HSG Test Explained
What to expect from a hysterosalpingogram—the test that checks your tubes.
Quick Facts
- What it is: X-ray test using dye to check if fallopian tubes are open
- How long: 15-30 minutes
- Pain level: Varies—most describe cramping; take ibuprofen beforehand
- Bonus: Some women have increased fertility in the months after
What Is an HSG?
A hysterosalpingogram (HSG)—yes, it's a mouthful—is an X-ray procedure that evaluates your uterus and fallopian tubes. It's one of the standard tests in a fertility workup.
During the test, a contrast dye is injected through the cervix into the uterus. As the dye fills the uterus and flows through the fallopian tubes, X-ray images are taken to visualize the structures.
🔬 What It Shows
Uterus: Shape, any abnormalities (fibroids, polyps, septum, scarring)
Fallopian tubes: Whether they're open (patent) or blocked, and where any blockage is located
The fallopian tubes are where sperm meets egg—if they're blocked, fertilization can't happen naturally. About 25-35% of female infertility involves tubal factors, making this a critical test.
Why Is an HSG Done?
Your doctor may recommend an HSG if:
- You've been trying to conceive for 6-12 months without success
- You have a history that raises concern for tubal damage (pelvic infections, STIs, previous ectopic pregnancy, abdominal surgery)
- You've had multiple miscarriages (to check uterine shape)
- Before fertility treatments like IUI or IVF
The HSG is typically done after basic blood work and semen analysis, as it's slightly more invasive.
The Procedure Step by Step
Step 1: Timing
The HSG is scheduled between day 6-12 of your cycle (after your period ends, before ovulation). This ensures you're not pregnant and the uterine lining is thin for better visualization.
Step 2: Preparation
You'll undress from the waist down and lie on an X-ray table with your feet in stirrups (similar to a pelvic exam position). A speculum is inserted to visualize the cervix.
Step 3: Catheter Insertion
A thin catheter is inserted through the cervix into the uterus. Some women feel a pinch or cramp at this point—it's brief.
Step 4: Dye Injection
Contrast dye is slowly injected through the catheter. As the dye fills your uterus and flows into your tubes, you may feel cramping or pressure. This is the part most women find uncomfortable.
Step 5: X-Ray Images
Several X-ray images are taken as the dye moves through your reproductive system. You may be asked to change positions. The radiologist watches on a screen in real-time.
Step 6: Completion
The catheter and speculum are removed. The whole procedure takes about 15-30 minutes. You can usually drive yourself home.
Does It Hurt?
The honest answer: it varies widely. Some women describe it as mildly uncomfortable; others find it quite painful. Most fall somewhere in between.
What Affects Pain Level
- Blocked tubes: If there's a blockage, dye can't flow freely, causing more pressure and cramping
- Tilted uterus: May make catheter placement trickier
- Anxiety: Tension can increase discomfort (try to stay as relaxed as possible)
- Skill of the provider: Experience matters
What It Typically Feels Like
- Catheter insertion: Brief pinch or pressure
- Dye injection: Cramping similar to period cramps (ranging from mild to intense)
- Duration: Discomfort usually lasts only while dye is being injected (1-2 minutes)
💊 Pain Management Tips
- Take 600-800mg ibuprofen (like Advil) 30-60 minutes before the procedure
- Some doctors prescribe a muscle relaxant or anti-anxiety medication
- Ask if your doctor uses a balloon catheter (may reduce cramping) vs. a tenaculum
- Practice deep breathing during the procedure
- Bring someone to hold your hand if allowed
After the Procedure
You may have:
- Mild cramping for a few hours (ibuprofen helps)
- Light spotting for 1-2 days
- Watery discharge as dye exits (normal)
You can resume normal activities the same day, though some women prefer to take it easy.
Understanding Results
Normal Results
The dye flows freely through the uterus and spills out the ends of both fallopian tubes. The uterus appears normal in shape with no filling defects.
Abnormal Results May Show
Blocked tubes:
- Proximal blockage: Near the uterus—may be mucus (can clear on its own) or scar tissue
- Distal blockage: Near the ovary (often from past infection)—may indicate hydrosalpinx (fluid-filled tube)
- One tube blocked: Pregnancy still possible through the open tube
Uterine abnormalities:
- Fibroids or polyps (filling defects)
- Uterine septum (a wall dividing the uterus)
- Asherman's syndrome (scarring)
- Bicornuate or other shaped uterus
⚠️ False Results Happen
False positive (appears blocked but isn't): Tubal spasm can make a tube look blocked when it's actually open. If one tube shows blocked, your doctor may recommend repeat testing or laparoscopy.
False negative (appears open but isn't): Rare, but possible if there's partial blockage or adhesions outside the tube.
The Post-HSG Fertility Boost
Here's an interesting finding: some studies suggest women have higher pregnancy rates in the 3-6 months following an HSG—particularly when an oil-based contrast dye is used.
Why Might This Happen?
- The dye may flush out minor debris or mucus plugs from the tubes
- It might "open up" tubes with mild obstructions
- The procedure may have an immune or inflammatory effect that aids implantation
- Oil-based dye may have additional benefits (though it's less commonly used due to other considerations)
📊 The Research
A study published in the New England Journal of Medicine found that women who had an HSG with oil-based contrast had higher ongoing pregnancy rates compared to water-based contrast. However, most facilities use water-based dye due to cost and safety considerations.
Regardless of the type of dye used, many doctors consider the HSG both diagnostic and potentially therapeutic—one more reason to get it done if recommended.
How to Prepare
Before Your Appointment
- Schedule correctly: Between day 6-12 of your cycle (after period, before ovulation)
- Avoid unprotected sex: From the start of your period until after the test (must not be pregnant)
- Take ibuprofen: 600-800mg, 30-60 minutes before
- Ask about antibiotics: Some doctors prescribe a prophylactic dose to prevent infection
- Arrange a ride: Not required, but some women prefer not to drive after
- Wear comfortable clothing: You'll undress from the waist down
- Bring a pad: For spotting and discharge afterward
Questions to Ask Your Doctor
- What type of contrast dye will be used?
- Should I take antibiotics before the procedure?
- Can you prescribe something for anxiety if I'm nervous?
- Will I get results immediately or at a follow-up?
- What are the next steps if something abnormal is found?
The Bottom Line
The HSG is a quick, outpatient procedure that provides crucial information about your fallopian tubes and uterus. While it can be uncomfortable, most women find it manageable—especially with ibuprofen beforehand. And the potential fertility boost in the months after is a nice bonus.
If your doctor recommends an HSG, don't put it off. The information you'll gain is worth the brief discomfort. 💚