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Why is Hysterosalpingography Performed?

An X-ray of the uterus and tubes known as a hysterosalpingogram (HSG) may be recommended in cases of infertility in order to diagnose a blockage of one or both tubes that may prevent union of the sperm and egg (fertilization).  In addition, this procedure gives a picture outline of the uterine cavity and may help in detecting abnormalities of the uterus that may cause infertility, repeated miscarriages, or abnormal vaginal bleeding.  Occasionally this procedure is ordered to diagnose causes of pelvic pain which originate inside the uterus.  The procedure is sometimes done a few months after tubal surgery in order to give information about tubal patency after surgery.

What is Hysterosalpingography (HSG)?

The HSG is an outpatient procedure performed in a radiology suite.  A special iodine-containing dye is injected through your cervix (see picture).  It flows into the uterine cavity and through the tubes.  If the tubes are not blocked, the dye will spill out of the tubes into the pelvis confirming that the tubes are open.  X-ray pictures will be taken during the procedure to provide a permanent record of the condition of the tubes and the uterine cavity.  The actual progress of the dye flowing through the tubes can be followed on a fluoroscopy TV monitor real-time moving images can be viewed during the procedure).  X-ray pictures are available in a few minutes and can be examined by the radiologist, the gynecologist, and the patient.  HSG is optimally performed within the first 12 days after the beginning of a normal menstrual period.

These pictures show a normal uterus and tubes (left) and a uterus with a septum (right). Click on the images for a larger view.

Is the Procedure Uncomfortable?

The procedure will cause some cramping and discomfort.  Most patients do well after taking 800 mg ibuprofen 1 hour prior to the procedure.  If you cannot take ibuprofen or have excessive anxiety, your physician may prescribe other medications such as narcotics and/or sedatives.  It is important that you do not drive a car during the 12 hours following the use of narcotics or anxiolytics.  It is also important that a responsible adult accompany you to provide transportation and observation following the procedure, no matter which medications you have taken prior to the procedure.

Occasionally the doctor may prescribe antibiotics for the procedure.

To undergo an HSG, the patient first lies flat on an X-ray table.  A vaginal speculum is then inserted (much like the speculum insertion during a Pap smear).  The cervix is sometimes grasped with a holding instrument, and a small tube is inserted into the cervical canal.  After injection of the liquid contrast, the uterus may respond by having cramp-like contractions.  Such cramps sometimes cause spasms in the tube which can cause more cramping or pain.

What are the Complications and Side Effects of a Hysterosalpingogram?

During the insertion of the instruments and injection of the dye, there will likely be cramping and discomfort which usually disappears after a few minutes.  A small percentage of patients may experience prolonged discomfort, especially when the tubes are blocked and the liquid is unable to flow out of the uterus promptly.

A small percentage of patients may develop infection of the lining of the uterus, tubes or pelvis following this procedure.  This is more common when the tubes have been damaged previously by infection or other causes.  Infection in the tubes could lead to infertility, but the risk of infection is low (commonly estimated at 1%).  If your HSG shows blockage of the tubes, you may be prescribed an antibiotic prescription to help prevent subsequent infection.

Allergic reactions are possible after injection of the iodine-based dye.  During the procedure, a small amount of X-ray radiation will be directed into the pelvic area and ovaries.  The possibility of injury to an unfertilized or recently fertilized egg exists, however the risk of causing a miscarriage or a malformed infant is not documented and the precise risk is unknown.

The potential risks of this procedure must be balanced against the information to be gained in evaluating the cause of the infertility.  Patients should discuss this with their fertility doctor and radiologist.

What are the Alternatives to Hysterosalpingography?

The information gained from an HSG can also be obtained by laparoscopy and hysteroscopy.  Information about the uterine cavity may also be gained by a saline contrast ultrasound.  For more information on these procedures, please click here.


Should I use Contraception during the Cycle I have my HSG?

The risk of abnormalities or problems related to the HSG are exceedingly rare.  There is some evidence in the medical literature that conceptions rates may be greater in the cycles immediately following an HSG.  You should consult your physician if you feel you may be pregnant.


After Having a Hysterosalpingogram:

1.  There will be slight vaginal bleeding and/or discharge for a few days after the procedure.  If bleeding increases or persists more than a few days, call your physician.

2. There may be moderate pain or cramping for several hours after the procedure.  If the pain increases or persists overnight, call your physician.

3. Fever (temperature> 100.5 degrees F) with persistent pain may indicate the possibility of early infection.  These symptoms should be reported to your physician or to the Emergency Room immediately.

4. Douching, vaginal intercourse, or use of tampons should be delayed until 48 hours after the procedure.

5. If you have any problems after the procedure you should come to the clinic or call the infertility clinic at (530) 771-0177.

6. For after hours emergencies please report directly to the emergency room