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X-Ray
HSG stands for hysterosalpingogram, an x-ray exam that checks whether your fallopian tubes are open and whether your uterine cavity has a normal shape. A doctor passes a thin catheter through your cervix and slowly fills your uterus with a liquid contrast that shows up white on x-ray. As the contrast moves, it should flow through both fallopian tubes and spill into your pelvis if they are open. Doctors order HSG mainly during an infertility workup, since blocked tubes and certain uterine abnormalities are common contributors to difficulty conceiving. It's also used to check the uterus after repeated miscarriages or a prior tubal surgery.
The exam shows whether contrast passes freely through each fallopian tube or stops partway, which points to a blockage. It also outlines the shape of your uterine cavity, flagging things like polyps, fibroids, scarring, or a septum. The radiologist records these findings as images and a report for your doctor to interpret alongside your fertility history.
HSG is built around a simple idea: contrast that is denser than tissue shows up bright on an x-ray, so filling a hollow space with it traces that space's shape. Your uterus and fallopian tubes are hollow, so filling them from below, through the cervix, outlines both structures on the same set of images.
If a fallopian tube is open, contrast fills it and then spills freely into the pelvic cavity around the ovary. If a tube is blocked, contrast stops at the blockage instead, and the radiologist notes where along the tube it stopped, since that location matters for planning treatment.
Filling the uterus before the contrast reaches the tubes also outlines the cavity itself. A rounded, unbroken outline is expected; a septum, an out-of-place fibroid pressing into the cavity, or scar tissue from a prior procedure shows up as a filling defect or an unusual shape.
Tubal blockage and uterine cavity problems are two of several possible reasons a pregnancy isn't happening, alongside ovulation and sperm factors, so HSG is usually one part of a broader evaluation rather than a stand-alone answer.
Most people feel cramping similar to a strong period for a few minutes during the contrast injection. The discomfort usually eases soon after the procedure ends. Your doctor can advise on pain relief beforehand if needed.
Some studies suggest pregnancy rates rise slightly in the months right after an HSG, possibly because the procedure clears minor debris from the tubes. This isn't guaranteed for everyone, and it doesn't replace other fertility treatment your doctor may recommend.
It's typically scheduled in the first half of your menstrual cycle, after your period ends and before ovulation, to avoid disrupting an early pregnancy. Ask your doctor or the centre for the exact timing that suits you.
Ask your doctor or the centre about any preparation, since instructions can vary. Some doctors prescribe a pain reliever or antibiotic beforehand depending on your history.
This page is general information about the test, not medical advice. Your own report's reference ranges apply — please discuss your results with your doctor.
No, HSG is not done if you might be pregnant, which is one reason it's timed to the first half of your cycle. Tell your doctor if there's any chance you could be pregnant before the appointment.
A blockage on HSG doesn't always mean permanent damage. Your doctor will weigh the finding alongside your full fertility history before deciding next steps, which can range from monitoring to surgery to assisted reproduction.
No, HSG outlines the inside of the uterus and tubes, not tissue outside them, so it can't directly diagnose endometriosis. Other tests, like laparoscopy, are used for that.