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What is Hysterosalpingography (HSG) test? 

Hysterosalpingography (HSG), is a fluoroscopy procedure that outlines the shape of the uterus (womb) and helps checks for any blockage in the fallopian tubes. Fallopian tubes are a pair of slender tubes that provide a path for eggs to travel from the ovaries to the uterus.

Fluoroscopy is a type of X-ray procedure in which a contrast dye is injected into the person’s body and then they are exposed to x-ray radiation to look at their internal organs. When they pass through the person’s body, some of the radiation is absorbed by the body organs and the rest is captured by a detecting device placed on the other side of the patient. Thick tissues like bones absorb more radiation and appear greyish while tissues like lungs appear black. A contrast dye helps better view any abnormalities in the tissue structure. Fluoroscopy gives moving pictures, rather than the stills provided by standard x-ray tests.  

Also known as uterosalpingography, HSG test is commonly performed to find the cause of infertility. Infertility is being unable to get pregnant despite having regular unprotected sex for one year.

Read more: IVF treatment

  1. Who cannot have a Hysterosalpingography (HSG) test?
  2. Why is a hysterosalpingography (HSG) test done?
  3. How do you prepare for an Hysterosalpingography (HSG) test?
  4. How is an hysterosalpingography (HSG) test performed?
  5. How will the hysterosalpingography (HSG) test feel like?
  6. What do the results of the hysterosalpingography (HSG) test mean?
  7. What are the risks and benefits of a hysterosalpingography (HSG) test?
  8. What happens after the hysterosalpingography (HSG) test?
  9. What are the other tests that can be done with a hysterosalpingography (HSG) test?
Doctors for HSG Test

The HSG test cannot be performed if you:

Your healthcare provider may order this test in the following conditions:

  • To check for problems in your uterus
  • To detect blockage in your fallopian tubes
  • As a part of infertility tests Read more: Female fertility panel test
  • To detect the cause of recurrent miscarriages
  • To check the effects of a fallopian tube surgery, such as:
    • Infection or scarring
    • Closure of tubes in a sterilisation procedure (done to prevent pregnancy) Read more: Salpingectomy procedure
    • Reopening of tubes after sterilisation or disease-related blockage

An HSG test is a simple, inexpensive and non-invasive method with high specificity. In case an HSG test is scheduled, a gynaecologist advises to refrain from sexual intercourse from the onset of menstrual cycle to the day of HSG test.

Prior to the test, a nonsteroidal anti-inflammatory drug is given to manage uterine cramps experienced during the test. 

Antibiotics, such as doxycycline may be prescribed a few days prior to the test to rule out any infection. It is better to carry out this test in the first half of the menstrual cycle.

You do not need to fast for an HSG test. But your doctor will ask you to keep your bladder full.

Your healthcare provider will give a consent form to sign. They will ask you to change into a hospital gown and remove all ornaments and metal objects before the test.

HSG test is performed by an experienced radiologist who also interprets the findings of this test. For the test: 

  • You will be asked to is asked to lie down on the X-ray table with your feet set on a stirrup.
  • The doctor will insert a speculum inside your vagina.
  • He/she will check and clean your cervix with an antiseptic solution.
  • Then, the doctor will insert a thin tube called a catheter through your cervix. The speculum will be removed at this point.
  • The doctor will put in contrast material through the catheter which will flow through the catheter to fill your uterus and fallopian tubes.
  • Once the dye is filled in, you will be carefully positioned under the fluoroscopy camera, and the images will be captured. 
  • After the test, the doctor will remove the catheter and assist you off the table.

The catheter and dye may cause some irritation or discomfort in your abdomen and cervix area. You may also have vaginal spotting or mild bleeding for a few days. It is nothing to worry about.

The HSG test can detect the following conditions:

  • Birth defects in the uterus or fallopian tubes
  • Uterine polyps (soft growths attached to the inner lining of the uterus) or polyps in the fallopian tubes
  • Presence of foreign bodies in the uterus or fallopian tube
  • Scar tissue (adhesions) in the uterus or fallopian tubes
  • Uterine fibroids (tumours that grow from the muscle walls of the uterus)
  • Blockage in fallopian tubes
  • Tumours in the uterus or fallopian tubes

 The benefits of the HSG test are:

  • X-rays cause no side effects when used in the diagnostic range.
  • It is a minimally invasive procedure which means, it does not require any major incisions and has less risk of complications.

The risks associated with the HSG test are:

  • Allergic reaction to the contrast dye
  • Infections in the uterus (endometritis) and fallopian tubes (salpingitis)
  • Perforation of (piercing a hole through) the uterus

You may feel a little shaky after the test. The doctor may ask you to relax for the rest of the day. You will be advised to avoid sexual intercourse and swimming in public places for a few days. The doctor may give you a painkiller in case you have any pain. Inform your doctor if you have any symptoms of infection, such as:

  • Pain that is severe or persistent
  • Foul-smelling vaginal discharge 
  • Fever

The doctor may order the following tests along with the HSG test:

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.

Dr. Vrinda Khemani

Dr. Vrinda Khemani

Obstetrics & Gynaecology
6 Years of Experience

Dr Megha Apsingekar

Dr Megha Apsingekar

Obstetrics & Gynaecology
4 Years of Experience

Dr. Dyuti Navadia

Dr. Dyuti Navadia

Obstetrics & Gynaecology
1 Years of Experience

Dr. Sheetal Aggarwal

Dr. Sheetal Aggarwal

Obstetrics & Gynaecology
15 Years of Experience

References

  1. Drew P. Oxford Handbook of clinical and laboratory investigation, 4th Ed 2018. Oxford University Press. Chapter 13 Radiology p 818.
  2. UCSF Department of Radiology and Biomedical Imaging: University of California [internet]; Prepare for a Hysterosalpingogram (HSG) Exam
  3. UCSF health: University of California [internet]; Hysterosalpingography
  4. Birmingham Women's and Children's National Health Service Foundation Trust. Information leaflet; Hysterosalpingogram (HSG)
  5. American College of Obstetricians and Gynecologists. [internet], FAQ, Special Procedures, Bethesda (MD); Hysterosalpingography
  6. Al-Jaroudi D, Abdullah AA, Alshamry WS, Alrashidi AS, and Bahnassy AA. Hysterosalpingogram findings among subfertile women undergoing assisted reproductive technology. International Journal of Women’s Health. 2018;10:432-438.
  7. Grau EG, Vizcaíno MCA, Oliveira M, Juanós JL, Collado RC, and Estevez YC. The Value of Hysterosalpingography following Medical Treatment with Methotrexate for Ectopic Pregnancy. Obstetrics and Gynecology International Volume 2011, Article ID 547946, 5 pages
  8. Onwuchekwa CR, Oriji VK. Hysterosalpingographic (HSG) Pattern of Infertility in Women of Reproductive Age.. J Hum Reprod Sci. 2017 Jul-Sep;10(3):178-184. doi: 10.4103/jhrs.JHRS_121_16. PMID: 29142446
  9. H Burks. Management of unilateral tubal block at hysterosalpingogram. International Journal of Obstetrics and Gynecology. Published Online 5 November 2018.
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