Might a Hysterosalpingogram spread bacteria?

(12th July 2017)

Dear Robert,

I am being seen by St Mary’s in Manchester. I have been told I need IVF as I have a low AMH (age 41) and I have a hydrosalpinx on my left tube. I have a had three scans at Stepping Hill, St Mary’s and a private one. Unfortunately the sonographer at St Mary’s typed in that the hydro was on the right, even though I am certain she said verbally it was on the left. I even got my own scan done to prove it but the consultant is saying I need an HSG done now because I have shown her the other two scan reports which say its on the left. They haven’t even done me a presciption for antibiotics and I am feeling really depressed about things. I don’t want the HSG if there is a risk it could make any bacteria spread. I have had the STI screen etc but I am still concerned. Do you think I am right to be worried?


Dear Sarah,

I am not sure why it matters whether the hydrosalpinx (a blocked tube filled with fluid) is on the left or right. In general the evidence that removal of a hydrosalpinx improves IVF success is a bit dubious anyway. But a good consultant should always organise a hysterosalpingogram because this gives invaluable information about whether your tube is operable (which it may be) or whether there is any problem with the uterine cavity. I am not sure how often I have reiterated the need for a hysteriosalpingogram on this website before almost any infertility treatment. I don’t want to sound a bit tetchy but please – all embryos and babies implant, are fed and grow in the uterus, so its integrity is vital to successful pregnancy. Take the doctors’ good advice and get the x-ray. Your hydrosalpinx is likely to be free of bacteria but if you are worried about infection you can take a prophylactic antibiotic for a few days though in the vast majority of cases this is unnecessary but some doctors regard it as good practice.

Best wishes
Robert Winston

(17th October 2021)

Dear Robert,

You kindly answered a question I had about having an HSG some time ago and I wanted to share with you what happened.

I had the HSG, which showed blushing and a blockage. I then had a laparoscopy and hysteroscopy. My womb was fine and the blocked tube was cut in half and cauterised as I didn’t want a clip. Three months later I got pregnant naturally which I lost at 5 weeks. Started on thyroid medication two months later and got pregnant again straightaway, lost that baby at 12 weeks (Down syndrome was given as a reason- it had fluid on neck etc) Two months later got pregnant again naturally and gave birth aged 43. I have a lovely little two year old now. She is quite the miracle!

I just thought you would be interested since its quite an unusual story. My consultant who did my op was Dr Raj Mathur at St Mary’s Manchester.

Thanks for your reply back in 2017. It definitely encouraged me on my journey.

Best Wishes

Dear Sarah,

Thank you for letting me know. It is not quite as unusual as you think and I am, of course, truly delighted. This is an excellent example of how important it is to keep trying naturally, advice which sadly is so often forgotten.

With my best wishes,

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