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The Dreaded HSG

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

Can I get pregnant. The same month after HSG

Hi Lara, Yes, many women find that if they had a blockage, it is cleared from the HSG procedure and they get pregnant soon after. Even if you do not have a blockage in your fallopian tubes, you could get pregnant in the month after the HSG. Good luck! Kim

Dr.. I had my hsg test on 7th march and my physician tod me they r both blocked. Could there be any chance of the hsg clearing the blockage and maybe conceiving?

Hi Kathy, There are some women who discover their tubes become clear after the HSG. If not, then a laparoscopy could be performed and the fertility doctor could try to remove the blockage. Give us a call at 1-855-955-BABY (2229) and we can help you connect with a fertility doctor in your area. Best, Kim

hi i had hsg test done yesterday, i had a bad experience with it.. i hyperventilated and my hand seized up and it was very painful. i know something was wrong but the nurses wouldnt tell me and said i would have to wait to here off my doctor she did however give an indication that one tube was blocked so naturally im panicking!! i do know not to have sex wear a tampon or have a bath.. i have been told the dye will flow out and i may bleed for a couple of hours or maybe a day.. as i rang up to make the appointment i was on day 1 of my period so it was day six when i went in.. i am getting alot of brown thick discharge and it feels sticky too. i have also noticed some bright red blood and thick clear mucus in my underwear.. is this normal.. and what should i expect to happen when i next see my doc.. im very concerned and worried that i'll never become a mum..

Hi Amanda, It sounds like the discharge is "old" blood and is most likely normal, but you should call your doctor just to be safe. Best of luck! Kim

Hi I'm hoping you can help. I had the HSG a week ago. My husband has been away for the week so we have only managed to have sex today. Afterwards we noticed quite a lot of bright red blood and I have been bleeding since. When I had my HSG they found it difficult to insert the instrument and took 3 different prople to have a go and about 20 mins later it was finally done. Could you tell me if the bleeding is normal and anything to worry about

Hi Tracy, I understand why you would be concerned. You should definitely call your doctor to let them know about the bleeding. Hopefully it isn't anything serious. Best, Kim

how much can this procedure cost with blood work?

Hi Heather, The cost of HSG varies depending on whether or not you have health insurance, where it is being performed, and your location. You can give us a call at 1-855-955-BABY (2229) if you are looking to connect with a fertility doctor in your area who provides HSG testing. Best, Kim

Hi My fiance and I have been ttc for the past year and a half a family member of mine had this done and became pregnant can you please email me (beautifuldee7@gmail.com) some clinics in Georgia I can get this done at.

sir i want to know that is my tubes are blocked from the beginning i get my periods 7 days before my date and after 10-12 days we had intercourse but not be able to concieve i got 5 years daughter and now we are planning please help me by giving me your precious advice thankyou

After reading all of the posts about how painful an HSG test could be I was TERRIFIED! I mean, I had myself in tears for two days. I called everyone I knew who may have had this test to ask them questions about the process. I looked online for hours trying to learn everything I could about the procedure. Well, I will have you all know that I just got done with my HSG two hours ago and it was FINE! I actually laughed at myself for getting so nervous and worked up. The worse part of the whole thing was wearing a pad afterward. I hate the way they feel. Yuck. At the hospital, when I first saw my doctor I told him that was extremely nervous. He assured me that everything was going to be ok. He was right! It was nothing. I am not going to say it was a pleasant experience, but it definitely wasn't painful. It felt just like a normal pap. Also, I don’t have any cramping afterward. It was an awesome thing to see the fluid flow through my fallopian tubes. The radiologist pointed to the screen and told me what I was seeing and how the dye was flowing freely through my tubes and how everything looked good and normal. So, please, don’t get all worked up about this procedure. Everybody’s bodies are different. Talk to your doctor, let them know that you are nervous. Make sure you take some pain medicine before. I took two extra strength Tylenol and a regular Advil an hour before. Good luck! Everything will be ok!

