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The Dreaded HSG

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HSG: hysterosalpingogram

A Blog by Serena H. Chen, M.D., IRMS Reproductive Medicine at Saint Barnabas, January 18, 2012

HSG — the hysterosalpingogram. This is the infertility test that women dread the most.

Hystero means uterus, salpingo means fallopian tubes and gram means image. This is a test that allows us to see what is going on with your uterus and your tubes. Is your uterus normal? Does it have a funny shape? Are there any polyps or fibroids or scar tissue inside the uterine cavity that could increase your risk for miscarriage? Are your tubes open? If the tubes are blocked, the sperm and egg cannot get together.

The HSG is dreaded because it is a test that causes a lot of intense pelvic cramping. It is the most invasive test that most infertile women will undergo these days. The other tests are a pelvic exam and sonogram, and blood tests. Of course the guy might have a few blood tests, and then he has to masturbate into a cup to produce the sperm sample for analysis. The guys will complain bitterly about this, but they would never be able to tolerate the HSG.

On the other hand, the HSG is much easier than childbirth. Basically, the test is usually done in a radiologic facility. It is done at a specific time in your menstrual cycle — after you finish bleeding and before you ovulate. For many women this will be between days 7 and 10 of their cycle, with day 1 being the first day of bleeding. Scheduling can be tricky if you are irregular, so definitely discuss that with your doctor or nurse if you are confused.

Before the HSG

Some doctors are nice (like me) and give their patients pain medications ahead of time. I usually give some antibiotics (not absolutely necessary, but a nice touch I think), a medicine for cramps such as Advil or Aleve (I give a prescription dose of Aleve), and I like to give a small dose of valium to help you relax a little. The worst part of the HSG is the anticipation of pain — the discomfort is usually not so bad but is definitely made worse by being anxious about the test. There are all kinds of reasons to feel anxious — all your girlfriends’ horror stories (were they trying to be helpful?); just the generalized anxiety of not being able to conceive; and concern about what abnormalities might be found and fear of the unknown. So a little bit of valium or something like that can really make things go much more smoothly. Not every doctor gives valium, but many will be OK with it if you ask. So talk with your doctor about it if you think it may be helpful. If you take the valium, you cannot drive, so you will need a ride, and then afterwards you will just want to go home and nap.

  • OK, so now you have your appointment, you have taken your premedications and you are sitting on the table in a gown in radiology. The doctor will place a speculum in the vagina, and then clean off the cervix with some antiseptic such as betadine. The key here is to RELAX. I know, how can you relax with a big metal clamp in your vagina? Not exactly a relaxing situation. However, if you can fight the urge to tense up and really keep all the muscles in your pelvis and hips relaxed (deep breath), the test will be significantly easier — faster and less uncomfortable. If you are really tense, just let the doctor know. S/he can often talk you through the procedure and help remind you to relax.
  • If you are allergic to iodine, then the doctor will use something other than betadine. Also, if you are allergic to iodine, you may be allergic to the HSG dye as well. Some people with relatively mild allergies can still have the test done, but may need medications prior to the test to prevent an allergic reaction. Usually this is an antihistamine and a corticosteroid like prednisone — both are taken orally. For severe allergies, it may be better to skip this test and do something else. Please ask your doctor about this. For women on Glucophage or metformin, this drug can interact with the dye and should be stopped prior to the HSG or any dye study. The risks with the HSG are low, since the dye is not injected directly into your veins, but we usually stop the metformin just to be safe. We stop the metformin for two days prior to the HSG and then restart it one day after the test is done. Please discuss the details with your doctor since each person’s situation is a little different.
  • Now the speculum is in, the cervix is clean, and the doctor will put a small clamp on the cervix. Actually, I usually give a paracervical block before I do this (again, this is not routine, but is a numbing injection that I like to do because I feel like it makes the procedure easier to tolerate. The downside is that it requires an injection of medication into the cervix, which can cause some mild discomfort — the nerves in the cervix are different than your skin or your mouth, so the discomfort is much less than an injection in those areas). The injection also causes more bleeding and there is a very small chance that you could have a reaction to the medication. I feel like the upsides outweigh the downsides, but not all doctors agree, so not everyone does this. Again, if you want to have this done, talk with your doctor.

