An HSG test or hysterosalpingography is an imaging investigation intended mainly for women with fertility problems, instrumental in their effective identification and treatment.
Hysterosalpingography (HSG) is a radiological exploration of the female genital tract, performed by instilling a radiopaque iodinated contrast agent through the cervical canal and visualizing it by radiological examination of the cervical canal, uterus, fallopian tubes, and peritoneum.
The cost of an HSG test
For the average person, the cost of an HSG test without insurance coverage will range anywhere from $600 to $1,800. This price includes all fees associated with performing this procedure at a medical facility. The geographic location and type of provider are important factors that affect these costs for each individual patient.
There are several terms and conditions to consider regarding health insurance coverage of the reversal procedure. For example, some insurers may not cover this since it tends to go into the infertility procedures category only if they’re medically necessary, which is uncommon in most cases. In such a case you will have to pay all the costs yourself. In some cases, hospitals are willing to offer a cash discount in exchange for payment upfront.
An article on the WhattoExpect.com blog has highlighted an example where a woman has her HSG test done recently. It turns out that even though she was told by hospital staff to submit insurance claims for this procedure since they deemed them necessary, her claim is ultimately denied, and she’s left with a $950 bill plus other charges, which really adds up fast.
According to the Advanced Fertility Center of Chicago, a hysterosalpingogram costs between $850 and $3,100.
For those looking for an HSG test, MDSave.com had more than 75 providers posting prices ranging from $220 to $850.
Some members on a Babycenter.com forum thread said they had to pay $820 for the facility fee, $250 for the doctor, and $150 for the anesthesiologist. In contrast, others state their total came to about $180 after the insurance provider covered some costs. Via yet another Facebook post, one mom in Michigan wrote she was only required to pay around $750 after her insurer paid its share.
How does the test work?
Performing an HSG usually takes between 10 and 20 minutes, during which the discomfort for the patient is minimal (similar to one during a gynecological consultation). The patient is placed on the examination table, face up, in a gynecological position, and the radiologist inserts 2 gynecological valves or a speculum in the genital area of a woman to allow the visualization of the cervix.
After highlighting the cervix, it is disinfected with Betadine, and the permeability of the cervical canal is checked using a hysterometer. Through a sterile probe, the radiologist introduces in the uterine cavity the iodinated contrast substance necessary for the visualization of the uterine cavity and the fallopian tubes during the X-ray examination.
During the examination, the progress of the contrast substance is monitored on the monitor in the examination room, and several radiographs are performed. Mild cramps may appear during the examination, similar to those during menstruation.
After the examination, the patient remains on the examination table for a few minutes, during which the contrast substance is removed. After completion of the investigation, the patient remains in the clinic for approximately 30 minutes to release the CD with digital radiographs and the radiological result.
There are no contraindications to resuming normal activity; patients may return to work or continue their activities normally immediately after the investigation.
Important things to consider
The optimal interval for performing HSG is between the 6th and 12th day of the menstrual cycle (day 1 is the first day with bleeding) when the uterine mucosa is thin, and at the same time, the risk of the presence of pregnancy is reduced.
In some cases, as a result of this medical investigation, the fallopian tubes may become unclogged, and a future pregnancy may occur without the need for further treatment.
Risks/complications of an HSG test
Being a minimally invasive procedure, hysterosalpingography presents very few risks. These depend very much on the center where the examination is performed and on the skills of the radiologist. In sporadic cases, the following risks may occur:
- risk of infection;
- allergy to medication;
- mild bleeding;
- small abdominal cramps, discomfort, bloating;
- menstrual disorders.
Contraindications and limits of hysterosalpingography
HSG examination is contraindicated and/or cannot be performed on the following patients:
- pregnant women;
- women with symptomatic acute pelvic inflammatory disease;
- women who show heavy abnormal uterine bleeding on the day of the examination;
- menstruating women;
- women weighing more than 220 pounds due to the limitations of RX equipment.
Is hysterosalpingography a painful procedure? Is HSG performed under general anesthesia?
Usually, hysterosalpingography is performed without anesthesia or only with the use of local anesthesia. A solution (usually lidocaine) is injected into the uterine cavity before the procedure as a local anesthetic.
Most women who have undergone HSG claim that this procedure causes bearable pain in the lower abdomen, which intensifies during the introduction of the contrast agent, but disappears within about 30 minutes after the completion of the investigation.
However, some women who underwent hysterosalpingography reported that the procedure was excruciating and had a hard time.
To reduce the cramping and pain caused by a Hysterosalpingogram (HSG), your doctor may recommend taking ibuprofen about 90 minutes before. This helps because it reduces some of the inflammation, which can lead to discomfort during HSG procedures.
A level of pain tolerance will be different for everyone. For some, it might not hurt at all, while others can handle more intense pains with ease.