What is an HSG Test?

If your doctor or fertility specialist has recommended an HSG test, you may be wondering just what those three letters stand for, and what’s involved. HSG tests — short for a hysterosalpingogram test — are a special form of x-rays taken of the fallopian tubes and uterus. These examinations allow your fertility specialist to determine internal health conditions that may be causing infertility or difficulty with pregnancy.

HSG tests are often one of the first tools fertility doctors use to pinpoint the cause of infertility or in situations when multiple miscarriages have occurred.

How HSG Tests Are Performed

HSG tests are considered outpatient procedures that may happen at your OBGYN or fertility specialist’s office. Because the test requires x-rays, it is normally performed between day 5 and 12 of your fertility cycle, after your period has ended but before you ovulate.

This timing is important because it helps ensure that you are not pregnant (although the amount of radiation produced in the x-ray process is minimal, it is still important to ensure that you are not pregnant when an HSG is performed).

During the test, your doctor will insert a speculum and do a pelvic exam before beginning (similar to an annual pap smear and exam). Next, your cervix will be swabbed clean in preparation, which helps reduce the already-low chance of any infection.

With the speculum still in place, a plastic catheter will be inserted into your service, and an iodine-based dye will be injected through the catheter. This dye moves from the cervix to your uterus, fallopian tubes, and into the pelvic cavity, allowing doctors to identify if there are any blockages on the dye’s route. This dye is also helpful at allowing fertility specialists to determine if your uterus has a normal shape.

An x-ray machine will be positioned over your abdomen so that when the dye begins to flow through your fallopian tubes, doctors will be able to create images of your reproductive system.

HSG tests normally take between 30 and 45 minutes, and during this time, your doctor may have you move into different positions so that the x-ray machine can get the best angle and views of your fallopian tubes and uterus. After all the x-ray images have been taken, the cervical catheter will be removed, and you’ll be able to get dressed.

In most cases, HSG tests are painless or may cause slight discomfort (such as cramping), though many women who undergo the test do not experience any pain. Afterward, you may have some slight cramping or light bleeding, similar to how your body responds to an annual pap smear.

Understanding HSG Test Results

After the HSG test is performed, a radiologist will examine the x-rays to determine any possible issues that could be affecting your ability to get pregnant; these results will then be sent to your doctor. When evaluating the results of your HSG test, a doctor or fertility specialist will be looking at two main factors:

  • Whether or not your fallopian tubes are open or blocked, which could be causing infertility by preventing the release of eggs
  • Whether your uterus has a normal shape; abnormally shaped uteruses can cause some fertility issues such as miscarriage

An HSG test can only provide insight to these two common factors of infertility, so understand that if you receive a satisfactory result from the HSG exam, it’s likely that difficulty getting pregnant is caused by another issue, such as a hormone imbalance or delayed ovulation.

If you receive an abnormal or unsatisfactory result from an HSG exam, it could be because your uterus is abnormally shaped, or because the dye used did not flow entirely through your fallopian tubes — indicating a blockage that could be preventing eggs from traveling through the fallopian tubes for possible fertilization. In these situations, your fertility specialist may order a follow-up HSG, or may consider ordering other tests to further examine the issue.

It’s also important to know HSG tests only identify problems, not the cause. If you receive an abnormal HSG result because of a blocked tube or unusually shaped uterus, this test can only highlight the issue, and will not be able to deduce why it has occurred.

How To Prepare For An HSG Test

Like many doctor’s visits, an HSG test can seem scary. You can practice breathing to help reduce anxiety, or ask your healthcare provider to walk you through the steps to relieve any fear of the procedure. Some women benefit from taking an over-the-counter pain reliever, such as acetaminophen or ibuprofen, about an hour before the procedure. You can also wear loose clothing to help increase your comfort following an HSG test, and should consider packing a pad or pantiliner in your bag in case you have some slight spotting or bleeding afterward. Any cramping you may feel afterward can be treated with a pain reliever, and should pass within a day or two.