During the HSG

So, having done the cervical cleansing, the paracervical block and the clamp on the cervix, I put the cannula (tube) into the cervix. Now the radiology tech will position the fluoroscope over the pelvis so we have a nice clear picture of the pelvis. While the fluoroscope is on, I inject the dye into the cervix, the uterus and out the tubes. We take pictures periodically, so we can show the dye going in. We cannot see your uterus or tubes on the X-ray, but can see the dye, so the dye will show us the inside of the uterus and the tubes. We can tell whether or not the tubes are open by the pattern of the dye. During the dye injection, many women may experience cramping. This is the reason for the Advil or Aleve ahead of time (one to two tablets an hour prior — clear it with your doctor first) and for the paracervical block. The injection and the pictures take only about one minute – really – only about one minute. Labor can last hours, so you can do this!

After the Test

Once the injection is done, the doctor takes out all the instruments and checks the cervix for any excessive bleeding. Remember the small amount of blood will be mixed with the clear dye, so it will seem like you have a watery bloody flow for a day or so. This is normal. The cramping should stop very quickly once the injection is done. One last picture is taken with the instruments out, and then you can get dressed. Remember to wear a pad. Usually we recommend nothing in the vagina or “pelvic rest” for 24 hours — no tampons, intercourse, swimming or baths (showers are OK). This prevents things going into the cervix and potentially causing an infection while the cervix may be a little open.

If your gynecologist or your reproductive endocrinologist is doing the HSG, then s/he may discuss the results with you right there in the room. If the doctor is a radiologist, s/he may just wish you a good day and send the ordering physician a report.

Whew! You are done — you did great.

If looking to book a fertility consultation at a fertility clinic near you, feel free to use our free directory of fertility doctors.

Comments (111)

Hi I had my tubes clamped April 17, 2014. My lmp was 7/14/14. I had a urine and bloob pregnancy test both negative. Now I have to go for that text tomorrow and I'm nervous. I dont know why my period stopped. This is my 3rd month without a period. Idk what could be wrong. Help.

Hi Erica, I don't have any advice to give you but I'm sure you'll find more answers after your procedure. Good luck tomorrow.

I had an HSG two weeks ago, apparently it cleared my blockage. Its now 5 days before my period and I have menstrual cramps and light white discharge. Hoping those are two good signs? Tested and negative today will try again in the next few days. We have been trying for 10+ months

Hi Shan,

Fingers crossed that this is a good sign!

Good luck,
Kim

Hi i had hsg test on 16th july and it shows my left is blocked and right tube is open .do i need surgery.as my husband is in merchant navy and he is away from me 5 months and then 3 months together..pls help i m really worried

Hi Shivani,

If you plan to do IVF, you won't necessarily have to clear the blockage. You could opt for laparoscopic surgery to see if the blockage could be removed and then try to conceive without IVF. Really, it is best for you to consult your doctor and choose the treatment that is best for you.

Good luck!
Kim

Hi all I'm 20 and diagnosed with pcos been with my partner 3 and a half years was reffered to gynae last year as never get a period maybe once a year not on any contraception I was wondering as I'm really scared to get the hystero would I be able to skip it and just go straight for treatment eg clomid are metformin thanks :)

Hi Grace,

It is not recommended to receive treatment without the HSG. If your tubes are blocked, you wouldn't know until you do the HSG. You would then take the Clomid or Metformin unnecessarily as you still would not ovulate past the blockage. I have had the HSG done and while it is painful in the moment, you recover from it quickly and shouldn't have any discomfort later in the day. Definitely consult your doctor about having the HSG done.

Best of luck,
Kim

Dear doctor, My doctor requested HSG X-ray. I have two questions please 1.can I do it on day 15 counted from my first period day knowing that I am sure I am not pregnant 2.do I have to perform any allergy tests before HSG ? Thanks in advance

Gem - if you are still experiencing symptoms I recommend that you call your doctor as soon as possible to determine what could be causing your cramps. Typically, you should only cramp for 2-3 days following the HSG. Consult with your doctor regarding these symptoms.

Hi! I had an HSSG last friday, an until now, I still suffer from cramps. Is it normal? And another thing, During the test, I heard one doctor saying that they only injected 15cc of fluid but another doctor indicated on my result that it was 30cc. My right tube was removed because of ectopic pregnancy... and now, found out that the left one was blocked.

Had a miscarriage and we ve being trying since then, went in for HSG and I heard the doctor say, my uterus is small and there is air loop...Please am worried, what does he mean

Hi Kiki,

You should definitely call your doctor for a better explanation. Remember, you are also an integral part of your treatment so don't be afraid to ask questions!

