Hysterosalpingogram

Overview

What is hysterosalpingogram?

A hysterosalpingogram (HSG) is an X-ray dye test used to diagnose problems related to fertility. During an HSG, an X-ray records images of your uterine cavity and fallopian tubes while they’re filled with a special dye. An HSG can help your provider spot issues in your reproductive anatomy that may prevent you from getting pregnant. These issues include blocked fallopian tubes and an irregularly shaped uterus.

When is a hysterosalpingogram performed?

Your provider will plan your procedure so that it happens during the first two weeks of your menstrual cycle — after your last period has ended but before you ovulate. This timing reduces the chance that you’ll be pregnant or menstruating during the procedure.

Who shouldn’t get a hysterosalpingogram?

You shouldn’t get an HSG if you’re pregnant or if you have a pelvic infection.

When would a hysterosalpingogram be needed?

An HSG can help your provider see if your fallopian tubes are open or blocked. This information can help your provider diagnose fertility problems. Open fallopian tubes allow a clear path for conception to occur. Sperm travel through fallopian tubes to fertilize an egg. The fertilized egg (embryo) travels through your fallopian tubes to your uterus (womb), where it can grow and develop into a healthy fetus.

Blocked fallopian tubes prevent these processes from happening and are a leading cause of infertility.

An HSG can also allow your provider to:

  • Check the success of a tubal ligation or tubal reversal: An HSG can show whether a tubal ligation procedure successfully closed your fallopian tubes so that you can’t get pregnant. It can also show if the procedure was successfully reversed.
  • Plan for further imaging: An HSG can show irregularities in your uterus (fibroids, abnormal shape) that your provider can use to plan for further imaging, including sonohysterography and hysteroscopy. A sonohysterography can further define the results of an HSG and provide a final diagnosis, while hysteroscopy can treat specific conditions involving your uterus.

Nowadays, hysterosalpingogram is used only to determine if the tubes are open, as other less complicated and more complete tests can be done to study the uterus.

Who performs a hysterosalpingogram?

Your gynecologist, a radiologist, or a reproductive endocrinologist can perform an HSG. Afterward, a radiologist will assess your X-rays and write a report communicating findings to your physician.

Test Details

How does the procedure work?

With an HSG, a dye fills your uterine cavity and fallopian tubes. The dye creates an outline of your uterus and fallopian tubes that stands out on an X-ray. If the X-ray shows the dye flowing through your fallopian tubes, they’re open. If the dye meets a barrier that prevents the flow, your fallopian tubes are blocked.

What to expect before a hysterosalpingogram?

Your provider will review your medical history to ensure you’re a good candidate for HSG. If you’re tracking your luteinizing hormone (LH) levels, your provider may review the results of your LH test to be sure that you’re not pregnant. Your provider will check whether you’re allergic to any parts of the dye solution used during the HSG.

Your provider will discuss any risks with you. The risks are minimal with HSG.

How do I prepare for a hysterosalpingogram?

Follow your provider’s instructions to prepare for your procedure. Your provider may recommend that you:

  • Take over-the-counter medicine for pain an hour before your procedure.
  • Take antibiotics beforehand to prevent infection.

Arrange for someone to drive you home after your HSG. You may feel up to driving yourself, or you may experience cramping that makes driving difficult. It’s a good idea to have someone to assist, just in case.

What to expect during a hysterosalpingogram?

An HSG takes less than five minutes. You’ll be able to go home the same day of your procedure.

During the procedure, your provider will inject a solution with dye into your uterus and fallopian tubes while an X-ray records images.

Preparing for the dye injection

  1. You’ll lie on a table, with your knees bent and legs open, as if you were having a pelvic exam. The machine taking the x-ray (fluoroscopy machine) will be positioned above the table.
  2. Your provider will insert a tool called a speculum into your vagina that will widen it, allowing your provider to access your cervix.
  3. Your provider will clean your cervix and insert a small catheter in the cervical canal and into your uterus. The catheter may be a thin plastic tube called a cannula. Or, your provider may use a thin plastic tube with a balloon at the end. The balloon inflates once it’s inside your body to hold the tube in place for the dye injection.

Injecting the dye

  1. Your provider will remove the speculum, and you will then be asked to straighten your legs flat on the table.
  2. Your provider will slowly pump the dye solution into your uterus while the radiology technician operates the fluoroscopy machine over your pelvic area. You may feel cramping at this point. If your fallopian tubes are blocked, they may slightly stretch from the pressure.
  3. Your provider may place you in different positions to assess how the solution moves through your fallopian tubes.
  4. If your fallopian tubes are open, the dye should spill out and be seen to spread close to your bowel (it will then get absorbed by your body without consequences). If they are blocked, the dye won’t spill out.

After enough X-ray pictures have been taken, your provider will remove the cannula or plastic tube with the balloon from your body, without reinserting the speculum.

