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Hysterosalpingogram (HSG)

Test Overview

A hysterosalpingogram (HSG) is an X-ray test. It looks at the inside of the uterus and fallopian tubes and the area around them. It may be done if you are having a hard time getting pregnant (infertility).

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 connected, 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 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 affect fertility.

Why It Is Done

A hysterosalpingogram (HSG) is done to:

  • Check for a blocked fallopian tube. The test may be done to look for the cause of infertility. An infection, endometriosis, or a previous ectopic pregnancy may cause severe scarring of the fallopian tubes and block the tubes. This can prevent pregnancy.
  • Find problems in the uterus, such as an abnormal shape or structure. The test can also look for an injury, polyps, fibroids, adhesions, or a foreign object in the uterus. These types of problems may cause painful menstrual periods or repeated miscarriages.
  • See if tubal implants for permanent birth control are blocking the fallopian tubes.
  • See if surgery to reverse a tubal ligation has been successful.

How To Prepare

  • Schedule your test for when you won't be having your period. Your doctor may suggest that the test be done soon after your period ends and before your ovary releases an egg (ovulates). This timing allows your doctor to see the inside of your uterus better. It also avoids doing the test when you could be pregnant.
  • Tell your doctor about any allergies that you have and any medicines you take. Your doctor will tell you if you should stop taking any medicines before the procedure.
  • Your doctor may have you take an over-the-counter pain medicine, such as ibuprofen, about an hour before your test. This can help with cramps and pain during the test.
  • You may want to bring a sanitary pad to wear after the test. That's because some of the dye may leak from your vagina after the test. You may also have some slight bleeding.

How It Is Done

  • You'll be asked to take off your clothes below the waist and drape a gown around your waist.
  • You will need to empty your bladder.
  • You will lie on your back on an exam table with your feet and legs supported by footrests.
  • You may take ibuprofen to help with cramps or pain during the test. You may also get a sedative to help you relax.
  • The doctor may place a tool called a speculum into your vagina. It opens the vagina a little bit so your doctor can see inside.
  • A thin tube is put through the cervix into the uterus. A dye is put through the tube.
  • The X-ray pictures are shown on a video screen during the test.

How long the test takes

The test will take about 15 to 30 minutes.

After the test

  • You will probably be able to go home right away.
  • You can go back to your usual activities right away.
  • Some of the dye may leak out of your vagina.
  • You may have some vaginal bleeding for several days after the test.

How It Feels

You will most likely feel some cramping like menstrual cramps during the test. The amount of pain you have depends on what problems the doctor finds and treats during the test.

Risks

  • There is always a small chance of damage to cells or tissue from being exposed to any radiation. This can include the low levels of radiation used for this test. The chance of damage from the X-rays is generally very low compared with the possible benefits of the test.
  • There is a small chance of a pelvic infection after the test. Your doctor may give you antibiotics if they think you might get a pelvic infection.
  • There is a small chance of damaging or puncturing the uterus or fallopian tubes during the test.
  • There is a small chance of an allergic reaction to the iodine X-ray dye.

Results

Hysterosalpingogram

Normal:

The shape of the uterus and fallopian tubes are normal. The fallopian tubes are not scarred or damaged. The dye flows freely from the uterus and through the fallopian tubes and then spills normally into the belly.

No objects (such as an intrauterine device, or IUD), tumors, or growths are seen in the uterus.

Abnormal:

Fallopian tubes may be scarred, malformed, or blocked so that the dye does not flow through the tubes and spill into the belly. Blocked fallopian tubes may be caused by pelvic inflammatory disease (PID), endometriosis, or a previous ectopic pregnancy.

The dye may leak through the wall of the uterus, showing a tear or hole in the uterus.

The uterus may have an abnormal shape or tissue (called a septum) that divides the uterus.

Growths, such as polyps or fibroids, may be present.

The uterine lining is growing into the muscle of the uterus (adenomyosis).

Uterine adhesions are seen.

Credits

Current as of: February 11, 2021

Author: Healthwise Staff
Medical Review:
Sarah Marshall MD - Family Medicine
Kathleen Romito MD - Family Medicine
Martin J. Gabica MD - Family Medicine
E. Gregory Thompson MD - Internal Medicine
Deborah A. Penava BA, MD, FRCSC, MPH - Obstetrics and Gynecology