Hysterosalpingography (HSG) is a diagnostic imaging procedure used to evaluate the internal structure of the uterus and the condition of the fallopian tubes. This X-ray examination involves introducing a liquid contrast material into the reproductive tract through the cervix. The primary purpose of the HSG test is to determine if the fallopian tubes are open (patent) and to identify structural irregularities within the uterine cavity. Since blocked fallopian tubes are a common cause of infertility, this test is a fundamental piece of the initial fertility evaluation. The results directly influence the subsequent treatment plan, helping physicians decide between less invasive options or assisted reproductive technologies like in vitro fertilization (IVF).
Who Orders and Coordinates the Test
The decision to undergo an HSG test is initiated by the physician responsible for the patient’s fertility workup and care coordination. For many patients, the test is first recommended by an Obstetrician/Gynecologist (OB/GYN) as part of a basic infertility screen. The OB/GYN acts as the primary coordinator, arranging the referral to the imaging center and ensuring the test is timed correctly within the menstrual cycle, usually between days seven and twelve.
A Reproductive Endocrinologist (REI), a subspecialist focused on fertility, may also be the ordering physician, especially when a patient has a complex medical history. The REI uses the HSG results to formulate treatment strategies, such as determining if tubal surgery is necessary or if the patient should proceed directly to intrauterine insemination (IUI) or IVF. The ordering physician integrates the HSG data with other diagnostic information, such as hormone levels and semen analysis, to create a patient profile. This coordinated approach ensures the findings translate into actionable steps for the patient’s fertility journey.
The Medical Professionals Performing the Procedure
The physical execution of the HSG procedure requires a team of specialized healthcare professionals, typically operating within a hospital radiology department or an outpatient imaging facility. The physician primarily responsible for performing the test is a board-certified Radiologist, who specializes in medical imaging and interventional procedures. In some fertility clinics, a trained Gynecologist or Reproductive Endocrinologist may perform the procedure. This physician inserts the speculum and the thin catheter into the cervix.
Once the catheter is positioned, the physician carefully injects the contrast material into the uterine cavity. This process is performed under continuous live X-ray, known as fluoroscopy, which allows the physician to observe the contrast filling the uterus and moving into the fallopian tubes in real-time. The Radiologist guides the entire process, ensuring the contrast flow is optimal for capturing clear images that demonstrate tubal patency and uterine contour.
Working alongside the physician is a certified Radiology Technologist (RT), who manages the technical aspects of the imaging equipment. The technologist operates the fluoroscopy machine, captures the necessary sequence of X-ray images, and ensures the images are properly labeled and archived. Nursing staff are also present to assist with patient preparation, monitor comfort levels, and provide post-procedure instructions.
Interpreting the Imagery and Delivering the Findings
The formal interpretation of the HSG images is the responsibility of the Radiologist who oversaw the procedure. The Radiologist analyzes the captured X-ray images, looking for two primary findings: the shape and integrity of the uterine cavity and whether the contrast successfully spills out of the fallopian tubes. Free flow of contrast confirms tubal patency, while an abrupt stop suggests a blockage. Irregular filling within the uterus may indicate the presence of polyps, fibroids, or scar tissue.
This analysis culminates in a formal, written diagnostic report detailing the Radiologist’s findings and conclusions regarding tubal patency and uterine anatomy. This report is transmitted back to the Ordering Physician (the patient’s OB/GYN or REI). The ordering physician synthesizes the technical radiology report with the patient’s clinical history and other test results. They then deliver the final diagnosis and discuss the implications of the findings, including recommendations for further testing or a fertility treatment pathway, with the patient.