The HSG Test Explained: What It Checks, How It Feels, and What Your Results Mean

Written by Cachita Hynes

Your doctor ordered an HSG? Learn what this fertility X-ray checks, when it's scheduled, what it feels like, and what your results can and can't tell you.

Woman talking with a fertility specialist about her HSG test results in a calm clinic office

If you are trying to conceive and your doctor has recommended a hysterosalpingogram, or HSG, you probably have questions. What does it check? Does it hurt? And what happens if something shows up?

The HSG is one of the most common tests in a fertility workup. It is quick, done as an outpatient procedure, and it answers an important question: are your fallopian tubes open, and does the inside of your uterus look normal? Here is what to expect, step by step.

What Is an HSG Test?

A hysterosalpingogram is an X-ray exam of the uterus and fallopian tubes. A small amount of contrast fluid is gently placed into the uterus through the cervix, and a live X-ray called fluoroscopy shows how the fluid moves.

If the fallopian tubes are open, the fluid flows through them and spills out the ends. If a tube is blocked, the fluid stops. The test also outlines the shape of the uterine cavity, which can reveal issues such as polyps, fibroids inside the cavity, scar tissue, or an unusually shaped uterus.

Why Is an HSG Part of a Fertility Workup?

An egg and sperm meet inside the fallopian tube, so open tubes are essential for natural conception and for treatments such as IUI. Blocked or damaged tubes are a common cause of infertility, and they often cause no symptoms at all.

An HSG may be recommended if you have been trying to conceive without success, after repeated miscarriages, to check the results of tubal surgery, or to confirm that a sterilization procedure worked. It is often ordered alongside bloodwork and a semen analysis. Not sure when to start testing? See our guide on when to see a fertility specialist.

It is just as important to know what an HSG does not show. It does not evaluate the ovaries or egg supply, and it cannot diagnose endometriosis or fibroids outside the uterine cavity. Other tests cover those questions.

The HSG Test, Step by Step

1. Scheduling the Test

An HSG is usually scheduled after your period ends and before ovulation, often around 7 to 10 days after the first day of your period. This timing helps make sure you are not pregnant during the X-ray.

Let your doctor know ahead of time if you have an allergy to iodine or contrast dye, signs of a pelvic infection, or any chance you could be pregnant.

2. Preparing for Your Appointment

Many doctors suggest taking an over-the-counter pain reliever, such as ibuprofen, before the test to ease cramping. Some also prescribe an antibiotic. Follow the instructions your own care team gives you.

It is a good idea to arrange a ride home in case you feel crampy afterward, and to bring a pad for any spotting.

3. During the Test

You lie on an X-ray table, much like a pelvic exam. Here is what typically happens:

  1. A speculum is placed and the cervix is gently cleaned.

  2. A thin, soft tube (catheter) is placed into the opening of the cervix.

  3. Contrast fluid is slowly added to fill the uterus and tubes while X-ray images are taken.

  4. You may be asked to shift position so the doctor can see the tubes from different angles.

  5. The catheter is removed and you can sit up.

The imaging itself usually takes less than five minutes, though the whole appointment may take around 30 minutes.

4. How Does an HSG Feel?

Most people feel mild to moderate cramping, similar to period cramps, for about 5 to 10 minutes. For some, cramps last a few hours. Cramping can be stronger if a tube is blocked.

Slow breathing during the test and a heating pad afterward can help, along with the pain reliever your doctor recommends.

5. After the Test

Most people can return to normal activities right away. Light spotting and a sticky discharge for a day or two are common. Some doctors suggest waiting a few days before having sex, so ask your care team what they recommend.

Call your doctor if you have a fever or chills, pain that gets worse instead of better, heavy bleeding, foul-smelling discharge, fainting, or a rash, itching, or swelling.

Is an HSG Safe?

The HSG is considered a very safe test. According to the American Society for Reproductive Medicine, serious complications occur in fewer than 1% of cases. Infection is the most common serious risk, especially for people with a history of tubal disease. Allergic reactions to the contrast dye are rare.

The radiation dose is very low, and no radiation stays in your body afterward. Because it uses X-rays, an HSG should not be done if you might be pregnant.

Understanding Your HSG Results

A normal result shows a smoothly shaped uterine cavity and contrast spilling freely from the ends of both tubes. Your doctor will review the images and explain what they mean for you.

If a tube looks blocked, it is not always a permanent problem. Sometimes the tube simply spasms during the test. Your doctor may recommend further testing, such as a hysteroscopy to look inside the uterus or a laparoscopy to examine the tubes directly. When both tubes are blocked, IVF is a common path because it bypasses the fallopian tubes entirely.

If the uterine cavity looks irregular, a saline infusion sonogram or hysteroscopy can give a closer look and guide next steps.

Can an HSG Improve Fertility?

You may have read that some people conceive soon after an HSG. Some studies suggest a small, temporary boost in fertility in the months after a normal HSG, possibly because the fluid flushes the tubes. The evidence is mixed, however, and the HSG is a diagnostic test, not a fertility treatment.

Taking the Next Step in Beverly Hills

An HSG is one piece of the puzzle. At the Center for Reproductive Health & Gynecology in Beverly Hills, Dr. Sam Najmabadi and our team bring every test result together into a clear plan. Learn more about the hysterosalpingogram and our full fertility workup.

Ready to talk about your results? Contact us or call (310) 360-7584 to schedule a consultation.

Book Your Consultation

FAQs

  • Most people feel mild to moderate cramping, similar to period cramps, for about 5 to 10 minutes. Some have cramps for a few hours. Taking an over-the-counter pain reliever beforehand, if your doctor recommends it, often helps.

  • An HSG is usually scheduled after your period ends and before ovulation, often around 7 to 10 days after the first day of your period. This helps make sure you are not pregnant during the X-ray.

  • The imaging itself usually takes less than five minutes. Including preparation, the whole appointment often takes around 30 minutes, and you can go home the same day.

  • Light spotting and a sticky discharge for a day or two are common. Call your doctor if you have heavy bleeding, fever, worsening pain, or foul-smelling discharge.

  • It is generally fine to keep trying to conceive after your HSG, but check with your doctor first. Some studies suggest a small, temporary boost in fertility after a normal HSG, but the evidence is mixed and the test is not a fertility treatment.

  • A blocked result is not always permanent, since tubes can spasm during the test. Your doctor may suggest further testing, such as a hysteroscopy or laparoscopy. If both tubes are blocked, IVF is a common option because it bypasses the tubes.

References

This article is educational content, not personal medical advice. Please consult your physician about your individual situation.

Cachita Hynes
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