What Can HSG Reveal About Fertility Issues?

Jun 4, 2024 7:13:00 AM Posted by Iowa Radiology

hysterosalpingogram fertility

Fertility issues, including difficulty conceiving and recurrent pregnancy loss, can have many different causes. Doctors often order a variety of tests in the effort to learn why a patient has trouble getting or staying pregnant. These can include blood tests, genetic screening, biopsy, and imaging tests such as sonohysterography or hysterosalpingography (HSG). In this article, we’ll explore how HSG works, how it can help to identify the cause of fertility issues, and what to expect if you undergo this test.

Why is HSG recommended for fertility evaluation?

Often, issues with achieving or maintaining pregnancy are related to structural anomalies in the uterus or fallopian tubes. The most common structural cause of repeated miscarriage is an intrauterine septum, a band of fibrous tissue that can interfere with embryo implantation and development. Uterine fibroids, polyps, scar tissue, or adhesions as well as fallopian tube blockages can also cause infertility. HSG allows doctors to visualize female reproductive anatomy so they can identify these kinds of problems.


How does HSG work?

HSG uses fluoroscopy, a real-time moving X-ray image, and contrast dye to allow doctors to see uterine structural features and identify blockages in the fallopian tubes. Before the test, the radiologist inserts a speculum into the vagina, cleanses the cervix with antiseptic soap, and passes a thin, flexible catheter through the cervix and into the uterus. The speculum is removed, and contrast dye is introduced through this catheter and flows into the uterus and fallopian tubes. The radiologist then takes X-ray images, which are displayed in real time on a video monitor and stored as digital files. After all needed images are obtained, the catheter is removed.


What should patients expect when undergoing HSG?

HSG is scheduled early in the menstrual cycle, after bleeding has stopped but prior to ovulation. Be sure to tell your doctor if you have symptoms of an STI or pelvic infection, such as pelvic pain, abnormal bleeding or discharge, or fever, and if you’ve ever had an adverse reaction to contrast dye. In some cases, patients are prescribed prophylactic antibiotics. To minimize discomfort, your doctor may recommend that you take an over-the-counter pain medication before the exam. At Iowa Radiology, we recommend 600 mg of ibuprofen 30 minutes before the appointment.

Prior to the exam, the radiologic technologist will take your medical history. Be sure to let them know about any medications that you take, allergies to medications, recent illness, or other medical issues. Scheduling the test early in the menstrual cycle minimizes the chance of pregnancy during the exam; however, it’s important to alert your provider if you have any reason to suspect you may be pregnant. HSG should not be performed on a pregnant patient. In this case, your doctor may choose to order a different imaging exam.

Before beginning the exam, you’ll be given a gown or blanket and asked to disrobe from the waist down. You’ll lie face up on the exam table during the test, which will take approximately 30 minutes. Many patients report cramping during and up to 48 hours after the exam, and spotting over the next couple of days is also common.

After the exam is complete, the radiologist may discuss the results with you as well as send a report to your referring doctor. At Iowa Radiology, our radiologists review results with HSG patients before they leave the clinic and then send a signed report to the referring provider within one business day.


What risks are involved with HSG?

HSG is a minimally invasive exam, and complications are rare, occurring in less than 1% of cases. However, some patients may experience an allergic reaction to the contrast dye, infection, or uterine injury. Be sure to tell your doctor if, following the procedure, you develop a fever or experience heavy bleeding, severe pain, foul-smelling discharge, fainting, or vomiting. Like all X-ray exams, HSG uses ionizing radiation, which is associated with an increased cancer risk. The radiation dose is small, however, and if your doctor recommends an HSG, they have determined that the benefit of an accurate diagnosis outweighs the risks of the test.


How can HSG help?

It can often be difficult to pinpoint the cause of fertility issues. An HSG test allows doctors to determine whether structural abnormalities are interfering with a patient’s ability to become pregnant or carry a pregnancy to term. Depending on what the test reveals, your doctor may be able to recommend ways to overcome limitations to fertility. For example, tubal blockage can be bypassed with in vitro fertilization, or intrauterine insemination could increase the chances of pregnancy when cervical scarring is present.

At Iowa Radiology, we pride ourselves on providing excellent patient care. If you have questions about an HSG or other exam scheduled at one of our clinics, please don’t hesitate to reach out. Learn more about our services, or subscribe to our blog for regular updates on important health topics.



American College of Obstetricians and Gynecologists. Hysterosalpingography (HSG). ACOG.org. Updated December 2021. Reviewed April 2023. Accessed May 14, 2024. https://www.acog.org/womens-health/faqs/hysterosalpingography.

American Society for Reproductive Medicine. Hysterosalpingogram (HSG). Reproductivefacts.org. Revised 2015. Accessed May 14, 2024. https://www.reproductivefacts.org/news-and-publications/fact-sheets-and-infographics/hysterosalpingogram-hsg.

Cleveland Clinic. Septate Uterus. ClevelandClinic.org. Reviewed April 21, 2022. Accessed May 14, 2024. https://my.clevelandclinic.org/health/diseases/22809-septate-uterus.

Radiological Society of North America. Hysterosalpingography. Radiologyinfo.org. Reviewed June 1, 2022. Accessed May 14, 2024. https://www.radiologyinfo.org/en/info/hysterosalp.

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