Hysterosalpingogram (HSG) Test for Infertility | What to Expect

What Is an HSG Test?

A Hysterosalpingogram (HSG) is a specialised X-ray test. It is done to look inside the uterus and check whether the fallopian tubes are open.

During the procedure, a contrast liquid is placed into the uterus through the cervix. X-ray images are taken while the liquid moves through the uterus and towards the tubes. If the tubes are open, the liquid usually flows through and spills out at the end of the tubes.

Why Do Doctors Recommend HSG?

HSG is usually recommended when a couple is having difficulty getting pregnant, and the doctor wants to rule out physical blockages.

It is mainly done to check if:

• The fallopian tubes are blocked
• The uterine cavity has an unusual shape
• There may be scarring inside the uterus
• There is a structural issue that could affect implantation

For many women, it becomes an important “next step” after basic blood tests and an ultrasound.

When Is HSG Done in the Menstrual Cycle?

HSG is usually scheduled after the period ends but before ovulation begins. This timing is chosen because pregnancy is unlikely during that part of the cycle.

Doctors generally avoid doing it during active bleeding or late in the cycle, as the chances of early pregnancy may be higher.

What Happens During an HSG Test?

This is what most women can expect during the procedure:

• You will lie on an X-ray table, similar to a gynaecology examination.
• A speculum is inserted to view the cervix.
• The doctor gently places a small tube through the cervix. This is simply used to guide the dye into the uterus.
• After that, the contrast liquid is slowly passed in, and X-ray images are taken as it moves through the uterus and tubes.
• X-ray images are taken as the liquid fills the uterus and travels into the tubes.
• The full process usually does not take long, but the most uncomfortable part is often when the contrast starts flowing.

Many women describe the feeling as cramping, similar to period pain. For many women, it feels like normal period cramps. A few may feel sharper cramping for a short moment, but it should hopefully settle quickly once the procedure is over.

How to Prepare for the HSG Procedure

There is usually no major preparation needed, but a little planning can make the day easier.

• Wear something comfortable so you don’t feel uneasy during the test.
• It’s a good idea to carry a sanitary pad, just in case you have a little spotting afterwards.
• Try not to schedule anything tiring right after, since mild cramps can happen.
• If you feel nervous, it can help to take a family member along for support.

What the HSG Test Results Can Show

An HSG test gives information about two main things: the uterus and the tubes. The doctor will check:

• whether the uterine cavity looks normal
• whether the dye moves through the tubes
• whether there is any blockage
• whether the dye spills out at the end of the tubes

In some cases, the test shows one tube open and the other blocked. In other cases, both tubes may be blocked. The uterus may also show a filling defect, which can suggest a polyp, fibroid, or scar tissue.

It is important to remember that HSG is not a complete fertility diagnosis by itself. It is one piece of the overall evaluation.

HSG Results Table (Normal vs Abnormal Findings)

Side Effects and Safety Concerns

Most women feel fine after an HSG test, but mild side effects are common. These may include:

• lower abdominal cramping for a few hours
• light spotting
• mild dizziness
• watery discharge

Serious complications are uncommon, but infection can occur in rare cases, especially if there is an underlying pelvic infection. The radiation dose is low, and the test is widely considered safe when performed properly under the guidance of an experienced specialist.

When to Call the Doctor After HSG

It is important to contact your doctor if you notice:

• fever
• foul-smelling discharge
• heavy bleeding
• severe or worsening pelvic pain

These symptoms are unexpected and may require urgent medical review.

Conclusion

The HSG test is one of the most commonly recommended investigations for infertility because it checks two important areas: the uterus and the fallopian tubes. While the idea of the procedure can feel stressful, it is usually quick and manageable. The results can help doctors decide what steps should come next. For couples trying to conceive, especially those facing delays, an HSG can provide clarity and direction.