A hysterosalpingogram (HSG) is an X-ray test that looks at the inside of the uterus and fallopian tubes and the area around them. It often is done for women who are having a hard time becoming pregnant (infertile).
During a hysterosalpingogram, a dye (contrast material) is put through a thin tube that is put through the vagina and into the uterus. Because the uterus and the fallopian tubes are hooked together, the dye will flow into the fallopian tubes. Pictures are taken using a steady beam of X-ray (fluoroscopy) as the dye passes through the uterus and fallopian tubes. The pictures can show problems such as an injury or abnormal structure of the uterus or fallopian tubes, or a blockage that would prevent an egg moving through a fallopian tube to the uterus. A blockage also could prevent sperm from moving into a fallopian tube and joining (fertilizing) an egg. A hysterosalpingogram also may find problems on the inside of the uterus that prevent a fertilized egg from attaching (implanting) to the uterine wall.
A hysterosalpingogram is done to:
Before a hysterosalpingogram, tell your doctor if you:
This test should be done 2 to 5 days after your menstrual period has ended to be sure you are not pregnant. It should also be done before you ovulate the next month (unless you are using contraception) to avoid using X-rays during an early pregnancy. You may want to bring along a sanitary napkin to wear after the test because some leakage of the X-ray dye may occur along with slight bleeding.
You may be asked to sign a consent form that says you understand the risks of the test and agree to have it done.
Talk to your doctor about any concerns you have about the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form (What is a PDF document?).
A hysterosalpingogram usually is done by a radiologist in the X-ray room of a hospital or clinic. A radiology technologist and a nurse may help the doctor. A gynecologist or a doctor who specializes in infertility (reproductive endocrinologist) also may help with the test.
Before the test begins, you may get a sedative or ibuprofen (such as Advil) to help you relax and to relax your uterus so it will not cramp during the test. You will need to take off your clothes below the waist and drape a gown around your waist. You will empty your bladder and then lie on your back on an examination table with your feet raised and supported by stirrups. This allows your doctor to look at your genital area.
Your doctor will put a smooth, curved speculum into your vagina. The speculum gently spreads apart the vaginal walls, allowing him or her to see the inside of the vagina and the cervix. The cervix may be held in place with a clamp called a tenaculum. The cervix is washed with a special soap and a stiff tube (cannula) or a flexible tube (catheter) is put through the cervix into the uterus. The X-ray dye is put through the tube. If the fallopian tubes are open, the dye will flow through them and spill into the belly where it will be absorbed naturally by the body. If a fallopian tube is blocked, the dye will not pass through. The X-ray pictures are shown on a TV monitor during the test. If another view is needed, the examination table may be tilted or you may be asked to change position.
After the test, the cannula or catheter and speculum are removed. This test usually takes 15 to 30 minutes.
You probably will feel some cramping like menstrual cramps during the test. The amount of pain you have depends on what problems the doctor finds and treats during the test.
There is always a small chance of damage to cells or tissue from being exposed to any radiation, including the low levels of radiation used for this test. The chance of damage from the X-rays is generally very low compared with the potential benefits of the test.
There is a small chance of a pelvic infection, endometritis, or salpingitis after the test. The chance may be higher for women who have had pelvic infections before. Your doctor may give you antibiotics if he or she thinks you might develop a pelvic infection.
There is a small chance of damaging or puncturing the uterus or fallopian tubes during the test.
There is a small chance of an allergic reaction to the iodine X-ray dye, especially if you are allergic to any shellfish.
In rare cases, if an oil-based dye is used, the oil can leak into the blood. This can cause blockage of blood flow to a section of the lung (pulmonary embolism). Most hysterosalpingogram tests use water-based dyes.
After the test, some of the dye will leak out of the vagina. You also may have some vaginal bleeding for several days after the test. Call your doctor immediately if you have:
The shape of the uterus and fallopian tubes are normal. The fallopian tubes are not scarred or damaged. The dye flows freely from the uterus, through the fallopian tubes, and spills normally into the belly.
No objects (such as an intrauterine device, or IUD), tumors, or growths are seen in the uterus.
Fallopian tubes may be scarred, malformed, or blocked so that the dye does not flow through the tubes and spill into the belly. Possible causes of blocked fallopian tubes include pelvic inflammatory disease (PID) or endometriosis.
The dye may leak through the wall of the uterus, showing a tear or hole in the uterus.
An abnormal uterus may show tissue (called a septum) that divides the uterus.
Reasons you may not be able to have the test or why the results may not be helpful include:
This test is not done on women who are having their period, are pregnant, or have a pelvic infection.
Other Works Consulted
- Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
- Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
Current as ofMarch 12, 2014
Current as of: March 12, 2014
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