If you’ve begun the process to evaluate the cause of your infertility, no doubt you are concerned about the testing that will be required. In particular, the HSG may be the test you are most dreading. Possibly, well-intended friends and family have shared their experiences in crisp detail. You’ve gone to Google for reassurance only to stumble upon blogs from other patients who have not had a good experience and are all too happy to discuss and embellish it. Actually, now you are more anxious than before.
The Hysterosalpingogram (HSG) is performed routinely for patients having difficulty conceiving because it is an excellent test not only to see if a patient’s fallopian tubes are open, but to assess whether the uterus has normal shape and make sure the cavity is not affected by fibroids, polyps or scar tissue. The HSG requires the assistance of a certain type of x-ray called a fluoroscopy. At Shady Grove Fertility’s Rockville office, we have an x-ray room dedicated to these procedures. We also perform these procedures at our GBMC location, and utilize the hospital’s x-ray facilities. It may sound complicated, but it is actually a very simple and often quick test that provides valuable information in a matter of a few minutes or less. And the best part? It rarely causes the discomfort you might expect.
What Exactly Happens
A speculum is inserted into the vagina, similar to getting your annual pap smear. The cervix is cleansed with an antiseptic solution, and a small flexible catheter (much thinner than a coffee stirrer) is inserted through the opening of your cervix and into the uterine cavity. Usually the speculum is then removed and you are lying flat on the table during the x-ray imaging. A small amount of dye is passed thru the catheter, filling the uterine cavity and then filling the fallopian tubes. Fluoroscopy is a “live” x-ray that allows us to watch as the dye is traveling through the tubes. The tubes are considered open when spillage of dye occurs at the end of the tubes. This means that the dye has escaped the tube and thus your tube should be able to “pick up” your ovulated egg. Often times, this takes less than a minute, with less than 3 tsp of dye.
Even though this may be a step that patients dread, I often will tell the patients prior to the procedure they will be “pleasantly surprised”. The dye is gently infused into the cavity and although some cramping may occur as the uterine cavity distends with this fluid, it is usually less than menstrual cramping. I’ve found that the patients who comment on intense cramping usually do so because of tubal blockage. If the dye cannot pass thru the tube, there is increased pressure at the point of the blockage. By the time a patient is expresses discomfort, I’ve recognized the problem, the catheter is removed and there is immediate relief. Again, all of this takes a minute or less. And to reduce the cramping, it is our practice at SGF to advise Ibuprofen or similar over the counter non-steroidal anti-inflammatory product 1 hour prior to the procedure.
Are There Any Complications?
Complications are exceptionally rare. Our patients are asked to start an antibiotic prior to the procedure to prevent an infection and are advised to refrain from intercourse for 24 hours. Occasionally, patients will experience spotting a few days following. A potentially serious complication can result if you are allergic to the contrast dye. If you have had any allergic reaction to prior contrast dye (as used with a CT scan, IVP) you need to notify your physician so that you can be prescribed medications to reduce your risk for a reaction.
So, if the prospect of having a HSG causes your hands to sweat and your heart to palpitate, please recognize that if you are like most of our patients, you will quickly jump off the table exclaiming “that really wasn’t so bad”.
Wende Allen rocks! She did my HSG at GBMC and it was completely painless. Ok, my tubes were not blocked in any way, but still…I’d completely worked myself up over what I thought was going to be a horrible procedure, but in the end, it was all just fine.
So, one question I had subsequent to my HSG and one I picked up from reading on internet support groups, is that an HSG can actually facilitate fertility and not just because it diagnoses problems. It has like a “lubrication” kind of effect. Is that true or merely a myth?
Thanks again!
Hi Natalie!
Yes, some people do conceive following the HSG, leaving many to question whether the HSG is therapeutic as well as diagnostic. One thought is that there may be “filmy” adhesions within a tube that are pushed away with the injection of the dye. These adhesions, if present, could potentially prevent the sperm from meeting the egg. But an HSG cannot open a tube that is truly blocked. So we still treat the HSG as a diagnostic test and do not expect it to be a form of treatment.
- Wende Allen
Over the past 7 years, I’ve had 3 HSGs – all of them have gone smoothly, with minimal discomfort. One of the positive side effects not mentioned in the post is that the dye can clear your tubes if they are “gunked” up (not with scar tissue). I am 32 weeks pregnant following my last HSG and an IUI – the dye wouldn’t pass through my right tube and the tech made me roll a bit and the pressure from the dye was finally able to clear my tube. Incidentally, the same side my follicles were on the following month. Little girl due in 52 days, thanks (in part) to my HSG.
Congrats on your success Ami!
Many do feel that the HSG can help clear out adhesions in the tubes. Sounds like that may have been so in your case.
I had my HSG done a few months ago and I did have some pretty intense cramping during mine. I have endometriosis, so i’m used to intense cramps, but I was pretty uncomfortable through the procedure, but it was quick, and it wasn’t anything that I couldn’t bare. I didn’t have any blockages thank goodness, but I do only have one tube and one ovary, so I don’t know if that is why my experience was different. I’m not trying to be negative, just trying to provide another perspective.
