HSG without antibiotics - what are the actual risks?

[sparechange]

The fertility clinic has referred me for an HSG, which I'm having tomorrow.

When she was referring me, the consultant also wrote me a prescription for 3 different antibiotics (2 oral, 1 supository) which she said I needed to take 5 days as there is 'a very small risk of infection' from the procedure.

For one reason or another (mainly forgetfulness, partly I really don't like taking unnessesary antibiotics) I haven't collected the prescription or started the course.

The doctor herself said the risk of infection is very small, but I am slightly worried about it now!

Has anyone had an HSG without antibiotics, or can anyone quantify the risk?

Many thanks

I would definitely persevere to get hold of the antibiotics if I were you. If you've gone as far as having an HSG you are obviously have concerns for your fertility so there's no point even putting yourself at the slightest risk of infection which could have any extra risk of compromising your fertility.

I would imagine the risk of infection is present from the time of the procedure so it would probably still be beneficial to take antibiotics as of now. Why don't you call the consultant's secretary and see what she thinks?

I agree with not wanting to take unnecessary medication but when it's to do with something that is so important to you, why take the risk?

I would take them too.

Antibiotics? With an HSG injection?

Have to say this must be totally new. My youngest is now 7, but in the days of taking HSG (from 1998-2002) I don't remember ever being offered antibiotics.

Oops, sorry about my grammar. I edited the sentence and missed a bit.

Aagh ignore me. I'm getting HSG and HCG mixed up (it was a long time ago!).

Again I didn't take antibiotics before my HSG. But I'm not surprised that they are prescribed these days to be honest - I knew a couple of women who developed infections afterwards.

Thanks ladies,
I'm sure they wouldn't dish them out if there wasn't some need, but I find it hard to believe the risks are that great as to justify taking such a lot of antibiotics as a purely preventative measure!

Is anyone able to quantify the risk? ie there is a 1 in 1000/50,000/whatever chance of an infection, and what would be the consequences of the infection if I got one?

The hospital where I'm having the procedure has got a good reputation for hygiene - does that have an impact?

Hi thanks for this thread, I am also having an HSG in a few weeks time and I will be demanding asking for antibiotics now!

The reason for my HSG is to see if there is scar tissue (Ashermans Syndrome) which I have been reading may be caused by among other things: infections

I am hoping that I will be OK, but right now I am reading too much and worrying myself sick about AS which can basically render women infertile.

I dont care how small the risk is in terms of numbers, if the risk of infertility from infection exists, then I will take the antibiotics everytime. I have also read, but admitedly there are never any more details, "in rase cases untreated uterine infections can be fatal"

FWIW, I had one in 2008, at Queen Charlotte / Hammersmith hospital - was not given ABs.
It is worth taking a couple of Nurofen just before.

Mummy abroad, any untreated infection could be fatal, surely? Hence pre-antibiotics, people would die from what are considered minor wounds these days.

I haven't seen anywhere that HSG without antibiotics can lead to infertility though - anyone shed any light on whether this is the case?

Hi sparechange,

Sorry if I am scaremongering, I dont have any evidence to say that an HSG without antibiotics leads directly to infertility. Just that I would welcome a doctor who wanted to be overly cautious about risks of infection, as it is something that I am now highly worried about.

It makes sense to me that if you open the cervix, which is designed to be closed most of the time to keep out bacteria and prevent infections occuring in the womb, you are creating a risk of infection. I really have no idea how great or small that risk is.

There is a lot more info about Ashermans here. Only severe cases are untreatable and therefore cause infertility.

Hey there. Please, please, please do NOT have this procedure done without antibiotics. I started my course the day before the procedure and continued to take them for a week afterwards. I won't lie to you - the high dose of (admittedly) potentially unnecessary antibiotics may cause slightly other unpleasant side affects (I got a nice dose of oral thrush for my troubles), but this is an extremely small price to pay to forego the alternative. Here is some info I found from a fertility specialist's website:

"There is up to an 11% risk of developing pelvic inflammatory disease (PID) in dilated or distally blocked tubes following an HSG if no antibiotics are used, a 3% risk of serious infection after HSG if there is a history suggestive of prior tubal infection or damage, and less than a 1% chance of infection if the patient is pretreated with Doxycycline regardless of history or findings of distal tubal disease."

