, therefore, preventing pregnancy.  A catheter is inserted through your cervix, into your uterus and dye is injected, while under x-ray, to see if it flows freely through your lady-bits.  Well fuck all that noise!  It should have been called a HellishSucktasticoGraphy because if all that sounds like torture, you're fuckin-A right!  That being said, you may have to have one done at some point and you're trying to get pregnant anyway, so this seems like a lovely introduction into the world of pain.  It's also a great trainer in the ways of throwing your modesty out the window.

I arrived at the imaging center sans my OB because she doesn't perform them.  After consulting several people in the back, the receptionist finally figured out how to process a cash payment (insurance companies are staffed with evil bitches).  I brought my sister along, God love her, and suggest you find someone equally capable to accompany you.  Doctors, especially those you've just met, sometimes fail to convey the facts of the matter and you may need a second eye on the monitor.

We were ushered to the back, where I was introduced to the torture chamber that was my procedure room and told to undress from the waist down in a tiny little bathroom.  I came out, gown open in the back, and she gave me a bit of information about the test.  It seems that protocol at this hospital deems a disposable catheter be used when their doctors perform the test instead of your OB or RE.  This sucks because the disposable catheters are plastic and, because plastic is slippery, they employ an inflatable balloon to remain in place.  This does not feel pleasant and should be avoided if possible.  Then, she had me hop up onto the x-ray table (which is damn near impossible to do gracefully without flashing your ass about the room) and prop my feet up on the table's edge.  As my sister had not previously been introduced to my cervix, I had her move to my side at this point. 

The doctor came in and seemed nice enough while running through the procedure again.  This, ladies, is the time to ask questions.  Tell them exactly what's been going on and how important it is for you to have this fixed.  My main goal was to find that there was a blockage but also have it cleared by the HSG (yes that can and does happen).  Most would think I'd rather have my tubes be completely clear to begin with but I needed some explanation as to why I've been having so much trouble with this.  After we hashed all that out, the procedure began.

He started by slathering an iodine cleaning solution all over my hooha.  This is not painful, but is cold and wet and generally uncomfortable.  Then came the speculum... fun times... and more iodine on my cervix.  That felt fucking weird.  I've got no better explanation.  A good doctor will warn you when they're about to insert the catheter, which he did, and I'd advise you to remember to breathe at this point (just not too fast).  It hurt but it was not unmanageable.  It feels like fairly determined cramps and if you've had a hard menstrual life, you get this already.  At this point, I was told to scooch (her words) myself up the table so my uterus was over the x-ray zone.  Let me tell you, with a speculum and catheter making your life a little more interesting, that table is a long motherfucker.  I was pretty sure I was about to "scooch" myself right off the damn thing when she finally told me to stop.  Then she lowered the camera to me and stepped back. 

When the doctor announced that he would be inserting the dye, he wasn't fucking kidding.  This took my cramps up to about a 9.5 and I started thanking the universe that this was a short procedure.  He told me to roll to one side, hold and then roll to the other.  Once I was flat again, I had hoped that I was nearing the end.  My breathing must have made my discomfort obvious because he let me know that he was just about finished.  About that time, a hellish wave of pain hit me and I wanted very much to kick the good doctor in the teeth.  Then the pain abruptly ended.  He retracted his torture devices and pushed the monitor up so that I could see what was going on.

The images they show you will be choppy as they are pictures, not a video.  It started with dye in the uterus (which looks very much like a caved in triangle).  The next frame showed dye in the right tube.  The frame after that did NOT show dye in the left tube.  At this point, I began to panic.  Likely sensing my horror, he flipped to the next frame and explained that he had some issues with the left tube but the dye finally went through.  I nearly started bawling.  That is exactly what I had hoped to hear.  My sister would later explain that she thought he was about to give up as the dye refused to go through the left tube.  Apparently, that last wave of pain was him pushing past the blockage.  For this, I am very thankful.  For this... I may just get pregnant this cycle.  Too soon to jump there though.  Your tubes are not short and thickish as biology and anatomy drawings have led us to believe, but instead they are long and stringy, extending upward (or so they were that day) into your abdomen.  So don't freak out if it looks like you're harboring a body-snatcher in your belly because that's just the way it looks.

Getting off the table was fun.  I don't like leaving a mess behind for someone but it's unavoidable considering the amount of dye and blood that will be leaking from your unmentionables.  Don't worry, they've seen it all before.  They advised that I would have a bit of spotting throughout the day and provided a pad for this reason.  After the initial clean-up and around an hour afterward, there wasn't nearly as much mess as I was expecting.  Overall, I'd do this again fifty times if it gave me the same result.

So, a few things you should remember when you have this done:

1. Talk to your OB a lot... especially if they aren't performing the procedure.  I set this up myself by calling imaging centers in the area because my OB didn't do it.  She left me in the dark for the most part so I hope you have more information than I did.

2. Make sure you have a scrip for antibiotics especially if you're showing the slightest signs of infection.  The dye goes out into your body and pushes anything that might be in your uterus and tubes with it so you NEED to take them.  My scrip was for prior to the procedure but others have been different so pay attention to the dosage.

3. TAKE 800 MG OF ADVIL WITH FOOD ABOUT AN HOUR BEFORE YOUR HSG!  I'm not even fucking joking about that amount either.  That's what I took and it still hurt.  This is an important step... do not forget it!

4. You should bring a pad with you for the reasons stated above.  The nurses will likely give you one if you don't stock them but if you have a preference, bring one along.  No tampons!

5. You should make sure and schedule this test right after AF leaves for the month.  They won't let you do it if you've ovulated and they make you take a beta (blood pregnancy test) at least 24 hours before.  Then no sex till after the procedure, though I doubt you'll want to until the next day.

6. You should only spot a little after.  My doc said if I notice more than a few teaspoons of blood or any signs of infection that I should call my OB immediately.

7. If your insurance doesn't cover infertility, call different labs.  There can be a huge difference between costs here so shop around.  Also, some billing offices give discounts for cash customers so pay in full up front if you can.  My HSG was a little over $400 and that was after a 40% discount.  They went as high as $1200 though so do your homework.  It may be cheaper for you to have it done at an outside lab even if your doctor does perform them.  All they really have to do is write the orders up and fax them to the imaging center.

8. Know that all women and hospitals are different.  Your procedure may not be exactly like this and you may have less (or more) pain than I did.  Just remember, this may be worth every penny and wince so keep an open mind, try to relax and pray it's over quickly.  My procedure lasted less than 10 minutes and once I left, minus some very mild cramping, I felt nothing.

So... all that being said, I hope you've enjoyed this episode of why HSGs are both horrible and fantastic!  Join me again next time as we discuss some more weird and squidgy facts of TTC.