Stacy – Thanks for sharing. Not everyone has the same experience, and it definitely isn’t a fun procedure. But while uncomfortable, as you said, it isn’t anything that woman should be scared of or too nervous about.
Oh good im not so nervous anymore i have one schedule in march wish me luck guys
Good Luck Alicia!
Thanks for the detailed info about the HSG, I’m scheduled for one this coming week. My question is since HSG is considered a diagnostic test, if my tubes are blocked and cannot be cleared from the dye, what happens next?
I had an HSG test done a couple of days ago and i guess because i have Endometriosis and only one tube, THE MALE doctor shot the dye up in my tube quickly and I was in so much intense pain that when i got off the table i went to the bathroom and could not get off the bathroom floor at the doctors for an hour and finally since I take the bus where I live, I had to call a taxi because i was unable to walk that much and the pain did not go away for 6 hours with 3000 milagrams of ibuprofen.
I just had my HSG performed by Wende Allen (she is wonderful, by the way) 1 hour ago. After reading all that horror stories on internet, I was so nervous! It was nothing at all. Like a regular OB exam, but a little bit longer. My both tubes were clear. You might feel something if your tubes are blocked. But please, don’t stress yourself, don’t read all the stories online, and relax. You are in good hands, so you will be fine anyway!!!
That is great to hear, Tanya!! I’ll definitely share with Wende. And yes, typically if your tubes aren’t block, it shouldn’t be anything more than a little uncomfortable. Glad to hear yours went well. Have a great day!
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I’m going there next week at K St. I hope Wende will do my procedure too.
Hi Dythe – How was your appointment? Wende works out of our Baltimore area offices but the DC staff is just a fabulous.
After reading all the comments, I was really scared about the pain that I read it causes and mostly scared about what if there’s any blockage in my fallopian tubes…On the contrary, even though it took more than 4 attempts for the doctor to insert the rubber pipe through my cervix, it was not at all painfully except for 2-4 seconds of our very known menstrual pain which occurred when they filled with the contrast dye…that was all, the next thing I see on the monitor of the x ray machine was that the dye reached the end of both my Fallopian tube and I was glad o come off the table..Trust, once you know that the tubes are not blocked, every lil bit of pain, if there is, subsides and gives a very happy and jumpy feeling at the end of the day…
Big thanks to the team of nurses and doctors at Chelsea n Westminster Trust Foundation, Greater London.
Thank you for sharing your experience, Raunak. Everyone reacts differently, the majority of patients have a slight pain as you described.
I had a HSG done be 4. It was painful a little and it s something i would try again 2 c if my tubes were blocked…
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My HSG went very smoothly. I only felt a little pinch when they inserted and inflated the catheter. When they injected the dye it just felt like a very dull menstral cramp and then it was over before I knew it! I’ve heard so many stories of women getting pregnant soon after. My concern is, are there any studies showing any risk to the egg that is present during the procedure? Since there is radiation involved, could that affect the quality of the egg? Thank you in advance for your time!
Hi Jennifer- That is a great question. The radiation used is minimal and there is no fetal impact. Hope all goes well with your journey!
I had hsg test 5 months ago it was painful when i
laid on the table but after an hour the pains disappeared. I wonder why am not pregnant yet
I am sorry, Windalin. For some women HSGs can be painful, typically when a blockage is found. What were the results of the test? Have you discussed the results with your physician?
Hi wende,
I had hsg 2day ago. Can you explain some of my result?
‘both the fallopian tubes are patent. The peritoneal
spillage of contrast however is loculated in the
para-adnexal regions. This could be due to adhesions.’
The doctor doesnt explain it in detail coz he had
operation to handle.
I realised the doctor inject me two times. The first
time of injection ive heard the doctor saying
something,n the second injection i saw she
push the needle a little bit far from the first
injection. I watch it on monitor.
So wende,hope you dnt mind to explain this to me.
Tq.
Hi Amy – Happy to help explain. Both of your tubes being patent is a good thing – it means they are open, which is what we want. The dye (contrast) spilled out of the ends of the open fallopian tubes into the abdomen (peritoneum). ‘Loculated’ relates to that the dye may appear ‘bunched up’ in some areas, possibly due to the presence of adhesions. The only way to know if they are adhesions is to have surgery which typically is not necessary and won’t impact treatment.
Hope this was helpful. Please let us know if you have any further questions.
I was told that one of my tubes was completely clear and the other one had some spillage, but not blocked. What does this mean as far as getting pregnant?
Hi Jill – For the tube that is clear, that is exactly what we want to see. And typically, given that other factors such a sperm, age, etc are reasonable, an IUI for treatment is usually considered.
For the tube that has spillage – just that the extra dye exited into the abdominal space – that can also be normal, but not enough to say one way or the other.
