How Hysterosalpingography Works & What to Expect

If you’ve struggled to become pregnant or carry a pregnancy to term, your doctor may order a hysterosalpingogram (HSG) to investigate the cause. This imaging test allows a radiologist to visualize the uterus and fallopian tubes to detect blockages and other abnormalities that can interfere with pregnancy. In this article, we’ll discuss how an HSG is performed, how it can help identify the source of female fertility issues, and what to expect if you undergo the exam.

What is a hysterosalpingogram?

An HSG is a fluoroscopy procedure that allows doctors to visualize internal female reproductive anatomy. Fluoroscopy is a moving X-ray image. During an HSG, contrast dye is introduced into the uterus via a narrow tube that is inserted into the vagina and through the cervix. The moving X-ray image shows the path of the dye as it fills the uterine cavity and passes into the fallopian tubes. By watching how the dye moves in the body, a radiologist can assess the shape of the cervix and uterus and detect blockages in the fallopian tubes.

What can an HSG tell me about infertility issues?

For sustainable pregnancy to occur, the egg must travel from the ovary through the fallopian tube, come into contact with sperm there, and become fertilized. Then, it must continue its journey to the uterus, implant, and grow. Abnormalities in the cervix, uterus, or fallopian tubes can interfere with this process. They could prevent sperm from reaching the uterus or fallopian tubes, prevent the passage of the egg into the uterus, or interfere with implantation and growth. An HSG allows doctors to evaluate the cervix, uterus, and fallopian tubes to determine whether anomalies exist and, if so, how they may be contributing to fertility problems.

How do HSG results guide fertility treatment?

By highlighting barriers to fertility, an HSG can provide doctors with the information they need to select the most promising treatment. For example, if scar tissue on the cervix makes it difficult for sperm to pass through to the uterus, then intrauterine insemination (IUI) could bypass this issue and increase the odds of achieving pregnancy. On the other hand, if a blockage in the fallopian tubes is preventing passage of the egg, they may recommend in vitro fertilization (IVF), in which eggs are fertilized outside the body and then transferred to the uterus.

Are there alternatives to HSG?

While HSG is commonly used to visualize the fallopian tubes, it is not the only test capable of doing so.

Sonohysterography

A sonohysterogram is similar to an HSG, but it uses ultrasound instead of X-ray and, typically, saline solution instead of contrast dye. The exam is frequently used to identify uterine abnormalities like polyps, tumors, and scarring. While sonohysterography allows some visualization of the fallopian tubes, its usefulness in assessing their patency (the openness of the passageway) is limited. As a result, HSG is commonly ordered to investigate suspected issues with the fallopian tubes.

Laparoscopy

Laparoscopy is a minimally invasive surgical procedure that’s often used to diagnose fertility issues such as endometriosis, fibroids, scar tissue, and fallopian tube blockage. Laparoscopy is considered the gold standard for evaluating the causes of infertility. However, because it is a surgical procedure performed under anesthesia, it carries greater risk of complications and is more costly to perform than HSG. As a result, HSG is often preferred as a first-line diagnostic tool when tubal blockage is suspected.

What should I expect if I undergo HSG?

HSG will be scheduled to take place between six and twelve days following the first day of the menstrual flow. Before the exam, you will be asked to change into a gown and empty your bladder. During the procedure, the radiologist will insert a speculum, cleanse the cervix with antiseptic soap, and insert a flexible catheter. They will then inject dye into the catheter, allowing it to pass through the uterus and into the fallopian tubes. The radiologist will monitor the movement of the dye using fluoroscopy and may ask you to move positions during this time. After collecting sufficient images, the radiologist will remove the catheter.

After the procedure, the radiologist will discuss the results with you and send a report to your referring physician within one business day. You may experience cramping and/or spotting for up to 48 hours. To minimize pain, you may be advised to take 600 mg of ibuprofen 30 minutes before the exam begins.

At Iowa Radiology, patient comfort is a priority. Our radiologists take measures to minimize pain during HSG, using specialized catheters and attention to patient positioning as well as regulating the speed with which contrast is injected. Many of our patients report that the procedure was less painful than they had anticipated.

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Resources

Cleveland Clinic. What’s the Difference Between IVF and IUI? Health.ClevelandClinic.org. Published January 30, 2022. Accessed February 13, 2024. https://health.clevelandclinic.org/iui-vs-ivf.

Radiological Society of North Americal. Hysterosalpingography. Reviewed June 1, 2022. Accessed February 13, 2024. https://www.radiologyinfo.org/en/info/hysterosalp.

Radiological Society of North America. Sonohysterography. Reviewed December 6, 2022. Accessed February 13, 2024. https://www.radiologyinfo.org/en/info/hysterosono.

Tan J, Deng M, Xia M, et al. Comparison of Hysterosalpingography With Laparoscopy in the Diagnosis of Tubal Factor of Female Infertility. Front Med. 2021;8. https://dx.doi.org/10.3389/fmed.2021.720401.