Patient Resources
Hysterosalpingogram (HSG) Referrals
Welcome to Fertility Care. Your physician has referred you to Dr. Nathaniel Zoneraich for a procedure called a HYSTEROSALPINGOGRAM (HSG). The procedure will be performed by Dr. Zoneraich at ArizonaSurgery Center which is within the same building asFertility Care.
Dr. Zoneraich specializes in Reproductive Endocrinology and Infertility and has been performing HSGs for over 12 years.
The HSG procedure is aimed at the evaluation of your fallopian tubes and is indicated for women who are trying to achieve pregnancy as well as for women who have undergone a tubal sterilization procedure with the Essure® Micro-insert or Adiana® device. For those undergoing a fertility evaluation, the HSG will determine if one or both tubes are open and if the uterus has a normal shape. For those women referred for the Post-Essure® or Post-Adiana® HSG, the procedure will confirm for you and your physician that the device was inserted satisfactorily and has successfully blocked your tubes.
Appointment Scheduling - Fertility Patients
For those undergoing the HSG procedure for fertility reasons, we recommend you call us on the first day of your menstrual flow in order to schedule the procedure after the menstrual bleeding has stopped (generally after day 4-5) and prior to day 13 of your cycle. This allows for the best visualization of the uterine cavity and tubes and also minimizes the risk of infection as well as interruption of an early pregnancy. All patients will be required to provide a urine specimen for a pregnancy test at our facility prior to undergoing the procedure. Please notify the appointment scheduler if you have an iodine or shellfish allergy. We will still be able to accommodate you, however, your chart will be notated and we will use a non-iodine contrast for your procedure.
Appointment Scheduling - Post Essure or Post Adiana Patients
For those undergoing the Post Essure® or Post Adiana® HSG, we can perform the procedure as long as you are not on your menstrual flow and preferably between day 5 and 13 of your cycle. However, if this is not possible for your schedule, we can also perform the HSG any other time of month as long as you are not having any bleeding. All patients will be required to provide a urine specimen for a pregnancy test at our facility prior to undergoing the procedure. Please notify the appointment scheduler if you have an iodine or shellfish allergy. We will still be able to accommodate you, however, your chart will be notated and we will use a non-iodine contrast for your procedure.
Preparing / Downloading Forms
In order to facilitate your HSG experience atFertility Care, we recommend the following:
- Download, print, and complete ALL the registration forms. This will greatly reduce the amount of time of your visit. Click Here to Download the forms.
- ANY children who cannot remain unattended in the waiting room should NOT be brought to the appointment. Unfortunately, we do not have the staff to supervise any unattended children, and due to the use of radiation, they will not be permitted in the procedure room. Your appointment will be rescheduled.
- While the HSG is minimally invasive, and generally takes under five minutes for Dr. Zoneraich to perform, some women do experience some very brief menstrual-like cramps. In order to minimize any discomfort, we do advise you to take 600-800 mg of Ibuprofen (Advil) or 375-500 mg naproxen sodium (Aleve) approximately 1-2 hours prior to the scheduled HSG, if not allergic.
- Due to Arizona State Department of Health Service regulations, no one except the patient will be permitted in the procedure room during the HSG. However, spouses or partners are welcome to come into the room after the procedure is over when Dr. Zoneraich reviews the results.
- DO NOT raise your anxiety level unnecessarily by speaking with friends who may have had this procedure performed at a different facility, by a different physician. In addition, AVOID reading internet blogs of other peoples' experiences. 99% of women who have not heeded this advice comment to Dr. Zoneraich after the procedure that they "lost sleep" and had heightened anxiety for absolutely no reason.
The HSG Procedure
The HSG is a procedure in which a special type of x-ray using a fluoroscope is taken of the uterus and fallopian tubes after a radio-opaque dye is introduced into the uterus through the cervix. This procedure outlines the interior contour of the uterus and determines if the fallopian tubes are open (tubal patency) or if after an Essure® procedure, identifies the satisfactory placement of the Essure® micro-inserts within the tubes. If performed after an Adiana® procedure, the HSG will note if the tubes are open or appear occluded by x-ray.
You will be asked to undress completely from the waist down. A speculum is then placed into the vagina and the cervix is cleansed with an antiseptic (Hibiclens). After the cervix is cleansed, local anesthetic (Lidocaine) is used to numb the cervix prior to placement of an instrument which holds the cervix in position. Rarely, one may feel a slight pinch and a 2 second burn from the injection, however, the majority of women feel nothing. You will not feel any discomfort from the instrument being placed on the cervix. At this point, another instrument (cannula) is then placed 1 cm into the cervical canal and radio-opaque contrast dye is injected slowly into the uterus. Some women may experience some discomfort similar to light menstrual cramps as the dye enters the uterus, however, the majority do not. X-rays will be taken as the dye fills the uterus and the fallopian tubes. After the procedure is completed, based on your preference, a tampon will be inserted by Dr. Zoneraich, or you may use a pad, since some of the contrast will leak out into the vagina. While the contrast dye itself is clear, you can expect to have some spotting over the next few days as result of the instrument placed on your cervix. The entire procedure is usually completed within 5 minutes. We recommend you abstain from intercourse for 24-48 hours after the HSG in order to minimize any risk of infection.
After the HSG/Results
After the HSG is finished, Dr. Zoneraich will review the findings with you in the room. A copy of the report will be both faxed and mailed to your physician for their review. In addition, a copy of the films will also be mailed to your physician. Any further medical decision making based on the findings will be between you and your referring physician. We recommend you abstain from intercourse for 24-48 hours after the HSG in order to minimize any risk of infection.
Billing/Payment Information
For those with Insurance:
At the time your appointment is scheduled, our receptionist will ask you to provide us with your insurance information so we can verify your coverage. You will be notified prior to the appointment if there is a problem with your insurance or the insurance company is denying coverage for the procedure. After the procedure, we will bill your insurance company. In most cases, within 2-4 weeks, you will receive two separate statements (Explanation of Benefits) from your insurance company reflecting two separate fees for the HSG procedure. The first fee will be fromFertility Care, PLLC for Dr. Zoneraich performing the procedure and interpretation of the findings. The second fee will be from ArizonaSurgery Center, LLC for the facility/technical component of the HSG. Depending on your policy, your insurance company may mail the payment for ArizonaSurgery Center directly to you. Any payment received by you for the HSG procedure MUST be forwarded to our office immediately upon receipt along with a copy of the insurance company statement. REGARDLESS of what is listed on your insurance company's statement (Explanation of Benefits), you will only owe (and receive a bill from our office) for any outstanding balance fromFertility Care, NOT from ArizonaSurgery Center.
Self-Pay Patients:
Patients who do not have insurance or whose insurance does not cover the HSG procedure will be expected to pay a discounted fee of $640 (which includes the cost of the urine pregnancy test) prior to having the procedure performed.