The hysterosalpingogram (HSG) is an x-ray test that lets your physician examine the inside walls of your uterus and fallopian tubes. We routinely perform an HSG for three primary reasons:
- To see if a patient’s fallopian tubes are open
- To assess whether the uterus has a normal shape
- To confirm that the uterine cavity is not affected by fibroids, polyps, or scar tissue
We may also use a sonohysterogram to detect abnormalities inside the uterus; however, sonohysterograms are not helpful in detecting blocked fallopian tubes.
How it works
The HSG requires the assistance of a type of x-ray called a fluoroscopy, or “live x-ray.” At Shady Grove Fertility’s Rockville and Towson offices, we dedicate a special x-ray room to these procedures. An experienced midlevel provider—certified physician assistant (PA-C) or certified registered nurse practitioner (CRNP)—or a physician will perform the procedure.
Preparing for the HSG
Your physician or nurse will advise you to take ibuprofen or a similar over-the-counter nonsteroidal anti-inflammatory drug (NSAID) 1 hour prior to the procedure to reduce the discomfort from possible cramping. Your nurse will also advise you to arrive 30 minutes prior to the test to review informed consent paperwork and provide a urine sample. The actual HSG procedure generally takes approximately 10 minutes.
The HSG procedure
During the procedure, the provider will place a speculum into your vagina in the same manner as if you were undergoing a Pap smear. He or she will cleanse the cervix with an antiseptic solution before placing a small, flexible catheter approximately 1 inch into the cervical canal, where it rests against the cervix. The clinician will pass a small amount of dye through the catheter, filling the uterine cavity and then filling the fallopian tubes. The tubes are considered open when the dye “spills” at the ends of the tubes (this is visible on the fluoroscopy). If your tubes are open, they should be able to “pick up” your ovulated egg. This part of the process generally takes less than 1 minute.
To examine the uterus, the clinician gently infuses the dye into the uterine cavity, and while some cramping may occur, it is usually less than menstrual cramping. If the dye cannot pass through the tube, a blockage is present.
After the HSG
While many women have no pain after the HSG, some may feel crampy or achy after the procedure, so it’s a good idea to have someone else drive you home. Some patients will also experience spotting a few days following the HSG—this is completely normal.
The clinician performing your procedure will review your images with you immediately and will provide you with your preliminary results. He or she will send the images to your electronic medical record so your physician may review them in a timely manner.
In the event that the clinician discovers a tubal blockage, your physician will provide potential treatment options. If scar tissue in or around the fallopian tubes is causing the problem, a physician can often surgically remove it. If your fallopian tubes are damaged, your doctor may be able to repair them with surgery, depending on the type and extent of the damage. If your tubal disease is severe, however, in vitro fertilization (IVF) that bypasses your fallopian tubes may be a valuable treatment to consider.