I has my hag done today I want to know how I know if im ovulating is it best for me try to conceive for my baby now

Hi Keyshona, The best way for you to know if you are ovulating after the HSG is to use Ovulation Prediction Kits (OPKs) available over the counter, or chart your Basal Body Temperature (BBT). Here is a great article for you to reference: http://www.fertilityauthority.com/your-fertility/ovulation/how-do-i-know... Best, Kim

I went to do the HSG yesterday 16/04/2013, but it could not be done and I was told my cervix is too narrow, but it was day 15 of my cycle and I am just wondering if this could be the reason. Pls could this be the reason

Hi Mutiat, You should talk to your fertility doctor about other available tests for checking your fallopian tubes. Best, Kim

i i post a comment or a question on this web ... can i pay for it or jst for free

Hi I had a C-section 21months ago. I have been trying to conceive for some months to no avail. My Gynaecologist prescribed HSG to be done in less than a week's time. Is it possible that the C-section could be the cause of my inability to conceive

Hi Lee, It is not likely that the c-section is preventing you from conceiving. You should consult a fertility doctor to have blood tests and ultrasound performed. Give us a call at 1-855-955-BABY (2229) or email carecoordinator@fertilityauthority.com and we can help you connect with a fertility doctor in your area. Best, Kim

Hi I went today for a hsg she inserted everything then she said to me don't worry it doesn't meant any thing necessarily wrong but it not letting as do the test after inserting due there's suppose to be a balloon on screen but its not appearing its like when I have sex same thing it's so painfull straight away sperm comes out also I had infection so was given that tablet to put in womb I realised after wards it all came out also recently was told my cervix tilted they told me at hsg that I need laparoscopy please can u help I don't gave clue what's happening I already have 2 boys 10&7

HI I AM ARUNA THE HSG TEST VERY PAIN FULL AND AFTER THAT BLEEDING MY DOCTOR ME TAKE SOME MEDICINE

I am a "40-45 cycle girl". My last period was on 2/26/13 and I ovulated on 3/24/13 CD27 (per OPK). Got my period again on 4/9/13 and my HSG was scheduled and done last week on Wednesday 4/17/13 (CD9) I didnt "spot for 1-2 days" I actually been bleeding since then (light flow, like a normal period) Dr said "It's normal" but if I develop a fever, have abdominal pains or soak a pad in a n hour, to call back. HSG determined both tubes open. (I had a Tubal Reversal last year 3/26/12) I've been having pain on my left side (like ovulation pains) for 2 days. I doubt that I can have my period twice in one month BUT should I consider this a period? Or wait till my "expected period date" sometime around 5/24'ish? Does the test make you ovulate earlier or delay ovulation?

I had the test done last friday and let me tell you ladies!! it was super painful , I know for some of you probably wasn't and that's wonderful. Today is sunday and I am still bleeding. The day I had the test done I went right back to work. I'm a room inspector of a very large Hotel,so I walked quite a lot that day, Do you think that is the reason why i am still bleeding? the doctor did not said anything about staying home. I hope some one can help me. Thanks!

Hi Allie, You may have some bleeding after the HSG. If you are concerned, call your fertility doctor to be sure everything is ok. Best, Kim

I did the HSG test today and the pain I felt was so bad that words can't explain. I moved around a lot during the test and the radiologists kept asking me to relax but I just couldn't. I want to ask if I haven't wasted my chances of a good result because I can't imagine repeating the test again

Hi Tem, I am so sorry you experienced such pain with the HSG. Some women do have intense cramping. I think as long as they were able to capture images of the dye flowing through your tubes, then you should be ok. You can probably call them to make sure. Best of luck! Kim

I had a myo op in feb, got a scanty flow march, started ttc after 6wiks of op.. Have not menstrated since april till dis day wit prego blood text neg. Had hsg text ystdy wit a cramp dat lasted 4 abt an hour. My qstn is, ll I hav 2 see my period b4 ttc $ how long will I wait b4 my period comes? Although I'll b pikin up my hsg result 2day but I'm certain it was ok cos d iodine came out of me wen I got hom. Pls has any1 had such xperience? Jst kynna worried

Hello, i had hsg on 16th April, i found it painful when the dye was injected but the pain vanished as soon as the injection stopped. anyway my question is can the hsg delay menstruation?? i'm normally 28 days but this is day 34 and still no sign. i haven't done a pregnancy test, i'm afraid it'll be negative.

