Mastering HSG Interpretation: Unveiling Reproductive Anomalies – ARC Summit

Today, I’ll discuss the interpretation of HSGs, focusing on diagnosing conditions such as hydrosalpinx, loculations, intrauterine adhesions, fibroids, and mullerian anomalies, all of which are commonly identified in an initial fertility workup.

I’m based in the beautiful Pacific Northwest and have ties to the University of Louisville. In fact, one of my colleagues here was a fellow during my time there. I have no disclosures; my career is centered around clinical work and education.

Mullerian anomalies are a significant aspect of fertility evaluations as they can contribute to infertility, pregnancy loss, and poor pregnancy outcomes. Typically, these are diagnosed through physical exams and imaging techniques such as ultrasound and saline infusion sonography, which Dr. Nakajima previously discussed. Building a strong relationship with the imaging facilities you use is crucial, especially if you do not have your own facility.

For example, let’s consider an HSG image showing a uterus with a non-standard shape and blocked tubes, suggesting possible mullerian anomalies like a septum or a bicornuate uterus. Differentiating these is vital because their management varies significantly.

Another scenario involves a 37-year-old patient trying to conceive, diagnosed with PCOS and shown to have blocked tubes on her HSG. Following up with an ultrasound, what was initially thought to be a septum appeared to be a fibroid. This confusion often requires further clarification through MRI, which provides a detailed view that is crucial for accurate diagnosis.

It’s also essential to interpret MRI images yourself whenever possible. For instance, identifying a septum versus a bicornuate uterus is critical as the surgical approaches differ greatly. For septal resections, I use a cold knife technique, carefully monitored by ultrasound to ensure precise incisions and to prevent excessive bleeding.

Moreover, understanding how to manage and when to intervene surgically is crucial. For instance, a patient might present with what appears to be an arcuate uterus, which does not typically impact reproductive outcomes and should be managed conservatively.

In summary, the effective interpretation of HSGs and subsequent management decisions require a thorough understanding of pelvic anatomy, a good relationship with diagnostic facilities, and a skillful approach to surgical interventions when necessary.