I had my first HSG attempt today. I was really nervous going into the exam. It was pretty painful when he inserted the speculum. He couldnt find the right position so it became irritating. Then he began with inserting the catheter and had no luck so he tried another and still no luck. It was very painful. No medicine was given. I was shaking on the table from feeling so tense. I had to remind myself to breath. He finally stopped because he could not get the catheter inserted. I have no issues with my cycle at all. Very regular. Mild cramping first day of cycle and that’s it. Is it possible that it did not work because i could not relax? Have you heard of this before?
I had an HSG test done on Monday and a positive Ovulation surge that evening. Can the HSG dye cause issues with conceiving? Also, is light bleeding normal a few days after the test?
I had an HSG test on Monday and positive ovulation surge that evening. Can the HSG dye or procedure cause issues with trying to conceive? Also, is light bleeding normal a few days after the test?
Hi Sally – Many apologies for just now seeing this comment. The procedure can not cause any issues with trying to conceive. As for any side effects (light bleeding, cramping, etc) everyone will respond differently – especially depending on what the test might find. I hope that your medical team/nurse has been able to help you with everything and best of luck with the rest of your treatment.
Cheers! It’s the best time to make some plans for the future and it’s time to be happy.
I had hsg yesterday it was painful and uncomfortable. Still weak and having slight pains this morning. I threw up after the test. I just hope it went well. Will see the Doctor on monday. I pray all is well.
I hope everything turned out okay. Patients will respond differently to HSGs – but hopefully any discomfort is gone and the test was able to produce information that will help with your treatment.
I had my HSG today at SG. I was worried about it being unpleasant and painful, but it was super quick and completely painless. I was so happy and relieved!
Glad it went well, Katie!
I had hsg this morning.it went well.it wasnt painful as i heard with some people.just a mild cramp when the fluid went in.i was given some shots of antibiotics after the procedure.After 4 long hrs of sleep,i woke up with these heavy cramps insidemy belly from under my breast to abdomen,made me so restless.i feel extra bloated ,like all the gas in d world is inside my stomach.I v taken 2 tablets of buscopan,am still feeling same way.i hope i ll be better by morning.
Hi Juli – I hope you feel better now that it is a couple days later. Like many procedures, patients will respond differently. If you are still in discomfort, contact your primary nurse so she is aware and can advise you on what to do.
I just had my hsg done and it reminded me of my first contraction! I just want toknow if the test will disturb my menstrual cycle? Hsg is normally done on the 10th-12th day of the cycle. Now that I have light bleeding after the test, does it mean that my next menstrual will fall on the 28th day counting from today?
Thanks.
I am having this test next month and I have been terrified about the pain. I did exactly what you described and googled it and then stupidly read about people saying it is so painful and like being in labour!
I feel better after reading this and hope that the pain won’t be too bad! Wish me luck!
I had a hsg a few days ago n the radiologist explained step by step. I saw the dye injected in my tubes but it looks like the dye didn’t move. They didn’t answer any questions have to wait for my doctor to get the results. Are my tubes blocked?
Hi
I had a HSG this morning. It was uncomfortable bu tnot nearly as bad as I had imagined. It showed I have a blocked right tube. What are my chances of conceiving naturally? After a stillborn and then an ectopic, I am feeling really defeated. I was hoping for better news.
I had my HSG scan 2 weeks ago and I only feel as if I have gotten back to normal now. My tubes were blocked and the male doctor decided to try to force the contrast fluid through. This was was not discussed with me at the time and my permission was neither sought nor given for him to force the fluid through. No pain medication was given before forcing the fluid. I was in agony. I was crying and begging the doctor to stop. He ignored me. Afterwards while I was still lying on the gurney and the nurse was removing the medieval torture device he had used, he turned to me and said brusquely while pointing at the monitor ‘ That’s why you can’t get pregnant. I recommend IVF’ and then just walked away. I really feel that he should have waited until the device was out and I could sit up and talk to him face to face like a human being. I was in pain for days afterwards: I blacked out at work the following day and had to be sent home. I’m supposed to get in touch with the clinic again about the IVF but I haven’t been able to bring myself to do so.
I had an hsg done yesterday may8,2013..i read online that it would cramp , can i tell you no pain at all, just received result sayign patent fallopian tube? what does this mean because i did an ultrasound which say both ovaries abnormal.
I had an HSG on May 2nd which was normal and no signs of blockages. I am currently on CD 20. I temp every morning and haven’t noticed a shift in temperature. My temperature has steadily been in the 96.6 to 97.1 range with no steady increase. Is it possible that I won’t ovulate this month? I have been really bloated and crampy for the past couple days but don’t think there is a chance that I could be pg because I didn’t see a shift in temperature. I have a call into the dr but they haven’t gotten back to me. Your thoughts are greatly appreciated
I had my HSG on CD 11 (tubes are clear!) and I ovulated on CD 15, what are the stats on conceiving on the same cycle as your HSG. Thanks for any help!! **Baby dust to us all**
I had HSG done today and tubal 7 years ago my right tube is blocked still however my left tube had trucked of openings and some scarred tissue I started cramping towards end a little but now I’m home and cramping bad. I was told if I got pregnant it would be ectopic due to left tube open and scar tissue is it possible at all for normal pregnancy?