A Hysterosalpingogram (HSG) is a procedure performed by using a real-time form of x-ray called fluoroscopy.

An HSG is usually done as part of an infertility evaluation for a woman of childbearing age. The fluoroscopic exam evaluates the shape of the uterus and checks whether the fallopian tubes are open. It's also used to investigate miscarriages due to problems in the uterus.

This exam is minimally invasive. Complications are rare.

The hysterosalpingogram should be performed between the 7th and 10th day of a woman’s menstrual cycle. Day one is the day menstruation begins. Women should also abstain from sexual intercourse from the onset of menstruation until the completion of the exam.

When would I get a Hysterosalpingogram?

The procedure may be recommended by a medical provider to investigate repeated miscarriages that result from congenital or acquired abnormalities of the uterus. A hysterosalpingogram may also determine the presence and severity of these abnormalities, including:

  • tumor masses
  • adhesions
  • uterine fibroids

An HSG is also used to evaluate the openness of the fallopian tubes, and to monitor the effects of tubal surgery, including:

  • blockage of the fallopian tubes due to infection or scarring
  • tubal ligation
  • the closure of the fallopian tubes in a sterilization procedure and a sterilization reversal
  • the re-opening of the fallopian tubes following a sterilization or disease-related blockage.

What Will I Experience?

The radiologist introduces a speculum into the vaginal cavity to visualize the cervix. The cervix is cleaned with a Betadine preparation and then a thin catheter is inserted through the cervical canal into the endometrial cavity.

A small balloon at the end of the catheter is inflated in the endometrial cavity to provide a good seal.

Under fluoroscopic observation, the radiologist injects a small amount of water-soluble contrast (15-20 cc), which fills the endometrial cavity of the uterus and both fallopian tubes. The tubal anatomy and patency can be assessed. Normally, the tubes are slender and spill freely into the peritoneal cavity. Side views of the uterus and tubes may be obtained by having the woman change her position on the table.

Typically, an HSG causes mild or moderate uterine cramping for about five to ten minutes. However, some may experience cramps for several hours. These symptoms can be greatly reduced by taking medications used for menstrual cramps before the procedure or when they occur.

A hysterosalpingogram usually takes less than five minutes to complete.