Best of luck!
Kim

most hysteropingogram test be done with the menstrual cycle of infertility test?.i have these 2 test same month,i have done the first blood test which I am to do the second one towards the end of the month and I have HSG inbetween but I couldn't do the HSG test due to some reasons. Do I start all over and forget the second test of infertility or finish the infertility test then take another appointment for the HSG test

Hello, You question is too specific please contact your doctor. They would be able to better guide you. Thank you, Bhavi

hi sr i had my HSG 13 MAY 2014. COMMENTS AFTER THAT TEST:1. Uterus retroverted with normal enometrial & myometrial echoes. 2.normal in size & morphology. 3.Rt ovary has a follicle measuring 13 mm. 4.Lt ovary has a follicle measuring 11 mm. 5. saline SSg done. 6.Bilateral spillage seen. 7.Post SSG fluid seen in POD. IMP- bilateral patent tubes. and docter gave me CEFIM 400 tablets daily one for five days. my periods next month 8th june can i get the pregnent same month of HSG my periods next month 8th june

When I had a csection I had an allergic reaction to the iodine scrub they used. I am not allergic to shellfish or anything, I think my skin was just sensitive to it. Does this mean I may have an allergic reaction to the dye?

Hi there,

I am not a doctor, so I can't say for sure. I would recommend you discuss this with your doctor before going in for the HSG. Best of luck to you!

Kim

My lmp was (4/10/14) I had an hsg on cd12(4/21/14). I am still having aches more like AF cramps but in my pelvic area. Could I be pregnant?

If you haven't already, I would mention these concerns immediately to the doctor.

My lmp was (4/10/14) I had an hsg on cd12(4/21/14). I am still having aches more like AF cramps but in my pelvic area. Could I be pregnant?

Dr., I had my hsg test on 7th march-2014 and my physician tod me they are both blocked and my uterus very small. can clearing the blockage and can be possible be pregnant?

Hi Lima,

You will most likely need laparoscopic surgery to attempt to clear the blockage, or IVF to bypass the blockages.

Good luck,
Kim

Dr said that my fallopian tube blockage by born. So, what can i do now? Thank's your reply and your suggestion.

Hi there,

If you have blocked fallopian tubes, you can have a laparoscopy to clear the blockage or do IVF to bypass the blockage.

Best,
Kim

Thank's your suggestion (IVF) but my uterus very thin. That why, can i Carrie a baby in my uterus without any problem?

I went for an HSG and the doctor was not able to do the procedure because she said that I have a tight cervix so the tube would not pass through. Many years ago I contracted genital herpes which spread to my cervix (during the first outbreak, which was bad) and my gynaecologist used some kind of acid to "burn" the sores that were on my cervix off. Aside from being excrutiatingly painful, could this procedure have created scar tissue on my cervix which is still there and may be causing this difficulty with the HSG procedure? If so, (1) is there an alternative way to check the tubes, and (2) should I be concerned about any potential scar tissue in the event of a pregnancy?

Hi Kristina,

You should definitely speak with a doctor about this. Are you working with a fertility specialist? Give us a call at 1-855-955-BABY (2229) if you would like to schedule a fertility consultation with a doctor in your area.

Best,
Kim

i went for an hsg and was told that my tubes were not bilaterally demonstrated. pls what does that mean?

Hi there, it sounds like they may not have gotten a clear view of both fallopian tubes. Definitely call your doctor for further explanation.

I had my HSG on the 14th of last month after my period on the day 6 after my period .I had no pain like other woman complain.no bleeding or sporting.d doctor said one tube is blocked and the second one looks like is also blocked but am surprised dat my period is not yet out .Could it be that am pregnant and d HSG cleared d blocked tube

I had an HSG test done one the 10th day of my cycle, after 2days I had intercourse with my husband, but I noticed the semen flows back and wen he penetrate me it burns.

Hi! I am concerned about a possible infection after the HSG test I had 4 days ago... Since the test, I have had UTI symptoms... but when I went into the walk-in over the weekend, they tested my urine and I had no bacteria in my urine... he will have it cultured, but he didn't think it was a bladder infection. I've been on pre-antibiotics since 2 days prior to the test, BUT, because I'm allergic to most anitbiotics, I was prescribed Cedinifir. Do you think that would work for that region to prevent an infection?? I am so worried! I can't understand why I would have this discomfort with no bacteria found, no fever, etc.... Have you ever seen someone having bladder reactions to this test??? I would love to know what your thoughts are!!! THANK YOU SO MUCH!! :-)

