An important part of every woman’s fertility journey is exploring and understanding each factor that is inhibiting her from successfully having a child. One of the first steps is to rule out both the male and female factors that contribute to a successful pregnancy. For our male partners, that could mean exploring and ruling out genetic history and performing a SA, or semen analysis. For females, that could mean checking AMH levels, looking at genetic histories and ensuring each part of our body’s natural cycle is functioning. The latter could be one of the most important things to understand, and correct, if not working properly.

The place most women start is checking their fallopian tubes. Something as simple as knowing whether your tubes are open, partially open, or closed can lead you to a plan and a direction that your infertility journey may take. The best way to determine this is through an HSG test. This procedure can give further information on the way your body works and help you define what steps to take next.

Here are some of the most commonly asked questions concerning the HSG procedure.

Why would I have an HSG?

An HSG would be performed in the event that a female has unexplained infertility. The procedure can help to determine if the fallopian tubes are properly open, and are allowing eggs to pass through during a normal menstrual cycle.

What is an HSG?

A Hysterosalpingogram (HSG) is an x-ray procedure of the uterus and fallopian tubes to determine if they are open or closed, and to ensure there are no deformities in the shape of the uterine cavity. The procedure is explained to be reminiscent of a pap smear, in that a speculum is placed to reach the Cervical opening.  Before the placement of the speculum the patient will first lay on the exam table with legs extended in calf stirrups. A machine called a C-arm, named for its C-like shape, will then be swung over the lower abdomen. This machine has foot pedals that allow the physician to take pictures of the procedure. From there the physician cleans the cervix with a solution, such as hibiclens, and cotton swabs to ensure no new bacteria is introduced to the body. The physician then places a long, thin catheter through the cervical opening and into the uterus. A small balloon located at the tip of the catheter will then be inflated to the size of a dime, to ensure the catheter does not slip from its placement. The physician will then inject a dye that will fill the uterus and, ideally, flow through the fallopian tubes and spill out into the abdominal cavity. All the while the physician will take pictures of the uterus and tubes as the catheter is placed, the dye is injected, the uterus fills, the tubes fill and the dye spills from the tubes. From the pictures taken the physician will be able to determine if the shape the uterus is uniform, the state of the tubes openness and anything that may play a factor in the hindrance of fertility.

What Should I do to prepare for an HSG?

This specific procedure requires that your bladder is empty. Be sure not to fill your bladder prior to the appointment and relieve yourself upon arrival if need be.

Some women do experience cramping from the inflation of the balloon in the uterus, and the pressure of the dye filling the uterus and fallopian tubes. It is advised that up to 800 mg of Ibuprofen is taken an  hour prior to the procedure, this will help with cramping. While some experience cramping, similar to menstrual cramps, most women do not experience pain. Most women do fine with the procedure.

There are a few women who have high anxiety and have a harder time relaxing when in an office setting. If this is you then you can ask your physician to prescribe a relaxant, such as diazepam, before the scheduled appointment. It can be taken an hour prior to the HSG to help you relax, but be sure to have someone there to drive you home from the procedure, as it is not advised to drive after taking the medication.

Is there anything I should not do before my HSG?

In preparation there is nothing that you should not do before your HSG procedure. HSGs are done routinely and take 5-10 minutes as long as the catheter is easily passed through the cervical opening, which is the case for most women.

If it can be helped, avoid the internet. While the internet may be one of our greatest resources, many of those who share the experiences of their HSGs are not physicians and can unknowingly misinform others on the procedure, and what it entails. If you do want to do research on the procedure prior to your appointment, a great resource is the Carolina Conceptions Website, which has a video with Dr. Grace Couchman, to further explain the HSG procedure.

What happens after my HSG?

When the procedure is finished the physician will be able to tell you the results of the test. If you were sent by a referring physician, the report and pictures taken during the HSG will be sent to your physician. A follow up appointment should be scheduled to review and discuss the results.

Some of the dye that was used during the procedure will spill out from the uterus and expel through the vagina. The dye is tacky (sticky) and could be mixed with blood from the uterine lining, causing some spotting. This is normal. A pad will be provided for you, if you do not have one on hand, and should be worn till spotting stops.

It is advised that nothing is put into the vagina (no tampons, intercourse or baths) for at least 24 hours after the HSG to ensure nothing passes through the cervical opening. This will prevent infection.

The HSG is considered an outpatient procedure. Bed rest is not required following the test. Cramping, if any should occur, will subside when the HSG is completed and you will able to return to work or any other activity.

My HSG was abnormal. Now what?

Your HSG may have shown both fallopian tubes are blocked.  In this case, you should make a follow-up appointment with one of our REI physicians to discuss options of surgery (if indicated) or IVF.

My doctor said my HSG shows I have a hydrosalpinx.  What is that?

Sometimes women are diagnosed with a blocked and dilated fallopian tube, known as a hydrosalpinx.  A hydrosalpinx is an indication for surgery.  Specifically the gold standard of treatment is called laparoscopic salpingectomy, which means minimally invasive surgery performed by the physicians at Carolina Conceptions in which the tube affected by the hydrosalpinx is removed.  A hydrosalpinx is filled with inflammatory fluid that decreases pregnancy rates even with treatments such as IVF.  This fluid can only travel back into the uterus as the tube is blocked and it cannot exit out the end of the tube. It is thought that the fluid can physically wash away the embryo from implanting in the lining of the uterus, and also that the inflammatory mediators within the fluid create a suboptimal environment for implantation.  Typically when a woman is diagnosed with a hydrosalpinx, we will advise surgery to remove the tube, followed by IVF or INVOCELL.

Is there anything else I should know about my HSG?

HSGs are a type of x-ray, which means they require a small dose of radiation. Doctors and assisting medical staff wear lead vests within the room to protect themselves from radiation overexposure. This is due to the amount of procedures they do and the excessive exposure to radiation that they encounter. Your time under radiation will be limited and monitored closely by the staff. You are not in any danger but, because of the radiation usage, we do not allow any partners or spouses in the exam room. This is for their own safety, as unnecessary radiation exposure could be potentially harmful.

The dye used to fill the uterus does contain trace amounts of iodine. If you know that you have an allergy to shellfish, iodine, or radiographic dye, please inform the physician’s office prior to your appointment. Depending on the severity of your allergy, the test may need to be performed in a hospital setting to ensure your safety.

Carolina Conceptions’ physicians performs HSGs in the office which reduces much of the discomfort frequently experienced if performed in a hospital or radiology office.