Center for Reproductive Health and Gynecology



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Hysterosalpinogram (HSG) Patient Instructions

You are scheduled for an HSG on________________at_________am/pm

At:

The Medical Imaging Center of Southern California

2811 Wilshire Blvd. Santa Monica, CA 90403

(310) 829-9788

Other

The study is scheduled between day 7 and 10 of your cycle. Please fill the prescription given you for:

Birth control pills

Zithromax or Doxycycline - Antibiotic

Valium 10mg - Sedative Motrin 800mg - Pain

Please advise if you are allergic to any medications, especially Erythromycin or Iodine.

The HSG/HYDRO is a procedure that helps to visualize the inside of the uterus and the fallopian tubes. To determine whether or not the uterine cavity is open and if the tubes are blocked by scar tissue and to identify other possible abnormalities (i.e. polyps, fibroids, etc). This test may clear you to begin fertility treatment, or indicate a need for corrective surgery. There is a slight risk of infection from a HYDRO/HSG; taking antibiotics in advance will decrease this possibility.

The night before the procedure:

Zithromax - Take two pills with dinner and plenty of water, and the morning of procedure take the remaining two pills with breakfast and plenty of water.

Doxycycline - Take one tablet twice a day starting 3 days prior to procedure; continue until all pills have been taken.

The day of your procedure: You MUST bring a licensed driver with you, as you will be under the effects of a sedative and unable to drive yourself home. You may eat a light meal prior to the procedure. Plan to arrive at least 30 minutes prior to your appointment time. Upon arrival take Valium and Motrin (30 minutes prior to you HSG/HYDRO). Although the test takes only 10-15 minutes to perform, you need extra time to complete the paperwork.

The procedure: During the “HSG/HYDRO” you will lie on your back on a table with your knees bent and you feet in footrests. A vaginal speculum is inserted in the vagina. The vagina and cervix are cleaned with an antibacterial soap. A small bendable plastic tube (cannula) is inserted gently through your cervix into your uterus. A tiny balloon in the tube is then filled with air to hold it in place while the speculum is removed. (For HYDRO a vaginal ultrasound probe is then inserted). While observing the uterine cavity, water for HYDRO or dye for HSG is injected through the cannula into the uterus and tubes while several pictures are taken. You might be asked to change positions to provide the clearest view. When the procedure is done the balloon is emptied of air and the tube is gently removed. You may then be asked to sit up for a few minutes to allow the liquid to escape.

Risks:

A HSG/HYDRO procedure is considered a relatively safe. Complications occur less than 1% of the time:

1) Infection- with fever >100.4, increasing pain or bleeding.

2) Spotting- which may occur for 1-2 days after the procedure.

3) Cramping- during and for several hours following the procedure.

4) Light headed or dizzy- during or shortly after the procedure.

5) Allergic reaction- which usually manifest as a rash.

6) Sticky vaginal discharge as the dye is expelled from the uterus.

You may choose to stay home and take it easy after the procedure. Normal activities may be resumed the next day. If you have any questions or concerns, please do not hesitate to call (310) 360-7584.

Print Name:____________________________________________________

Patient signature:________________________________________________Date:____________________________

Instructions Reviewed With:________________________________________Date:___________________________

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