Hi,I had my hsg on 19/3/14,it was so painful andand doctor said dat my two fallopian tubes aare blocked dat if I see my menstual flow again,I shuld come for chrotubation or consider having Ivf.But my question is dat could hsg open my fallopian tube because I and my husband cannot afford ivf treatment

I had a HSG done on day 10 of my cycle, an OPK line is getting darker but I have been experiencing thick, sticky, clumps of mucus. Could this be where the HSG has cleared me through as this is not a normal mucus for me at this stage of my cycle…. feeling a little confused

i hv delayed periods after hsg by .my periods are late by three days . my pregnancy test is negative.i hav backach ad severe headach.plz advice

My period has been delayed 8 days now after i had the HSG.I did home pregnancy test but it came out negative.Am feeling pains on my nipples,white/milky vagina discharge,eats more and even at midnight. fell feverish at times.Could it be pregnancy or what?

Pregnancy tests are generally quite accurate. If you have any questions, you should check with doctor who did the HSG. Best, Claire

i had hsg done on 21/2/14 and i can categorically state here that it is not painful at all. you will only feel uneasy because of the external materials been inserted in to you. the first time i went for it, after an instrument has been inserted into my private part, i was discovered that i am still menstruating so, i was re booked for it and the same process was carried out again the second time. once again, it is not painful at all.

I am booked for. Hsg test tomorrow,I've heard so many scary stories on the pain people have during the test,do I take Valium and if yes what dose or do I just take ibuprofen 800mg

I had HSG done the 29th of January, ten days after last period day. My radiologist and doctor told me to TTC immediately. I tried the night of the test and a week later. It is now the 13th of February and currently and since the beginning of the week I have been experiencing really bad cramps, I have bad menstrual cramps as it is, but the placement of the cramps are within the uterus area. Wondering if the procedure can cause menstrual cramps to be worse or implantation cramps to be severe. (My first child I had severe implantation cramps and I went to the hospital) very confused. It's still early for a pregnancy test also

Had hsg test done on 20/01/2014,started having dark brown vagina discharge on 24/01/2014 and has not stopped till now,having pains in my nipple

If you have any concerns about pain, discharge or otherwise, you should see a doctor. Best, Claire

I did HSG last week and i have blocked one tube and other is quite small but not blocked. it is possible to pregnant ?

It is possible to get pregnant if you have one open fallopian tube. You should talk to your doctor about your specific situation. Did you do blood tests as well?

Hi, I have been ttc for 2 years with no luck. :-( I have had an U/S as well as Bloodwork done & my Dr. tells me all is good & the U/S does not show any blockage in my FT. I really would like to put my mind at ease. How can I suggest to my OB/GYN that I want to have an HSG test done?? I really need a little reassurance that my tubes are all clear. PLEASE HELP!!!!

I'm sorry sorry you're having trouble getting pregnant. Here's the thing. It's important that you switch from your ob/gyn to a fertility doctor - a reproductive endocrinologist. You may love your doctor, but he or she is not a specialist who will run all the tests and prescribe the treatments you may need to get pregnant. And once you do, you can go back to your ob/gyn. If you need help finding a fertility doctor please contact our patient care advocates at 855-955-2229 or carecoordinator@fertilityauthority.com.

Hello, thank you for responding so quickly. I should have mentioned that I have also seen a RE specialist last November & she has also informed me that everything looks normal. I have a 6 yr old so I feel as though they aren't being as thorough because I have concieved previously with no problems. My Insurance does not pay very much when it comes to Infertility so I was hoping that the HSG test was something that my OBGYN could request. I'm soo obviously frustrated seeing it's been so long ttc.

I can only imagine how frustrated you are! You ob/gyn should be able to request the HSG test. Have you asked him or her? If not, maybe your former RE can request it? A full workup sounds completely reasonable, given that you've been TTC for awhile, and your last pregnancy was 6 years ago. I hate to see you waste any time :-( Keep us posted. Best, Claire p.s. have you checked out our forums on FertileThoughts.com? A great, supportive community, with lots of women who have been in your situation.

I had my HSG done yesterday, I too was horrified after reading about other women's expieriences. Am glad to report that mine was a breeze, felt a little cramp when dye was injected in but that was all, in out and all done. I only wished radiologist would have given me results all he told me was "your uterus is beautiful" during procdure and when he was done he said "well all I can say is keep trying". Now waiting for my OB/GYN to call me with results. I have 2 daughters (16 &14) from previous realtionship. Been TTC for 10 months now, so far all my test have been normal, yet husbands SA count and motility are low.

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