In this article 5 sections
An HSG, or hysterosalpingogram, is a test that helps a doctor assess the fallopian tubes and the inside of the uterus. It uses a small amount of contrast fluid and X-ray images to show whether fluid can pass through the tubes. It is often recommended during a fertility assessment when knowing whether the tubes are open would affect the next step.
The test answers a specific question rather than giving a complete picture of fertility. It cannot measure egg quality, assess sperm or explain every reason pregnancy has not happened. Its findings are considered alongside your history, ultrasound and other results.
Why the fallopian tubes matter
The fallopian tubes provide the usual meeting place for an egg and sperm. Damage or blockage can make that meeting more difficult, while some types of tubal damage increase the risk of an ectopic pregnancy. Previous pelvic infection, surgery or endometriosis may be relevant, although a blockage can also be found without a clear history.
An HSG can show whether one or both tubes appear open and may identify an unusual outline of the uterine cavity. It does not show every detail of the uterus or how well an open tube functions. Further imaging may be useful when a finding needs clarification.
Preparing for the appointment
The clinic will usually arrange the test after your period and before ovulation, when pregnancy needs to be excluded. Follow its specific instructions about sex, contraception and pregnancy testing before the procedure. If your period is late or you think pregnancy is possible, contact the clinic rather than attending without mentioning it.
Tell the doctor about previous reactions to contrast, pelvic infections and any current pain, fever or unusual discharge. The clinic may recommend infection screening or other precautions according to your history. Ask what pain relief is suitable for you and whether you will need someone to accompany you home.
What happens during the test
A speculum is used to see the cervix, and a thin tube is placed so contrast can enter the uterus. X-ray images are taken as the fluid moves into the tubes. You remain awake, and the team should explain each stage and respond if you are uncomfortable.
Cramping can occur as the fluid enters, and the level of discomfort varies. Some people find it mild, while others experience more marked pain for a short time. Tell the team if pain is severe; you do not need to stay silent because the procedure is expected to be brief.
Understanding the result
If contrast passes through both tubes, the report usually describes them as open or patent. If it does not, the doctor considers where the apparent blockage is and whether spasm or a technical factor could have affected the image. An abnormal result may therefore need confirmation before treatment decisions are made.
One open tube may still allow natural conception, depending on the rest of the assessment. Confirmed blockage of both tubes may lead to discussion of surgery or IVF in suitable circumstances. The best option depends on the location and extent of damage, age and other fertility factors.
After the HSG
Mild cramping and light spotting may occur afterwards, and the clinic should explain what to expect. Follow its instructions about pain relief, intercourse and when you can resume usual activities. Arrange a review so that the report is explained in the context of your treatment plan.
Contact the clinic promptly if you develop fever, worsening abdominal pain, heavy bleeding or foul-smelling discharge. Seek emergency help for breathing difficulty, collapse or signs of a severe allergic reaction. These symptoms are different from the mild, temporary discomfort that can follow an uncomplicated test.