What can I expect from an HSG test?

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Q:

What is a Hysterosalpingogram and what can I expect from the procedure?

A:

The Hysterosalpingogram or (HSG) is an essential tool for evaluating fertility. Hystero (uterus) salpingo (tube) gram (study) is a test to evaluate not only whether the fallopian tubes are blocked or open but the status of the uterine cavity (where the embryo implants). This is the only non-invasive (meaning non-surgical) way to make sure fallopian tubes are open.

People often say, “My tubes can’t be blocked because I have periods” but it doesn’t work like that— you can have periods, no pain, no symptoms and still have blocked tubes.

Most women with blocked tubes will have a history of pelvic surgery, pelvic infection, or endometriosis but occasionally women with no risk factors will have this fertility issue.

The test itself is not the most comfortable—it is crampy but quick!

It requires special equipment so is often done in a radiology department (although my clinic has it in the office which is wonderful for patients!) It’s like a pelvic exam (ugh)—assume the position, speculum, catheter (tube) in cervix and as fluid (we call it dye but it’s clear-colored contrast fluid) flows through the uterine cavity and fallopian tubes.) Fluoroscopy or x-ray photos are taken in real time to watch the fluid flow through the tubes.

Tips:

  1. It can be painful but many women describe cramps that resolve after the test is complete (which only takes a few minutes)
  2. Ask your provider about medications beforehand like Motrin for cramps or maybe something a little stronger or a relaxing medication if you are anxious about it.
  3. Ask your provider but usually, you can still try to conceive in the same cycle as the test so you won’t miss an opportunity.
  4. Some small studies describe a higher chance of conception for the 2-3 months following the HSG - although I don’t use it as a treatment, this fact can be encouraging to some women who are nervous about it.
  5. f you have blocked tubes talk to your provider about options but the usual recommendation is in vitro fertilization (IVF).


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Written by Dr. Lora Shahine
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Lora Shahine, MD, FACOG is a board-certified reproductive endocrinologist currently practicing at Pacific NW Fertility and IVF Specialists in Seattle. Dr. Shahine is an accomplished author of many blogs and articles as well as three books. Her first book, “Planting the Seeds of Pregnancy: An Integrative Approach to Fertility Care” she co-authored a guide to both Eastern and Western approaches to fertility care. Her second book, “Not Broken: An Approachable Guide to Miscarriage and Recurrent Pregnancy Loss” is an evidence-based review of the current evaluation and treatment for miscarriage. Most recently, she published “Not Broken Illustrated: A Gift for Those Who Have Suffered Pregnancy Loss.” She is dedicated to changing the conversation surrounding infertility and miscarriage from one of shame and guilt to one of support and empowerment. Full Bio