A hysterosalpingography (HSG) is an X-ray procedure that assesses a woman’s reproductive system. It evaluates the internal structure of the uterus and checks for open fallopian tubes. Often part of a fertility evaluation, the HSG identifies physical barriers that could affect conception.
Reasons for the Test
Doctors recommend an HSG test when investigating challenges with conception. The procedure identifies blocked fallopian tubes, which prevent sperm from reaching an egg or a fertilized egg from traveling to the uterus. Blocked tubes are a common cause of infertility.
Beyond tubal patency, the HSG test provides details about the uterine cavity’s shape and structure. It can reveal abnormalities such as polyps, fibroids, or scar tissue within the uterus that might hinder embryo implantation or lead to recurrent miscarriages. The test can also evaluate the success of procedures like tubal ligation or its reversal, confirming whether the tubes are properly closed or reopened.
Timing the Procedure
HSG test timing within the menstrual cycle ensures accuracy and patient safety. It is scheduled during the follicular phase, after menstrual bleeding has stopped but before ovulation, typically between day 6 and day 12 of the menstrual cycle (day 1 is the start of menstruation).
Performing the test during this phase minimizes the risk of X-rays and contrast material harming an undetected pregnancy. It also ensures a thin, blood-free uterine lining for clearer imaging. Patients should avoid unprotected intercourse or use contraception from the start of their menstrual cycle until the test to prevent pregnancy.
What Happens During the Test
An HSG test is performed in a radiology department or specialized clinic and takes 15 to 30 minutes. The patient lies on an examination table, similar to a gynecological exam, with knees bent. A speculum is inserted to visualize the cervix, which is then cleaned with an antiseptic solution.
A thin catheter is threaded through the cervix into the uterine cavity. Through this catheter, iodine-based contrast material is injected. As the contrast fills the uterus and fallopian tubes, X-ray images are taken using fluoroscopy, allowing real-time visualization. If the fallopian tubes are open, the contrast flows through them and spills into the pelvic cavity, where it is naturally absorbed by the body. Patients might experience sensations such as cramping or pressure as the dye is injected, which can be more intense if tubes are blocked.
Important Considerations
Before an HSG test, healthcare providers often recommend taking over-the-counter pain medication, such as ibuprofen, about 30 to 60 minutes prior to the procedure to help manage potential cramping or discomfort. In some cases, antibiotics may be prescribed, particularly for patients with a history of pelvic infections, to reduce the risk of post-procedure infection. Patients should inform their doctor about any allergies, especially to iodine or contrast dyes.
After the test, it is common to experience mild cramping, spotting, or a watery discharge as the contrast material exits the body. These symptoms typically subside within a day or two. While generally considered safe, potential risks include infection, which occurs in less than 1% of cases, or a rare allergic reaction to the contrast dye. Radiation exposure during an HSG is minimal, often compared to that of a chest X-ray, and is not shown to cause harm even if conception occurs later that month. Preliminary results are often available immediately, with a detailed analysis provided during a follow-up appointment.