If you have a hysterosalpingogram (HSG) coming up, feeling a little nervous is completely understandable. The good news is that an HSG test is quick, common, and one of the most useful steps in a fertility evaluation.
At InVia Fertility, Dr. Vishvanath Karande, a board-certified reproductive endocrinologist and Director of the IVF Program, leads a team that performs HSG testing to give you clear answers about your fallopian tubes and uterus. We’ll walk you through each step so you can feel prepared.
What Is an HSG Test?
An HSG is an x-ray test in which your provider fills your uterus with a contrast dye to see whether your fallopian tubes are open and whether your uterine cavity has a typical shape. The name describes the test itself, since “hystero” refers to the uterus and “salpingo” refers to the fallopian tubes.
Why Your Doctor May Recommend an HSG
An HSG is a standard part of a fertility evaluation, and most fertility specialists recommend one early in testing. According to the American Society for Reproductive Medicine (ASRM), an HSG shows whether your tubes are open and can reveal differences inside the uterine cavity. Your doctor may recommend an HSG to:
- Check whether your fallopian tubes are open
- Look for a hydrosalpinx, a blocked tube filled with fluid
- Spot changes inside the uterine cavity, such as polyps, fibroids that bulge into the cavity, scar tissue, or a difference in uterine shape
- Locate an intrauterine device (IUD)
How to Prepare for Your Hysterosalpingogram
Your HSG will be scheduled after your period ends and before you ovulate. A few simple steps will help you feel ready:
- Your doctor may suggest taking an over-the-counter pain reliever such as ibuprofen before your appointment, which can greatly reduce cramping
- Tell your care team if you are allergic to iodine, contrast dye, or seafood, since your provider can use a contrast solution without iodine
- Let your team know if you have a pelvic infection or could be pregnant
- Arrange a ride home in case cramping lingers
What Happens During the HSG Procedure
During your hysterosalpingogram procedure, you will lie on an exam table, and your provider will insert a speculum and place a thin tube through your cervix. Your provider will then gently fill your uterus with contrast while taking x-ray pictures. According to ASRM, the HSG procedure takes approximately 5 minutes.
Many practices recommend taking an over-the-counter pain reliever before your HSG, and following your doctor’s guidance on timing can help you feel more comfortable during the procedure.
Does an HSG Test Hurt?
An HSG usually causes mild to moderate cramping for about 5 to 10 minutes. Some people feel stronger cramping or cramps that last several hours, and cramping can be stronger when a tube is blocked.
Most people find relief with an over-the-counter pain reliever, and your doctor may also offer a local anesthetic around the cervix for added comfort. Light spotting for 1 to 2 days after an HSG can also happen.
Is an HSG Safe?
An HSG is a very safe test. According to ASRM, serious complications occur in fewer than 1% of cases, with pelvic infection being the most common serious problem. Infection is more likely if you’ve had tubal disease in the past, so your doctor may recommend antibiotics in some situations.
Contact your doctor if you have increasing pain or a fever within 1 to 2 days of your HSG, heavy bleeding, or any rash, itching, or swelling. The radiation dose from an HSG is very low, less than with a kidney or bowel x-ray study.
What Your HSG Results Can Show
If your tubes are open, your provider will see the contrast spill out from their ends. Differences in the uterine cavity can show up as changes in how the contrast fills the uterus. Your results may show common tubal findings on HSG or uterine findings on HSG, and your doctor will explain what each one means for you.
An HSG does not evaluate your ovaries or fibroids outside the uterine cavity, which is why InVia Fertility pairs HSG with ultrasound for a more complete picture. Your doctor may also recommend a hysterosonogram or hysteroscopy to look more closely at the uterine cavity.
According to ASRM, some studies show a slight increase in fertility for about 3 months after an HSG with open tubes, though whether the test enhances fertility is still debated. The main purpose of your HSG is to give your doctor the information needed to guide your plan.
Next Steps After Your HSG Test
Your doctor will review your images with you and build a plan around your full evaluation. In some cases, your doctor may be able to open a blockage using a special catheter during the HSG itself.
If a tube is blocked, treatment options for blocked tubes may include surgery such as laparoscopy to repair or remove the tube, or in vitro fertilization (IVF), which does not rely on the fallopian tubes. For a hydrosalpinx, your doctor may recommend a combination of surgery and IVF. Every path is a valid one, and your doctor will help you find the approach that fits your goals.
Questions to Ask About Your HSG
A few questions can help you feel prepared and confident. You might ask:
- When in my cycle should I schedule my HSG?
- Which pain reliever should I take for cramping, and when?
- Do I need a different contrast dye because of an allergy?
- When will I get my results?
- How could each possible result shape my plan?
Every answer from your HSG brings you closer to a clear plan, and we’re here for you every step of the way.
Schedule a Fertility Evaluation at InVia
When you’re ready, schedule an appointment at one of our six Illinois locations or through a virtual visit. Our team will answer your questions and help you take your next step with confidence.
