Hysterosalpingography

Hysterosalpingography (HSG) evaluates the shape of the uterus and checks whether the fallopian tubes are open. It’s also used to investigate miscarriages due to problems in the uterus.

Tell your doctor if you are pregnant and discuss any recent illnesses, medical conditions, allergies, and medications you’re taking. Do not have this procedure if you think you may be pregnant or have an active pelvic infection. Tell your doctor if you are allergic to iodinated contrast material. Tell your doctor if you have a pelvic infection or an untreated sexually transmitted disease (STD). Wear loose, comfortable.

What Is a Hysterosalpingogram?

A hysterosalpingogram (HSG) is a procedure that uses an X-ray to look at your fallopian tubes and uterus. It usually takes less than 5 minutes and you can go home the same day.

Your doctor will probably do the procedure after your period but before you ovulate, since it’s less likely you’ll be pregnant during this time. This will be during the first half of your cycle, probably between days 1 and 14.

How is a hysterosalpingogram done?

A woman is positioned under a fluoroscope (a x-ray imager that can take pictures during the study) on a table. The gynecologist or radiologist then examines the patient’s uterus and places a speculum in her vagina. Her cervix is cleaned, and a device (cannula) is placed into the opening of the cervix. The doctor gently fills the uterus with a liquid containing iodine (a fluid that can be seen by x-ray) through the cannula. The contrast will be seen as white on the image and can show the contour of the uterus as the liquid travels from the cannula, into the uterus, and through the fallopian tubes. As the contrast enters the tubes, it outlines the length of the tubes and spills out their ends if they are open. Abnormalities inside the uterine cavity may also be detected by the doctor observing the x-ray images when the fluid movement is disrupted by the abnormality. The HSG procedure is not designed to evaluate the ovaries or to diagnose endometriosis, nor can it identify fibroids that are outside of the endometrial cavity, either in the muscular part of the uterus, or on the outside of the uterus. Often, side views of the uterus and tubes are obtained by having the woman change her position on the table. After the HSG, a woman can immediately return to normal activities, although some doctors ask that she refrain from intercourse for a few days.

What are some common uses of the procedure?

Doctors primarily use this exam to examine why you might be having difficulty becoming pregnant. The doctor looks at the openness of the fallopian tubes, the shape and structure of the uterus, and any scarring within the uterine or nearby peritoneal (abdominal) cavity.

The exam also evaluates the openness of the fallopian tubes and checks the effects of tubal surgery. These effects include:

• Blockage of the fallopian tubes due to infection or scarring
• Tubal ligation
• Closure of the fallopian tubes in a sterilization procedure and a sterilization reversal
• Re-opening of the fallopian tubes following a sterilization or disease-related blockage

The exam can investigate repeated miscarriages resulting from congenital or acquired uterine problems such as:

• Uterine fibroids
• Endometrial(uterine) polyps
• Adhesions
• Congenital problems (uterine anomalies)
• Tumors

What are the risks and complications of HSG?

HSG is considered a very safe procedure. However, there is a set of recognized complications, some serious, which occur less than 1% of the time.

• Infection – The most common serious problem with HSG is pelvic infection. This usually occurs when a woman has had a previous tubal disease (such as a past infection of chlamydia). In rare cases, the infection can damage the fallopian tubes or make it necessary to remove them. A woman should call her doctor if she experiences increasing pain or a fever within 1-2 days of the HSG.
• Fainting – Rarely, the woman may get light-headed during or shortly after the procedure.
• Radiation Exposure – Radiation exposure from an HSG is very low, less than with a kidney or bowel study. This exposure has not been shown to cause harm, even if a woman conceives later the same month. The HSG should not be done if pregnancy is suspected.
• Iodine Allergy – Rarely, a woman may have an allergy to the iodine contrast used in HSG. A woman should inform her doctor if she is allergic to iodine, intravenous contrast dyes, or seafood. Women who are allergic to iodine should have the HSG procedure performed without an iodine-containing contrast solution. If a woman experiences a rash, itching, or swelling after the procedure, she should contact her doctor.
• Spotting – Spotting sometimes occurs for 1-2 days after HSG. Unless instructed otherwise, a woman should notify her doctor if she experiences heavy bleeding after HSG.

How should I prepare?

Schedule your exam for seven to 10 days after the first day of your menstrual period, but before ovulation. This is the best time for the exam.

Do not have this procedure if you have an active pelvic infection. Tell your doctor and technologist if you have any signs of pelvic infection or an untreated STD. Tell your doctor if you are allergic to iodinated contrast.

Before the procedure, you may take over-the-counter medication to minimize any discomfort. Some doctors prescribe an antibiotic prior to and/or after the procedure.

Tell your doctor about all the medications you take. List any allergies, especially to iodine contrast materials. Tell your doctor about recent illnesses or other medical conditions.

You will need to remove some clothing and wear a gown for the exam. Remove any metal objects or clothing in the pelvis that might interfere with the x-ray images.

Women should always tell their doctor and technologist if they are pregnant. Doctors will not perform many tests during pregnancy to avoid putting the fetus at risk. If an x-ray is necessary, the doctor will take precautions to minimize radiation exposure to the baby. 

What are the benefits?

• This exam is minimally invasive; complications are rare.
• It can offer valuable information on problems getting pregnant or carrying a fetus to term.
• It can potentially open blocked fallopian tubes to allow you to become pregnant in the future.
• No radiation stays in your body after an x-ray exam.
• X-rays usually have no side effects in the typical diagnostic range for this exam.

What is the next step if my tubes are blocked?

If your tubes are blocked, your doctor will likely recommend either a surgical procedure to directly view the tubes (laparoscopy) or to bypass the tubes and perform in vitro fertilization (IVF). This is a complex decision that should be discussed with your doctor. For more information, please see the ASRM booklet Laparoscopy and hysteroscopy and fact sheet What do I need to know about conceiving after tubal surgery?

Are there other options to evaluate tubal patency?

Laparoscopy can also determine if tubes are open, using a procedure called chromopertubation. An alternative procedure to evaluate tubal patency is a sonohysterosalpingogram (SHG). For SHG, a catheter (narrow tube) is placed in the uterus through the vagina and saline and air are injected. In women who have open fallopian tubes, tiny air bubbles may be seen going through the fallopian tubes during the ultrasound. However, this procedure is inferior to HSG for assessment of tubal patency.