HSG Test – Preparation, Procedure and Side Effects

Women who have trouble conceiving may realize that the possible reasons are manifold. One of the reasons for not able to get pregnant can be a blockage in the fallopian tubes known as tubal factor infertility. An obstruction in the fallopian tubes can prevent the sperm from reaching the egg or in some cases the fertilized egg to enter the uterus for implantation.

Blockage in the fallopian tube can occur due to several reasons. Doctors commonly recommend a diagnostic test called Hysterosalpingogram or HSG test to determine the cause. HSG test involves injecting an iodine-based dye into the cervix and taking an X-ray to examine the uterus, in order to check if the fallopian tubes are congested. In case a woman has suffered two or more miscarriages, she may also require taking HSG test to check if the uterus has any structural issues like fibroids or polyps.

What is a Hysterosalpingogram?

Couples trying to conceive may often ask ‘what is an HSG test’. HSG or Hysterosalpingogram is a radiological procedure performed using an X-ray to gauge female fertility. HSG test uses a special radio-opaque contrasting dye which is injected into the cervix with the help of a thin catheter that enables picturing of the fallopian tubes and uterus. If the dye flows unobstructed through the tubes and uterus, it implies no blockage. But if the dye stops at any juncture, it may suggest a tubal blockage.

Why is the HSG Test Performed?

The HSG test is performed to ascertain the cause of infertility in cases where couples are unable to conceive. Also, when a woman has had a few miscarriages, HSG test is done to study the shape of the uterus as the irregular uterine shape can lead to repeated miscarriages. Physical anomalies in the uterus may be genetic or acquired. Similarly, if the uterus has problems like polyps and fibroids, it can make conception difficult.

The test also determines if there is a blockage in the fallopian tubes or not. Some of the common causes of obstruction in the fallopian tubes can be surgery, scar tissues from earlier pelvic infections or endometriosis.

In case a woman had tubal surgery, HSG test will help establish if the surgery was successful and in case of tubal ligation (a surgical procedure involving sealing of the fallopian tubes), the doctor can find out through HSG test if a reversal to reopen the fallopian tubes is possible or not.

How to Prepare for the Test?

You may wish to keep the following points in mind while preparing for the test:

  1. The doctor will like to conduct the HSG test after the end of your periods but before the start of ovulation. In this way the likelihood of doing the test while you are pregnant reduces.
  2. But your doctor is the best person to guide you regarding when to schedule the test. Ideally, he will plan the test anywhere between the tenth and twelfth day of your menstrual cycle.
  3. The test does not include the use of general anaesthesia.
  4. You are not required to fast the night before, but you will have to empty your bladder before the test.
  5. You will be requested to take off any piece of metal on your body like ornaments before the test as metal can interfere with the functioning of the X-ray.
  6. On D-day the doctor may advise taking a painkiller an hour earlier than the time of the test lest you feel any discomfort during the test.
  7. Some doctors may also suggest antibiotics to prevent the occurrence of any likely infection.
  8. You may like to inform the doctor before the test about your allergies if any particularly to iodine, any STDs or pelvic infections, asthma, any bleeding issues, any current medications you are on especially.
  9. You may also want to discuss with the doctor in case you have a medical history of kidney problems or diabetes.

Woman waiting for clinical tests

What is the HSG Test Procedure?

The HSG test procedure may entail the following steps:

  1. After draping a gown, you will be asked to lie down upon a table with stirrups. In case there are no stirrups, you may have to lie with your knees bend and your feet resting flat on the table so that your legs are apart.
  2. The doctor will place a metal device called speculum in your vagina to envision the cervix. Some women can experience certain distress during the process.
  3. The doctor will then let down an x-ray machine over your abdomen.
  4. Next, a swab will be inserted to clean your cervix.
  5. Following this, a thin tube called a cannula will be slipped through the cervical opening.
  6. Then through the tube, an iodine-based dye will be slowly injected. You may experience a warming sensation when the dye enters your body.
  7. The dye will travel through your uterus to reach the fallopian tubes in case there is no blockage and finally, fall into the abdominal cavity.
  8. If there is some congestion in the tubes, you may feel pain. Inform your doctor immediately if you do.
  9. While the dye is inside you, the doctor will take x-ray pictures. The doctor may ask you to roll over on your side to get an oblique x-ray picture.
  10. Once the doctor has taken the needed pictures, the instruments will be taken out from the vagina. You may be able to go home.
  11. HSG test procedure time is usually less than half an hour.

