Hysterosalpingography (HSG) is a specialized X-ray procedure used in fertility assessments. This diagnostic tool involves injecting a liquid contrast dye through the cervix into the uterus and fallopian tubes. X-ray images are captured as the dye moves through the reproductive tract to visualize the uterine cavity and determine the patency of the fallopian tubes. The test identifies structural issues, such as blockages or uterine abnormalities, that could prevent conception or lead to recurrent pregnancy loss.
Immediate Post-Procedure Experience
Following the quick procedure, most individuals experience mild to moderate side effects similar to menstrual discomfort. Cramping is the most common sensation, ranging from a dull ache to an intense, wave-like pain, especially if the fallopian tubes resisted the dye flow. This discomfort typically subsides within a few hours. Taking an over-the-counter non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen, about an hour before the procedure can help mitigate post-test cramping.
Vaginal discharge is common for up to 48 hours afterward, appearing sticky, light pink, or brown due to the contrast dye. Patients should wear a sanitary pad, not a tampon, to manage this discharge. Most people can resume normal daily activities, including work and light exercise, immediately after the procedure. However, providers recommend avoiding sexual intercourse for a few days to minimize the risk of infection.
Contacting a healthcare provider is necessary if symptoms develop that could indicate a complication, such as an infection. Abnormal signs include a fever, severe abdominal pain not relieved by medication, or heavy vaginal bleeding. Heavy bleeding is defined as soaking more than one sanitary pad per hour for several hours. While complications are uncommon, patients with a history of pelvic infection may be prescribed a preventative course of antibiotics.
Interpreting the Test Results
The HSG results are usually available within a few days, and a specialist reviews the images to assess the uterine structure and fallopian tubes. The most important finding is tubal patency, describing whether the tubes are open or blocked. If the fallopian tubes are patent (open), the contrast dye flows freely through the tubes and spills into the abdominal cavity, where the body harmlessly absorbs it.
If the dye does not spill into the abdominal cavity, it suggests the tube is blocked (occluded), which is a significant cause of infertility because it prevents the sperm and egg from meeting. The location of the blockage is noted, described as proximal (near the uterus) or distal (near the end of the tube). Distal blockages can be associated with a hydrosalpinx, a tube swollen with fluid.
The HSG also provides a detailed outline of the uterine cavity, which is normally triangular. The images can reveal structural abnormalities like uterine septa (an abnormal division of the uterus) or filling defects caused by polyps or fibroids. These findings help explain fertility challenges and guide the next steps in treatment. A normal HSG indicates proper anatomy but does not confirm normal fallopian tube function, as the test cannot assess the delicate internal cilia that move the egg.
Planning for Conception and Follow-Up
The HSG results directly influence the subsequent plan for conception, whether through natural means or assisted reproductive technology. If the test shows both fallopian tubes are open and the uterine cavity is normal, patients are often advised to continue trying to conceive naturally. This recommendation is supported by the “therapeutic flush” effect.
The pressure and flushing action of the contrast dye may clear minor blockages or debris, such as mucus plugs, temporarily increasing the chances of natural pregnancy. Studies suggest a slight increase in conception rates, sometimes up to 30%, may be observed in the first three to six months, particularly if an oil-soluble dye was used. Patients with open tubes can typically begin trying to conceive during the same menstrual cycle as the HSG.
If the HSG reveals one or both tubes are blocked, the follow-up plan becomes specialized. A proximal blockage (near the uterus) may sometimes be addressed with a minor procedure called selective tubal cannulation. However, if both tubes are blocked distally or if the blockage is severe, a fertility specialist may recommend bypassing the fallopian tubes entirely.
In cases of significant tubal damage, such as a hydrosalpinx, the most effective path to pregnancy is often in vitro fertilization (IVF), which does not require functional fallopian tubes. Other diagnostic procedures, like laparoscopy, may also be recommended to confirm the extent of the damage and remove scar tissue or other factors that could compromise fertility. The final treatment decision is guided by the location and severity of any structural issues found on the HSG.