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An HSG (hysterosalpingogram) is an X-ray test that checks whether your fallopian tubes are open and whether the inside of your womb has a normal shape. It is one of the common tests when a couple is finding it hard to conceive.
This guide explains why tubes get blocked, how to prepare for the test, what happens on the day, and what treatment options exist if a blockage is found.
Why the fallopian tubes matter
The fallopian tubes are the two narrow channels that carry an egg from the ovary to the womb. Fertilisation normally happens inside a tube. If a tube is blocked or scarred, the egg and sperm may not meet, or a fertilised egg may not reach the womb.
The World Health Organization lists blocked fallopian tubes as an important female cause of infertility. It links them to untreated sexually transmitted infections, complications of unsafe abortion, infection after childbirth, and abdominal or pelvic surgery. The NHS adds pelvic inflammatory disease and endometriosis to that list. You can read more in our guide to pelvic inflammatory disease.
Many women with blocked tubes have no symptoms at all, and their periods are regular. That is why a test is needed.
What is an HSG test?
The NHS describes an HSG as an X-ray of the womb and fallopian tubes taken after a special dye is passed in through the cervix. The dye shows up on the X-ray. If the dye flows through the womb and spills out of the tubes, they are open. If it stops, there may be a blockage.
A hospital information leaflet from Cambridge University Hospitals in the UK describes the test as an outpatient X-ray that checks the womb cavity and the tubes, and helps plan treatment or gives reassurance when the result is normal.
Other tests for the tubes
- HyCoSy (ultrasound with fluid): an ultrasound scan that follows a small amount of fluid through the womb and tubes, without X-rays.
- Laparoscopy: keyhole surgery with a tiny camera, usually kept for when a problem is likely, for example after a past pelvic infection or when a scan suggests a blocked tube. Dye may be passed through the cervix during the procedure.
- Transvaginal ultrasound: checks the womb and ovaries and can hint at tube problems, but it cannot always show whether the tubes are open.
Which test is best for you depends on your history. Your doctor will decide, so ask why a particular test is being suggested.
How to prepare for an HSG
Instructions differ between hospitals, so follow the ones you are given. The leaflet from Cambridge University Hospitals gives a useful example of what is typical:
- The test is done in the first part of the cycle, ideally before day 10, and not while you are bleeding.
- If your appointment is after day 10, you may be asked to avoid sex from day 10 until the test, so that you are not pregnant.
- You will be asked to confirm that you are not pregnant. If your periods are very irregular, you may need a home pregnancy test that morning.
- Some people take a simple pain-relief tablet about an hour before the test. Ask your doctor what is suitable for you.
- Antibiotics are not given routinely at that hospital, but may be prescribed if the tubes turn out to be blocked.
- Tell the staff if you have ever reacted to X-ray contrast dye, or if you think you might be pregnant.
Tip: Bring a sanitary pad. A little spotting is common afterwards, and pads are preferred to tampons.
What happens during the test
- You change into a gown and lie on the X-ray table.
- A speculum is placed in the vagina, as in a Pap test, so that the cervix can be seen.
- A thin tube is placed at the cervix and the dye is gently passed into the womb.
- X-ray pictures are taken as the dye fills the womb and tubes.
- The tube is removed and the dye drains out of the vagina.
It usually takes less than half an hour. Most women feel cramps similar to period pain, mild to moderate in strength, which normally ease soon after the test but may continue for a few hours.
After the test and the risks
- You can usually go home soon after and resume normal activities. Many people feel well enough to drive, but you may prefer to bring someone with you.
- Spotting for a day or two is common.
- The risk of infection is very low (under 1 percent at the hospital leaflet quoted), though a little higher when the tubes are blocked.
- Allergy to the dye is rare.
- The radiation dose is very low and does not affect your ability to conceive later.
- Results are sent to the doctor who referred you, who will explain them. This can take several days.
When to be cautious: Tell the team before the test if you think you may be pregnant, and tell them about any past reaction to contrast dye used in scans. Never skip these questions.
What the result can mean
- Both tubes open: reassuring. Other causes of delay, such as ovulation or sperm quality, are then looked at.
- One tube blocked: pregnancy is still possible through the open tube. Your doctor will talk through the options.
- Both tubes blocked: natural conception is unlikely. Treatment is usually advised.
- Womb shape problems: the test may show an abnormality inside the womb, which your doctor may check further.
Your doctor may confirm an unexpected result with another test, such as a laparoscopy, before planning treatment. Do not draw a final conclusion from one report.
Treatment options for blocked tubes
The NHS says that for scarred or blocked tubes, surgery can break up scar tissue so eggs can pass, and how well it works depends on how badly the tubes are damaged. A possible complication is ectopic pregnancy, so early scans are important if you conceive; see our guide to ectopic pregnancy symptoms.
If surgery is unlikely to help, or tubes are badly damaged, IVF is the usual alternative because the egg is fertilised in the laboratory and the embryo is placed straight into the womb, bypassing the tubes. Read how this works in IVF step by step and compare it with IUI in IUI vs IVF.
When to see a doctor
- You have been trying for a year without success (sooner if you are 36 or over, as the NHS advises).
- You have had pelvic infection, endometriosis or abdominal or pelvic surgery.
- You have severe pelvic pain, fever or foul-smelling discharge after an HSG. Seek care promptly.
- You have a missed period and sudden one-sided tummy pain: this is urgent. See the emergency page.
The infertility and reproductive care speciality at Chaitanya Hospital includes IUI, IVF and fertility counselling.
Talk to a doctor
If you have questions about tubal tests or fertility, you are welcome to book an appointment or call +91 944 103 0587. Chaitanya Hospital is in Kadapa, near RTC Bus Stand, Simhapuri Colony, and teleconsultation is also available. This article is for general awareness and is not a substitute for a doctor's advice.
References
This article was written in our own words from the following public health sources.
Educational content
Please note. This article is for general awareness and is not a substitute for a doctor’s advice, diagnosis or treatment. If you are worried about your health, or in an emergency, call +91 944 103 0587 or visit the hospital.
