Hysterosalpingogram (HSG) Test

A hysterosalpingogram (HSG) test is a radiological procedure performed using a low-dose X-ray beam called fluoroscopy and iodinated contrast dye. It is an efficient method to evaluate the female reproductive tract. It is usually conducted at the radiology department of a hospital, outpatient radiology facility, and obstetrics and gynecology clinics. The procedure hysterosalpingography is also known as ultrasonography (US). The best time to schedule hysterosalpingography is ten days after the first day of the menstrual cycle, however, before ovulation. The doctor may prescribe an antibiotic and advise taking any over-the-counter (OTC) pain relievers before the procedure.

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    Frequently Asked Questions

    HSG is an important test used as a part of routine infertility checkups to determine the female fertility potential. In detail, this minor procedure is used to:

    1. Examine the inside walls of the uterus to identify the presence of: 
    • fibroids (leiomyomata), or 
    • endometrial polyps, and
    • other growths
    1. Uterine scarring
    2. Analyze whether the inside of the uterus is in normal shape and size
    3. Identify whether the fallopian tubes are partially or completely blocked 
    4. Locate the position of the blockage in fallopian tubes and
    5. Investigate recurrent spontaneous miscarriages

    The HSG test results are analyzed by a radiologist, who is a doctor qualified to supervise and interpret the radiology examinations. The radiologist further sent the signed report to the treating or referring doctor, further discussing the results with the patient. Maybe a follow-up examination is required. During the follow-ups, the physician may evaluate the issue with more views, change in the state of the issue over time, the need for special imaging techniques, and whether the treatment is working.

    The HSG tests are usually conducted to determine the abnormalities or scarring in the uterus or fallopian tubes. To rule out the causes of pregnancy problems or infertility. It is also used a few months after the tubal ligation procedure, which is a sterilization method in females, is also used to evaluate its success rate.

    The procedure takes about 10-30 minutes. During HSG, the iodinated contrast dye is injected through the vagina into the uterus and fallopian tubes. On the X-ray screen, the dye shows up in contrast to the body structures. It outlines the inner shape and size of the uterus and the fallopian tubes.

    HSG can identify the presence of tumors, fibroids, uterine scar tissue, congenital uterine abnormalities, blockage in the fallopian tubes, and polyps.

    If the fallopian tubes are blocked, the doctor may suggest taking another test called laparoscopy, which allows the doctor to directly examine the fallopian tubes. The doctor may also suggest in vitro fertilization (IVF) treatment.

    The treating doctor's opinion should be followed. However, generally, the patient can try to conceive within a few days. Even though the main purpose of HSG is to serve as a diagnostic test, it may boost the chances of getting pregnant to nearly 25% three months after the procedure.

    If the patient is having problems conceiving or has had several recent miscarriages, the HSG test is usually indicated. Nearly 10-15% of miscarriages are associated with defects in the uterine shape. However, HSG is not mandatory before IVF treatment, although it is necessary before intrauterine insemination (IUI), a method of artificial insemination.

    The contrast dye used in HSG flushes out the fallopian tubes and may clear some minor blockages. Thereby, improving the fertility rate, oil-based HSG is more efficient in this aspect than the water-based HSG. However, it cannot open or repair major blockages.

    If the results of the HSG test are normal, it is recommended to wait at least three months before proceeding to laparoscopy due to the potential therapeutic effect of HSG. Even after one year, if pregnancy has not occurred, then it is suggested to go for laparoscopy.

    HSG is regarded as a relatively safe procedure. All procedures have their risks and benefits. There is less than one percent chance of infection, fainting, iodine allergy, radiation exposure, and spotting in the participants.