Hi Sarah, The HSG shouldn't interfere with your cycle, but definitely contact your doctor to be sure. Best of luck! Kim

Do a pregnancy test...I had my HSG today and the dr told me that for a lot of women, they get pregnant right away after the HSG.

I had an HSG done on day 10 of my cycle. My husband and I had intercourse 24 hours later and now I have light spotting when I wipe, is this normal? My ovulation started the day after the HSG could I be pregnant?

I just had my HSG done on 5/16/13. It went really well for me (sorry to hear about all the pain other women were having). I spotted a little immediately after the test, but was fine the rest of the day. The next day I began bleeding as if it were a light/medium flow period. I've also had some clots. Still bleeding on 5/18/13 and now with mild cramping. I've already had my period this month. Is this normal or should I be concerned? I haven't called my doctor since it is the weekend

While some spotting is normal, you should definitely call your doctor to report bleeding. Best of luck, Kim

I lost one tube b'se of ectopic three years ago i've bn ttc but it is failing, i went for an hsg this month and my tube is open, will the hsg b of help since i have one tube?

Hi Tunah, The HSG is meant to determine if your tubes are open. Since you have the one fallopian tube and you are saying the results show the tube is open, then it should help your fertility doctor in designing a treatment protocol for you. Good luck! Kim

i had my HSG on 19/06/2013 and it was diagonised i had one tube blocked. is it possible to get pregnant following month after the HSG

Hi Lara, If you have one tube open, you may still ovulate from that side. For some women, the HSG helps open up their blocked tube, so that is a possibility as well. Hoping for the best for you! Kim

i had my hsg done 7/5/13 i start cramping on 7/6/13 i had sex in the morning after hsg the cramping started on one side of my stomach what could that be both of ny tubes are ooen... please help

Hi Kim, Cramping is normal after the HSG. You should consult your doctor with any concerns. Best of luck! Kim

the hsg was super painful can i repeat it again to be sure coz i believe there was spasm?

Hi Neema, You should talk to your fertility doctor about repeating the HSG. It is definitely an option as long as your doctor agrees. Best, Kim

I am supposed to have mine HSG done but i am scared because of the cost....if I have insurance what are the cost for it? I know every doctor and state are diffrent. Thank You

I had the HSG done two weeks ago, it wasn't too painful, the results were clear and there was no blood after. Two days ago I noticed blood or spotting, not red but pinkish brown which has never happened before and I'm not due for my period for another week. Is this normal?

Hi Hannah, You should check with your doctor to make sure the bleeding is normal. It might be an early onset of your period, but definitely call to confirm. Best, Kim

I just had my hsg test done yesterday, it surprisingly went well. I felt more of a pressure like feeling all day and when I had to use the restroom. Come to find out everything is fine and none of my tubes are blocked. Is it likely I could get pregnant after this test?

Hi Kena, Many women do become pregnant after the HSG, but it depends on your diagnosis. Definitely consult your doctor to know your odds of conceiving! Best, Kim

hi, i had my hcg done on the 23 /08/13. results indicated i had localisation of spillage due to adhession. m 2 day late. can i be pregnant

I had my hsg on 21 August, AF due 31st came on the 30th, day 1 was light day 2 I woke up flooded tampons lasting 5-10 minutes, I had to sit on the toilet, whilst it was dripping like a ticking clock, passing huge clots, that lasted about 1.5 hours, then it almost came to a stop, is this normal

If you are concerned about abnormal bleeding, you should see a doctor right away.

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