Is a hysterosalpingogram painful?

Mild pain or discomfort is common with an HSG, both during the procedure and afterward. You may feel cramping when your provider inserts the dye solution into your uterus. You may experience more cramping when your tubes are blocked.

The cramping may last anywhere from five minutes after your procedure to a few hours. It may feel mild or moderate. Taking over-the-counter NSAIDs can help ease your cramps.

What to expect after the test?

After the test, you may need to wear a pad to catch the extra dye solution as it leaks from your vagina. Often, the discharge is sticky and contains small amounts of blood. You may also notice side effects, such as:

  • Cramps.
  • Dizziness.
  • An upset stomach or nausea.
  • A small amount of vaginal bleeding for a day or two.

Depending on your comfort, you may resume your everyday activities immediately after your HSG.

What are the risks of this test?

An HSG uses radiation to record X-ray pictures, but the amount of radiation is minimal. An HSG isn’t considered risky. Rare complications may include:

  • Infection.
  • Injury to your uterus.
  • An allergic reaction to the dye solution.

Results and Follow-Up

What type of results do you get, and what do the results mean?

Your provider will tell you your results and advise you on next steps. If the HSG shows blockage, your provider may recommend additional procedures like a laparoscopy to further diagnose and treat the problem. Or, they may recommend fertility treatments that don’t require your fallopian tubes to be clear, like in vitro fertilization (IVF).

When should I call my doctor?

Call your provider if you notice any of these signs, which may indicate an infection:

  • Fever.
  • Chills.
  • Fainting.
  • Vomiting.
  • Heavy vaginal bleeding.
  • Foul-smelling vaginal discharge.
  • Severe cramping in your abdomen.

Additional Details

Does a hysterosalpingogram increase the chance of pregnancy?

“Tubal flushing” refers to the process of injecting dye into your uterus and fallopian tubes, as with an HSG, but without doing an X-ray. Some studies suggest that tubal flushing improves fertility, especially during the first three to six months following the dye injection. Research shows that conception rates increase when the dye solution contains what’s known as an oil-soluble contrast medium in particular.

Still, these studies are of varying quality. More research is needed before HSG can be considered a fertility treatment as well as a diagnostic procedure.

Can an HSG test clear blocked tubes?

The dye solution can potentially clear minor blockages and increase your chance of becoming pregnant. More research is needed to prove this theory.

What are the side effects of an HSG test?

The most uncomfortable side effect of an HSG test is cramping. Your provider may recommend that you take over-the-counter pain medicines for a few days after your HSG to help ease your symptoms. You may notice a sticky vaginal discharge where the dye leaves your body, but these symptoms eventually resolve.

Is it safe to get pregnant right after an HSG test?

Generally, it’s safe to try to become pregnant within a few days following an HSG. Ask your provider, to be sure.

A note from Cleveland Clinic

A hysterosalpingogram can help your provider spot irregularities in your uterus or fallopian tubes that might prevent you from becoming pregnant. Blocked fallopian tubes are a leading cause of infertility. The results of your HSG can help your provider get one step closer to determining what’s making it difficult for you to conceive. Ask your provider about how your test results will shape next steps.

Last reviewed by a Cleveland Clinic medical professional on 01/08/2022.

References

  • Chalazonitis A, Tzovara I, Laspas F, Porfyridis P, Ptohis N, Tsimitselis G. Hysterosalpingography: technique and applications. (https://pubmed.ncbi.nlm.nih.gov/19632497/) Curr Probl Diagn Radiol. 2009;38(5):199-205. Accessed 1/08/2021.
  • Dreyer K, van Rijswijk J, Mijatovic V, et al. Oil-based or water-based contrast for hysterosalpingography in infertile women. (https://www.nejm.org/doi/full/10.1056/nejmoa1612337) N Engl J Med. 2017;376(21):2043-2052. Accessed 1/08/2021.
  • Simpson WL Jr, Beitia LG, Mester J. Hysterosalpingography: a reemerging study. (https://pubmed.ncbi.nlm.nih.gov/16549607/) Radiographics. 2006;26(2):419-431. Accessed 1/08/2021.
  • van Rijswijk J, van Welie N, Dreyer K, et al. Tubal flushing with oil-based or water-based contrast at hysterosalpingography for infertility: long-term reproductive outcomes of a randomized trial. (https://pubmed.ncbi.nlm.nih.gov/32553471/) Fertil Steril. 2020;114(1):155-162. Accessed 1/08/2021.
  • Wang R, Watson A, Johnson N, Cheung K, Fitzgerald C, Mol BWJ, Mohiyiddeen L. Tubal flushing for subfertility. (https://www.cochrane.org/CD003718/MENSTR_tubal-flushing-subfertility) Cochrane Database of Systematic Reviews 2020, Issue 10. Art. No.: CD003718. Accessed 1/08/2021.

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