The Hysterosalpingogram (HSG) is an X-ray procedure used in fertility evaluations. This diagnostic test allows medical professionals to visualize the internal structure of the uterus and determine the patency of the fallopian tubes. By using a contrast agent, the HSG provides images that can reveal structural abnormalities within the uterine cavity or blockages that might prevent conception. The results guide subsequent treatment options for individuals experiencing difficulty becoming pregnant.
Preparing for the Test
Scheduling the HSG test requires planning around the menstrual cycle. The procedure is typically performed between cycle days six and twelve, after menstrual bleeding has completely stopped. This timing minimizes the risk of testing during an undetected pregnancy and ensures the uterine lining is thin enough for clear imaging.
The procedure can cause cramping similar to a heavy period, so anticipating discomfort is standard preparation. Healthcare providers commonly recommend taking an over-the-counter non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen, about 30 to 60 minutes before the appointment. Preemptive pain management helps mitigate uterine spasms that occur when the contrast material is introduced.
Safety checks are necessary before the procedure to prevent complications. A recent negative pregnancy test is mandatory. Screening for pre-existing pelvic infections (via blood tests or swabs) is often required because the procedure could potentially spread infection into the abdominal cavity. Following these preparatory steps ensures the test is performed under the safest possible conditions.
The Step-by-Step Procedure
The patient lies on their back on an X-ray table, often with feet in stirrups, similar to a gynecological exam. A medical professional will first insert a speculum into the vagina to hold the walls apart, allowing clear access to the cervix. This initial setup is identical to that experienced during a routine Pap smear.
The cervix is cleansed, and a thin catheter or cannula is inserted through the cervical opening into the uterine cavity. The tube is secured to prevent the contrast material from flowing back out. Patients may feel a brief pinch or pressure during placement.
Once secured, the fluoroscope (X-ray machine) is positioned above the patient to capture real-time images. A sterile, iodine-based liquid contrast agent is slowly injected through the catheter into the uterus, making internal structures visible on the X-ray monitor.
As the uterus fills with the contrast material, many patients experience intense cramping. Cramping is caused by the distension of the uterine cavity and the fluid’s passage into the fallopian tubes. If the fallopian tubes are blocked, pressure increases because the dye cannot escape, intensifying the cramping.
The radiologist observes the monitor, capturing images as the dye progresses through the uterus and fallopian tubes. Images are taken rapidly to document the dye’s path and identify structural abnormalities, such as polyps or fibroids. The entire active imaging and injection process is relatively brief, usually lasting only between five and fifteen minutes. Afterward, the speculum and catheter are quickly removed.
What the Results Mean
Following the procedure, mild cramping, similar to menstrual discomfort, typically subsides within a few hours. The body naturally expels the contrast agent, resulting in a sticky, sometimes brown-tinged discharge that may last up to 48 hours. Patients should use a sanitary pad rather than a tampon to manage this discharge and to monitor for any signs of complications.
While rare, signs such as fever, severe abdominal pain, or heavy bleeding warrant immediate medical attention. Most patients can resume normal activities immediately after leaving the clinic.
The primary goal of the HSG is to determine the patency of the fallopian tubes, revealed by the contrast agent’s flow pattern. If the tubes are open, the dye spills freely into the abdominal cavity, confirming a clear pathway for egg and sperm. If a tube is blocked, the dye stops abruptly or pools, indicating an obstruction that prevents normal egg transport and fertilization. The resulting images are usually reviewed quickly by the radiologist, and the findings guide the next phase of the treatment plan.