What to Expect During a Hysterosalpingogram

If you've been struggling to conceive for several months, your OB-GYN may refer you to a fertility specialist. The first step either your OB-GYN or the fertility specialist will take is to prescribe a battery of tests, including a hysterosalpingogram (HSG).

An HSG is a quick, outpatient test. A special dye is injected through your cervix and enters your uterine cavity, spilling into your fallopian tubes. An X-ray is taken in time with this process, documenting what the outline of your uterus and fallopian tubes look like. It's a noninvasive procedure with no major side effects that provides vital information for your fertility journey moving forward.

Why the test is prescribed

The test is prescribed to evaluate whether the tubes are open or not, said Rebecca Pierson, M.D., an Indianapolis-based reproductive endocrinologist and fertility specialist. She explained there are many reasons why a patient's fallopian tubes may be blocked, including a history of gonorrhea, chlamydia or pelvic inflammatory disease (PID).

The HSG test can also be used to detect abnormalities within the uterine cavity, added Tara Scott, M.D., medical director of integrative medicine at Summa Health System in Akron, Ohio. "Abnormalities here could be a uterine septum, uterine didelphys [two uteruses], bicornuate uterus [heart-shaped] or a uterine fibroid, polyp or mass."

While not all of these conditions complicate conception, it's still important information to know about your reproductive health.

What to expect during the procedure

Pierson said an HSG is scheduled around days five through nine of your menstrual cycle, because you're unlikely to be on your period but you also haven't ovulated yet. By doing the HSG before the most common days for ovulation, it's also guaranteed you aren't pregnant at the time of the test.

The test takes place in a radiology room to accommodate the X-ray machine. You lie on the table like you would for a pelvic exam, with your knees bent and legs open. The healthcare provider performing the test uses a speculum to widen your vagina and allow access to your cervix. A small catheter is inserted past the cervical canal and into your uterus.

Once the catheter is properly placed, the speculum is removed, and you can straighten your legs on the table. The provider slowly allows the dye to fill your uterus as the radiology technician takes images of your pelvis, capturing the way the dye travels throughout your uterus and fallopian tubes. The dye eventually travels down your fallopian tubes, where it leaks out and your body absorbs it.

The best part about an HSG is that it's a quick test, lasting no more than five minutes. However, it's not uncommon to experience some moderate-to-severe discomfort during the test.

"The stretching of the uterine muscle when the dye is injected and fills up the uterus…causes cramping, much like menstrual cramps. For some women, this is very painful…but others barely feel it. Most women have some degree of pain or discomfort, though," Pierson confirmed.

Although the pain can be intense, it is short-lived, like the procedure itself. Pierson said that as soon as the catheter is removed, most of the dye runs out through the cervix and the uterus returns to normal. Cramps usually subside after a few minutes, but may last up to a few hours.

What can make the experience more comfortable

While most women experience at least some discomfort during their HSG, you can take certain measures to curb it.

"Take over-the-counter naproxen or ibuprofen about 30 minutes before they have the HSG to try to help with the crampy pain," Pierson suggested.

It's also important that patients have eaten recently, even if it's just a light snack. You do not need to fast for the HSG test, and a snack can prevent you from getting light-headed.

Though the HSG is a very quick procedure, Pierson emphasized the importance of the provider explaining the procedure to the patient before it starts, and informing the patient of what's happening as the test proceeds. Knowing what to expect and what's happening to your body can lower the anxiety caused by the test and, as a result, possibly decrease discomfort.

Some doctors may prescribe a drug called Cytotec so there's less chance of discomfort when the catheter is placed.

"Cytotec, usually given for ulcer prevention, helps soften the cervix to make dilation easier," Scott explained.

While this is not a standard course of treatment, it is an option you may wish to discuss with your doctor.

HSG provides vital information

The HSG is a noninvasive, quick test that takes place toward the beginning of your menstrual cycle. It may be uncomfortable, though eating a snack and taking a dose of over-the-counter naproxen or ibuprofen beforehand may help. The pain should subside quickly after the test is over. While you may not look forward to this test, the information it provides is vital to inform your doctors of the best ways to proceed on your fertility journey.