What to Expect After the Test?

Women undertaking HSG test may have concerns about what happens after HSG test.

Some women may suffer mild to moderate cramps. However, if the pain seems to be escalating after the test or one starts to run a temperature, seek medical intervention. Developing a fever can be indicative of some infection.

In some cases, women can have light spotting or nausea. But usually one can resume their normal day to day activities after the test. Some doctors may propose abstaining from sexual intercourse for a couple of days after the test.

Woman consulting doctor

Is HSG Test Painful?

Most women do not feel any substantial pain while enduring the HSG test. Nevertheless, the experiences can vary from individual to individual. Some women can feel slight discomfort during the insertion of the catheter into the cervix. Women have also reported experiencing slight to moderate cramps. You are likely to feel a kind of warming sensation when the dye passes through the body.

What to do if it’s painful?

In the event of a blockage in the fallopian tubes, the inserted dye will not be able to move freely through the tubes and therefore may exert some pressure resulting in pain or discomfort.

During the HSG test, if you suffer intense pain, do let your doctor know instantly. He may be able to address your concerns and help in eliminating the pain. In any case, the pain won’t last more than a few minutes. In most cases, anxiety and fear concerning the test add to the pain quotient more than the actual discomfort. Painkillers like ibuprofen can help in easing out the pain.

Risks and Side Effects of HSG Test

HSG test is largely a safe procedure. Nonetheless, certain possible risks and side effects of HSG test are listed below:

  • Infection can develop in very rare cases. The incidence of infection is more likely to happen if the woman has a history of infections or is susceptible to PID (Pelvic Inflammatory Disease).
  • Some women may run a fever after the test. If this happens, report to your doctor right away.
  • In some instances, a woman may faint during or at the end of the test. If you feel faintness after the test, avoid trying to get up and keep lying down on the table till the sensation passes.
  • Feeling increasing pain after the test may not be normal.
  • A major concern can be an allergic reaction to the iodine-based dye. In case of any swelling or itching after the test, inform your doctor.
  • Although the HSG test contains very less radiation, there may be the slightest chance of some cell damage due to skin’s exposure to radiation.
  • There is a possibility that a little dye may drip from the vagina or there can be some vaginal bleeding following the procedure.

What do HSG Test Results Mean?

From the x-ray pictures, the radiologist tries to analyze if there are any irregularities in the uterus or tubal defects like dilation and blockage. If the x-ray displays a regular uterine shape and the inserted dye flows freely through the fallopian tubes, the test results, in that case, are thought to be normal. But this does not imply that the fertility is also normal. It simply means that the cause of infertility could not be detected. Infertility which may be due to hormonal reasons is not likely to be diagnosed by HSG test.

If the dye fails to pass unhindered through the fallopian tubes, it suggests a problem. Once the problem area is detected, it pointedly assists in determining the future course of treatment like IVF or reconstructive procedures such as laparoscopy.

What Are the Chances of Pregnancy After HSG Test?

After an HSG test can I get pregnant is the likely question. The simple answer is pregnancy after HSG test principally depends on the cause of infertility. But studies indicate that the pregnancy rate after HSG test significantly enhanced in a small percentage of women by 2 to 3 times. Perhaps the movement of the dye possibly displaced a slight blockage like an endometriosis lesion, clearing the fallopian tube for a probable pregnancy.

Right infertility diagnosis can be very important for couples who are struggling to get pregnant. HSG test is a positive step in that direction. It is quite natural to feel nervous about the test. You may try some relaxing deep breathing to calm yourself. Moreover, the procedure does not take much time and any discomfort if experienced is usually short-lived.

Also Read: Fertility Treatment – GIFT (Gamete Intrafallopian Transfer)