I think the risk of infection itself is actually pretty minimal, but I really wouldn't want to test the theory, especially if you have a problem of which you're not aware. If you've got this far down the road for fertility testing, you hopefully don't have too many more of these horrible prodding and poking procedures to endure.

It would seem the women who do suffer infections are those who are unwittingly allergic/ or have an allergic reaction to the dye. Since having your cervix opened and having dye injected into your womb is not something any of us do very often, I would strongly recommend that you follow your doctor's instructions on this one. This is one of those few occasions where I would argue that the tablets are there to protect you and your baby making equipment.

Sorry if this all seems melodramatic and scary, but I have had a womb infection due to a long-winded miscarriage and I promise you it really isn't worth the risk. I still have no idea if this is the cause of my infertility.

Thanks Broken. My doc hasnt prescribed any, will definitely being going back for a chat! xxx

I had one done two weeks ago and meant to come back on here to give the low down as I was worried before hand. So worried that when I got there I couldn't remember the date of my last period - I'd worked it all out when I booked the appointment but was so anxious my brain just wasn't cooperating! Glad you reminded me anyway to come back and share!

I think practice varies by country. A quick Google showed me that some countries do anti-biotics as a matter of course and that some also offer sedation/anaesthetic. A google also revealed some women saying it was easier than a smear and others saying it was worse than childbirth!

So for me - I had no anti-biotics and no anaesthetic, athough I did take Ibuprofen and paracetemol half an hour before hand. Frankly, although I know that obviously women's experiences can vary, I am amazed that anaesthetic/sedation is ever offered mainly as the key thing about this procedure is that it is quick. The pain of the speculum and catheter was slightly more for me than a smear (which most times for me is unpleasant) but it doesn't take long. The nurse warned me that the dye could exert pressure but for me, it was minimal, once the catheter was in place I was, whilst not dancing with delight (!), pretty much ok. Afterwards there was some leakage and some blood (not lots) and I felt sore from the speculum, a bit like they'd grazed or nicked me, but nothing to make me think that anti-biotics were necessary. I guess variation in anti-biotic prescription reflects attitudes to the (over) use of these drugs in general. I get that the cervix isn't normally open but the equipment should be sterile and you wouldn't normally pre-prescribe anti-biotics every time a bit of the body was opened that isn't normally so I wouldn't worry too much.

Anyhow, I see it is today that you were scheduled so I hope it went ok and that my experience helps someone else.

Hi,i have done my HSG test on tuesday 14th april. And dr prescribed me the antibiotech penciline and other containing amoxiline to get that dose in thr morning of test to be done. I could buy that antibiotech on the same day of my test i took that three antibiotech tablets 30 mins before my procedure. Can any one tell me please if it was still safe to have my HSG done. I am still in pain even two days after and just started little bleeding also. Please please please reply me

Gosh, it must really depend in what hospital you are at. I'm based in Edinburgh and had an HSG in early Januray and at no point were antibiotics mentioned. Nor anything about anaesthetic.
It was a very quick procedure and everything was sterile and I was daubed with that brown iodine solution prior to it.
All over within 15 mins.
It felt crampy during and I had some mild oeriod type pain after for a few hours but it seemed very straight forward.
I had no idea there are so many concerns about it. I think I was a bit too naive to be honest.

A few notes on this convo, antibiotics are necessary if you've had
fibroids or endometriosis removed prior to the procedure. This is avoid pelvic infection. I was prescribed Cipro, (2) prior to the procedure and (3) more after. Outside of the antibiotics if you have had surgery in your abdomen over two months prior, expect extreme extreme cramping 3-4 hours after the procedure and into the next day.

Had HSG at Guy’s and S Thomas’s, was prescribed preventative antibiotics to be on the safe side. I’m reluctant to take them (very small chance of infection) because I have worked so hard in the past year to restore my gut microbiome . Has anyone gone without antibiotics and been fine ?