Hysterosalpingogram
A hysterosalpingogram (HSG) is an X-ray test. It looks at the inside of the uterus camera.gif and fallopian tubes and the area around them. It often is done for women who are having a hard time getting pregnant (infertile).
During the test, a dye (contrast material) is put through a thin tube. That tube is put through the vagina and into the uterus. Because the uterus and the fallopian tubes are hooked together, the dye will flow into the fallopian tubes. Pictures are taken using a steady beam of X-ray (fluoroscopy) as the dye passes through the uterus and fallopian tubes. The pictures can show problems such as an injury or abnormal structure of the uterus or fallopian tubes. They can also show a blockage that would prevent an egg from moving through a fallopian tube to the uterus. A blockage also could prevent sperm from moving into a fallopian tube and joining (fertilizing) an egg. The test also may find problems on the inside of the uterus that prevent a fertilized egg from attaching (implanting) to the uterine wall.
Your provider will plan your procedure so that it happens during the first two weeks of your menstrual cycle — after your last period has ended but before you ovulate. This timing reduces the chance that you’ll be pregnant or menstruating during the procedure.
You shouldn’t get an HSG if you’re pregnant or if you have a pelvic infection.
An HSG can help your provider see if your fallopian tubes are open or blocked. This information can help your provider diagnose fertility problems. Open fallopian tubes allow a clear path for conception to occur. Sperm travel through fallopian tubes to fertilize an egg. The fertilized egg (embryo) travels through your fallopian tubes to your uterus, where it can grow and develop into a healthy fetus.
Blocked fallopian tubes prevent these processes from happening and are a leading cause of infertility.
An HSG can also allow your provider to:
- Check the success of a tubal ligation or tubal reversal: An HSG can show whether a tubal ligation procedure successfully closed your fallopian tubes so that you can’t get pregnant. It can also show if the procedure was successfully reversed.
- Plan for further imaging: An HSG can show irregularities in your uterus (fibroids, abnormal shape) that your provider can use to plan for further imaging, including sonohysterography and hysteroscopy. A sonohysterography can further define the results of an HSG and provide a final diagnosis, while a hysteroscopy can treat specific conditions involving your uterus.
Nowadays, hysterosalpingogram is used only to determine if the tubes are open, as other less complicated and more complete tests can be done to study the uterus.
Your gynecologist, a radiologist, or a reproductive endocrinologist can perform an HSG. Afterward, a radiologist will assess your X-rays and write a report communicating findings to your physician.
With an HSG, a dye fills your uterine cavity and fallopian tubes. The dye creates an outline of your uterus and fallopian tubes that stands out on an X-ray. If the X-ray shows the dye flowing through your fallopian tubes, they’re open. If the dye meets a barrier that prevents the flow, your fallopian tubes are blocked.
Your provider will review your medical history to ensure you’re a good candidate for HSG. If you’re tracking your luteinizing hormone (LH) levels, your provider may review the results of your LH test to be sure that you’re not pregnant. Your provider will check whether you’re allergic to any parts of the dye solution used during the HSG.
Your provider will discuss any risks with you. The risks are minimal with HSG.
Follow your provider’s instructions to prepare for your procedure. Your provider may recommend that you:
- Take over-the-counter medicine for pain an hour before your procedure.
- Take antibiotics beforehand to prevent infection.
Arrange for someone to drive you home after your HSG. You may feel up to driving yourself, or you may experience cramping that makes driving difficult. It’s a good idea to have someone to assist, just in case.
An HSG takes less than five minutes. You’ll be able to go home the same day of your procedure.
During the procedure, your provider will inject a solution with dye into your uterus and fallopian tubes while an X-ray records images.
Preparing for the dye injection
- You’ll lie on a table, with your knees bent and legs open, as if you were having a pelvic exam. The machine taking the x-ray (fluoroscopy machine) will be positioned above the table.
- Your provider will insert a tool called a speculum into your vagina that will widen it, allowing your provider to access your cervix.
- Your provider will clean your cervix and insert a small catheter in the cervical canal and into your uterus. The catheter may be a thin plastic tube called a cannula. Or, your provider may use a thin plastic tube with a balloon at the end. The balloon inflates once it’s inside your body to hold the tube in place for the dye injection.
Injecting the dye
- Your provider will remove the speculum, and you will then be asked to straighten your legs flat on the table.
- Your provider will slowly pump the dye solution into your uterus while the radiology technician operates the fluoroscopy machine over your pelvic area. You may feel cramping at this point. If your fallopian tubes are blocked, they may slightly stretch from the pressure.
- Your provider may place you in different positions to assess how the solution moves through your fallopian tubes.
- If your fallopian tubes are open, the dye should spill out and be seen to spread close to your bowel (it will then get absorbed by your body without consequences). If they are blocked, the dye won’t spill out.
After enough X-ray pictures have been taken, your provider will remove the cannula or plastic tube with the balloon from your body, without reinserting the speculum.
Mild pain or discomfort is common with an HSG, both during the procedure and afterward. You may feel cramping when your provider inserts the dye solution into your uterus. You may experience more cramping when your tubes are blocked.
The cramping may last anywhere from five minutes after your procedure to a few hours. It may feel mild or moderate. Taking over-the-counter NSAIDs can help ease your cramps.
After the test, you may need to wear a pad to catch the extra dye solution as it leaks from your vagina. Often, the discharge is sticky and contains small amounts of blood. You may also notice side effects, such as:
- Cramps.
- Dizziness.
- An upset stomach or nausea.
- A small amount of vaginal bleeding for a day or two.
Depending on your comfort, you may resume your everyday activities immediately after your HSG.
An HSG uses radiation to record X-ray pictures, but the amount of radiation is minimal. An HSG isn’t considered risky. Rare complications may include:
- Infection.
- Injury to your uterus.
- An allergic reaction to the dye solution.