Prepare for a Fluoroscopic Hysterosalpingogram (HSG) Exam

Fluoroscopic hysterosalpingography (HSG) is an x-ray examination of the uterus and fallopian tubes using a special form of low dose x-ray called fluoroscopy and iodinated contrast material (a liquid containing iodine that is visible to x-rays).

Why Get an HSG Exam?

The most common reason for an HSG is to evaluate subfertility/infertility or repeat miscarriages. The main purpose of the exam is to evaluate for blockages of the fallopian tubes, but the exam also provides information about the uterine cavity, such as shape and presence of scarring, and whether there may be adhesions or scarring in the pelvis.

Normal HSG catheter with balloon inside of the uterus. Contrast material fills the uterus and flows through both fallopian tubes spilling into the pelvis confirms no blockage.

Patient Safety Tips Prior to a Hysterosalpingogram

  • This exam should NOT be performed if:
    • You think you may be or are pregnant
    • You currently have a pelvic infection
  • Please let us know if you have any allergies or adverse reactions to medications or iodinated contrast material.
  • Please leave your valuables at home.
  • Please let us know if you need interpreting services, this can be arranged for you.
  • Please bring a list of your current medications with you.

Preparation for a Hysterosalpingogram Procedure

  • The exam should take place between 7-10 days after the beginning of your last menstrual period.
  • A course of antibiotics may be prescribed prior to the test depending on your referring provider’s recommendations.
  • You can eat and drink as per usual the day of the test.
  • We recommend you take ibuprofen several hours prior to the test to decrease possible discomfort.
  • If you have additional questions or concerns or feel anxious about the exam, consider discussing additional premedication options with your referring doctor ahead of time to bring to the appointment.
  • If you take an anxiolytic, please arrange for a ride to and from the appointment.
  • Please arrive 15 minutes before the scheduled exam time.
  • You will be given a contrast screening form to complete.
  • You will be asked to change into a hospital gown before the procedure.
  • The technologist will verify your identification and exam requested.
  • There will be an opportunity for you to talk to the radiologist about the plan for the procedure and give your consent.

During the procedure

  • The duration of the procedure will vary, but averages about 45 minutes.
  • The technologist will position you on the exam table in the same way you would be positioned for a gynecologic exam with your back on the exam table with knees bent and feet supported on footrests.
  • The radiologist will insert a speculum into the vagina, clean the cervix and insert a catheter into the uterus. The speculum is then removed, and contrast material infused through the catheter while images are taken.
  • Insertion of the catheter and/or infusion of contrast material may cause some discomfort. Some patients describe a sensation comparable to menstrual cramps.

What to Expect After a Hysterosalpingogram

  • If you are going home, you may resume normal activities.
  • You may experience vaginal spotting (bleeding) and pelvic cramps for 1 day after the procedure.
  • Tylenol/ibuprofen (or previously tolerated pain control for menstrual cramps) may be taken as indicated after the procedure for pain relief.
  • In some instances, you may be prescribed an antibiotic after the procedure.
  • If you experience increased pain, fever, or heavy bleeding after the exam, contact your doctor immediately.

Hysterosalpingogram (HSG) Frequently Asked Questions

Can you eat before an HSG test?

Yes, you can eat and drink as per usual the day of your HSG exam.

Is an HSG exam painful?

Some patients find minimal discomfort whereas others report a feeling like intense menstrual cramps. Any discomfort is usually brief and taking an over-the-counter pain medication before and/or after the procedure can help minimize any discomfort. If necessary, you can also ask the radiologist to terminate the exam at any time.

Can an HSG exam open blocked tubes?

HSG was originally established as a diagnostic test to check for fallopian tube blockage. However, the act of introducing contrast into the fallopian tubes is also thought to provide a potential therapeutic effect by flushing out debris or mucus that may be limiting free passage of an egg/fertilized egg or sperm.

Does having an HSG exam make you more fertile?

There may be some therapeutic effect of HSG in improving fertility. For example, in one study, those who underwent HSG had an increased probability of natural conception with an absolute increase in 6-month pregnancy rate of +6% and a 1.4x increase in ongoing pregnancy rates compared to those who did not undergo HSG. (1)

What are the possible complications of this procedure?

Possible complications include:

  • Infection: HSG has a 1.4-3.4% rate of infection (2).
    • At UCSF, antibiotic prophylaxis is at the discretion of our referring clinicians. Occasionally, observations during an HSG, such as a dilated fallopian tube, may prompt post-procedure antibiotics.
  • Rare allergic or allergic-like reaction from contrast

Will I be exposed to a lot of radiation?

The average radiation dose to the female gonads is 2.7 mGy or an effective dose of 1.2 mSv (3). To put this into perspective, a person is exposed to background radiation around 3.1 mSv a year or 0.4 mSv per mammogram.

The risk for anomalies in a future embryo or induction of a fatal cancer depends on patient age, but for someone 20-29 years of age, the fetal anomaly risk is 2.7 x 10-5 while that for cancer induction is 1.45 x 10-4, both 1000-fold lower than background rates (3). Risk further decreases with increased patient age. Although radiation dose and theoretical risks are not significant, every effort is always made to minimize radiation exposure.

Additional Resources

Hysterosalpingography at RadiologyInfo.org website.

References

  1. Dreyer K, van Eekelen R, Tjon-Kon-Fat RI, van der Steeg JW, Steures P, Eijkemans M, van der Veen F, Hompes P, Mol B, van Geloven N. The therapeutic effect of hysterosalpingography in couples with unexplained subfertility: a post-hoc analysis of a prospective multi-centre cohort study. Reprod Biomed Online. 2019 Feb;38(2):233-239. doi: 10.1016/j.rbmo.2018.11.005. Epub 2018 Dec 7. PMID: 30579824.
  2. ACOG Practice Bulletin No. 195: Prevention of Infection After Gynecologic Procedures. Obstet Gynecol. 2018 Jun;131(6):e172-e189. doi: 10.1097/AOG.0000000000002670. PMID: 29794678.
  3. Perisinakis K, Damilakis J, Grammatikakis J, Theocharopoulos N, Gourtsoyiannis N. Radiogenic risks from hysterosalpingography. Eur Radiol. 2003 Jul;13(7):1522-8. doi: 10.1007/s00330-002-1809-0. Epub 2003 Feb 11. PMID: 12835963.