The Basics Of The Hysterosalpingogram (HSG)

When you go to a fertility doctor or clinic, they will more than likely begin by doing some basic diagnostic blood work and testing. One of the first tests typically performed is a Hysterosalpingogram or HSG. While you have to wait for results from other tests, the HSG is one the few fertility testing procedures that provides you with instant results. The Hysterosalpingogram is used to determine if there are any blockages in either of your fallopian tubes and it will also show if there are any uterus abnormalities or fibroids.

The HSG is usually done at a local hospital’s surgical/surgery center, although many fertility clinics have the necessary equipment to perform the test right in the clinic as it is a fairly common fertility test. The HSG is a quick procedure that typically takes less than 15 minutes from start to finish. During the procedure, you will like on your back on a table with your legs raised. The doctor will inject contrast die through your cervix into your uterus while simultaneously taking an x-ray of the area. The contrast die will spread through your uterus and tubes and will show if there are any abnormalities or blockages in the tubes. In many cases, you will be able to watch the die spreading on a TV in the room. I was able to watch the procedure and the doctor explained what was happening and what he saw as the die spread.

Your doctor or clinic will probably advice you that during the HSG you “might” feel a “slight discomfort”. I have found through talking with other women in my fertility support group, that the discomfort or pain associated with the procedure is different for every woman. A few women stated that the procedure did not bother them at all and one friend said she came up off the table when they inserted the die. I fell somewhere in between the two extremes. Because my tubes were blocked, the doctors said that added to the pain I felt and that women without any blockages typically feel less discomfort with the HSG. Most doctors will prescribe something like a prescription strength Tylenol for you to take before the procedure. I had a second HSG after I had surgery to unblock one tube and remove the other. My doctor let me take pain medication left over from my surgery before the second HSG. One of the girls in my support group was very scared to have the HSG done because of the uncertainty of the pain. She knew she would not be able to relax during the procedure, which is important, so her doctor prescribed one valium for her before the procedure.

You might experience slight uterine cramping for a few hours after the procedure and this is normal. You should also wear a panty liner for a few days as some of the die might come back out of your cervix.

The results of the HSG are very important in helping to determine your next steps or procedures in the fertility process. A normal HSG that shows no blockages or abnormalities rules out blocked tubes as a possible cause for your fertility problems and your doctor will begin further testing. If the HSG shows a blockage in one or both of your fallopian tubes, your doctor will discuss your alternatives with you. This boils down to two choices: you attempt to unblock the tubes through laparoscopic surgery which will increase your probability of pregnancy or your can choose to not have the surgery, keeping the blockages in place and decreasing the probability of pregnancy. Whether or not to have the surgery is obviously a personal decision and you need to take the time to decide what is right for you.

A blocked tube carries some risks and complications. First of all, when one or both of your tubes are blocked, you are at an increased risk for having an ectopic or tubal pregnancy. This is a very serious condition, especially if the tube ruptures. The second complication involved in a blocked tube is that most doctors will not do an IUI or IVF procedure when a tube is blocked as it will decrease your chances of a successful procedure and can actually work against it. For instance, when you do an IUI with a blocked tube and the sperm is injected directly into the uterus, the chances of the sperm and egg meeting are slim to none since the tube is blocked and the egg and sperm can’t get through it to meet. If you do an IVF with a blocked fallopian tube, the blocked tube can cause fluid to back up into the uterus which impedes the embryo from implanting in the uterus.

If you decide to have surgery to unblock the tubes, your doctor will likely schedule a second HSG once you have healed from the surgery. They do this to make sure that the tube is open and that the die passes through the way it should. This second HSG will help determine what your next step will be.

Having gone through the HSG, I want to pass two things that I learned on to you. First of all, take someone with you when you have the procedure done. When I went the first time, I insisted on going by myself because I felt like everything was going to be ok. My husband would have gladly gone, but I guess I was being stubborn. Anyway, when things weren’t ok, I really wished that I had had him come with me. Second of all, if your doctor offers you any pain medication before the procedure, take it. You never know what your pain or discomfort experience is going to be like with the HSG, so it is best to be prepared for anything.

For many, Hysterosalpingogram is the most important procedure that they have done during the fertility process. For me, it was the most important procedure done during our fertility journey as it gave us instant results and instant answers as to what was going on to prevent us from getting pregnant. Although, slightly uncomfortable, it is over quickly and you are able to walk away from the HSG knowing what your next step will be.

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