Hysterosalpingogram or HSG is an important test used to determine the female fertility potential. This test is a radiological process or procedure that is carried out in an outpatient radiology facility or hospital’s radiology department. A hysterosalpingogram test includes an X-ray of the fallopian tubes and uterus, allowing visualization of the inside of uterus and fallopian tubes. The picture reveals any abnormalities in the uterus as well as other tubal defects or problems such as blockage and dilation (hydrosalpinx). If a sterilization reversal is well planned, the blocked tubal areas can be seen and this helps greatly in planning the reconstructive procedures.

Why Is the HSG Test Done?

This test can be ordered or done as part of the infertility work up. It’s commonly done when a woman has experienced a few miscarriages before, since recurrent miscarriages can be caused by abnormal uterine shape. The test checks whether the fallopian tubes are blocked or open, when blocked, the woman cannot get pregnant because the egg can’t meet the sperm. The test also checks whether the shape of the uterus is normal. About 10% to 15% of women who have recurrent pregnancy loss will usually have an abnormally shaped uterus. Some of the uterine problems can be treated with surgery.

How to Prepare for the HSG Test

Before you undertake hysterosalpingogram, it’s important to tell your doctor if:

  • You are pregnant or you might be pregnant.
  • Currently you have pelvic infection or sexually transmitted infections.
  • You are allergic in any way to the iodine dye that is used or any other substance that contains iodine. In addition, you can tell your doctor if you have asthma, allergies to any medicine or if you have had a severe or serious allergic reaction to anything such as a bee sting.
  • You have any bleeding problems or you are currently taking any blood thinning medicines such as warfarin or aspirin.
  • You have a history of diabetes or kidney problems, especially if you are taking metformin, Glucophageto control diabetes. The iodine dye which is used during this test has a potential to cause kidney damage to people with poor kidney function. In addition, if you have a history of kidney problems, the doctor may have to do some blood tests usually blood urea nitrogen before performing the actual test; this is meant to check if your kidneys are well functional.

The hysterosalpingogram test should be done about 5 days after your menstruation cycle has ended to ensure that you are not pregnant. It also needs to be done before ovulation to prevent using X-rays during early pregnancy.

Before the test you may be required to sign a consent form just to ascertain that you understand the risks that may come with this procedure. You can talk or consult your doctor in case you have any concerns regarding having the test done, as well as the risks and the procedures used. You can fill out the medical test information form which can help you understand the importance of the test.

Important notes: Who should not have the HSG test?

There could be reasons that may deter you from having the test and also why the results may not be helpful, they include:

  • If your fallopian tube has spasm, which can make a fallopian tube to look like it’s blocked.
  • If your medical doctor is not able to put a catheter into your uterus.

Most importantly, this test is not performed on women who are pregnant, or have a pelvic infection as well as those women who have a period.

How Is the HSG Test Performed?

Before the doctor begins the test, you may get an ibuprofenor a sedative to help you relax as well as relax your uterus muscles to prevent cramping during the test. You will be asked to take off your clothes below the waist, and then you will drape a gown around your waist. You will also need to empty your bladder. The test will only take about five minutes apart from the time you may have to fill the forms and register at the facility. This is how the test is performed:

  • The woman will be required to lie down on her back bringing her feet up in a “frog leg” position.
  • The doctor then places a speculum in the vagina to visualize the cervix.
  • A soft and thin catheter is then placed through the cervical opening into the uterine cavity. The doctor can also use a tenaculum which is placed on the cervix and then a narrow metal cannula inserted through the cervical opening.
  • Contrast is then injected slowly through the catheter or cannula into the uterine cavity. As the uterine cavity is filing, an X-ray picture is taken and then additional contrast is injected so that the tubes fills and begins to spill into the abdominal cavity. More pictures are taken as this goes on.
  • As both tubes spill, the woman may be asked to roll over on one side so that an oblique X-ray image can be taken to delineate the anatomy further.
  • After this, the procedure is complete and the instruments are then removed from the vagina and the cervix.

The woman will remain on the table for a while so as to recover from the cramping that is caused by the injection of the contrast. The results and images will immediately be available and reviewed several times with the woman.

Here is an animation video to show you how the HSG test is performed:

Will the HSG Test Be Painful?

Many women may wonder if this test causes any pain, the truth is that you may or may not experience pain, and here are some circumstances where you can experience some pain:

  • Some women will experience cramping and a few of them will report severe cramping while others may just have moderate or very mild cramping.
  • The insertion of dye injecting device may just remind you of how Pap smear is done, if you tend to feel pain often, during pelvic examinations, you are more likely to experience pain.
  • When the dye is injected, you will feel some strange warming sensation.
  • Pain may also be felt if one of the fallopian tubes is blocked.
  • Fear and anxiety about the test, can be a factor that may increase your perception of pain.

It’s normal to feel nervous about the test, but you need to relax before the test and a relaxed breathing technique can be of great help. When the pain escalates and it seems not normal after the test, be sure to contact the doctor.

What Risks Will the HSG Test Bring About?

There will always be a very small chance that this test can damage your cells due to tissue exposure to radiation. The potential benefits of the test are greater as compared to chances of damage from the x-rays. There is usually a small chance of pelvic infection, salpingitis and endometritis after the test. However, the chances may be high in women with a history of pelvic infection.

During the test, there is small chance that the fallopian tube tissues and the uterine tissues may get damaged and also very rare chance for allergic reactions. Oil based dyes are not used due to their dangerous nature; thus, most of the tests will rely on the water based dyes. After the test, some of the dye may leak out of the vagina, and you may have some vaginal bleeding for a couple of days after the test. Contact your doctor immediately if you experience the following:

  • Heavy vaginal bleeding
  • Severe belly pain
  • A fever
  • Vaginal bleeding lasting for more than 3 days.