What Is HSG?

by | Oct 28, 2022 | Fertility 101

A guide to the hysterosalpingogram procedure

One common fertility evaluation test is called a hysterosalpingogram, or HSG. The HSG procedure assesses the uterus and fallopian tubes to see if there are any blockages or anatomic abnormalities that might impact fertility.

How Does an HSG Work?

In order to conceive, sperm must be able to travel freely through a uterus to fertilize the egg in a fallopian tube. The fertilized egg then travels through the tube to the uterus to implant in the uterine lining. If, however, there are any blockages or challenges in the fallopian tubes or uterus, it may be harder to get pregnant. The HSG procedure helps identify any anatomical issues by using a special fluid to fill the uterus and fallopian tubes. The fluid contains a dye that shows up on a X-ray, so the doctor can see the shape of the uterus and if the dye flows freely through the fallopian tubes.

Usually, fertility specialists use HSG as part of an initial fertility assessment, to rule out any:

  • blockages in the fallopian tubes
  • uterine cavity issues like polyps, scarring, or fibroids that could impact embryo implantation.

However, HSG can also be used after a tubal ligation to make sure the fallopian tubes were fully blocked during the sterilization procedure.

What to Expect From the HSG Process

Typically, your clinic will schedule your HSG during the first half of your menstrual cycle. This reduces the chance that you might be pregnant or menstruating during the procedure. Your fertility specialist or primary care provider may prescribe an antibiotic before the procedure, or recommend that you take over the counter pain medication approximately one hour beforehand. Ask your team before taking any medications.

The actual HSG procedure is quick and done in-office. First, you’ll lie back with your feet propped up, in the same position as for a pelvic exam. There will be an x-ray machine in the room or above the table as well.

Similar to a Pap smear, your doctor will use a tool called a speculum to open the vaginal canal and allow access to the cervix. The doctor inserts a small plastic tube through the cervix. Then, they take out the speculum and place the special fluid through the tube into your uterus and fallopian tubes. As the doctor adds the fluid, the x-ray machine will take images. Your doctor may ask you to change positions to see how the fluid moves through your body. If your fallopian tubes are clear, the fluid will spill out of them into your abdomen, where your body will absorb the extra fluid with no negative effects. Once enough images are taken, the doctor will remove the tube, and the procedure is finished.

Does HSG Hurt?

Many patients experience mild cramping or discomfort during or after an HSG. Typically, any pain is mild to moderate, and goes away within a few hours after the procedure. If you’d like, over the counter NSAIDs can help with cramping. 

After the test, you can expect some sticky vaginal discharge as extra fluid drains out. You may also see small amounts of blood mixed with the fluid. This is completely normal. You can use a pad to catch the discharge; don’t use a tampon for at least a few days after the procedure.

You may also feel mild nausea or dizziness; these symptoms should go away within a day or two, as well.

Is HSG Risky?

Severe side effects or complications from HSG are rare. There is a small chance of an allergic reaction to the dye, and any surgical procedure carries a risk of infection. Call your doctor if you experience any of these symptoms:

  • Fever or chills
  • Fainting
  • Vomiting
  • Foul-smelling vaginal discharge
  • Heavy vaginal bleeding
  • Severe abdominal cramps

However, these complications are not common with HSG.

Comprehensive Fertility Testing

HSG is just one of several in-house tests we offer as part of our initial fertility assessments. The first step towards creating a personalized treatment plan is getting a complete picture of your current reproductive health. After your HSG, your fertility team will go over the results with you, including any diagnoses and next steps. PNWF is committed to providing our patients with top-tier fertility care, and the information you need to navigate your fertility journey. Get started today by scheduling your initial consultation.

Additional reading: https://www.acog.org/womens-health/faqs/hysterosalpingography