Hysterosalpingography: Everything You Need to Know About This Test

If you’re looking for information about hysterosalpingography (HSG), your doctor has likely recommended it to evaluate the condition of your fallopian tubes and uterus. This test is key in fertility assessments, and although it may sound complex, I’ll explain everything clearly — including a real experience — so you know exactly what to expect.

What is Hysterosalpingography?

Hysterosalpingography is an imaging test that uses X-rays and a contrast medium to visualize the shape of the uterus and check if the fallopian tubes are blocked.

It’s primarily used in women who are having difficulty getting pregnant, as a blocked tube can be a common cause of infertility.

What is the test for?

This test helps detect issues such as:

• Blockages in the fallopian tubes that prevent the egg from passing.
• Uterine abnormalities like polyps, fibroids, or adhesions.
• Congenital uterine malformations that may impact fertility or increase the risk of miscarriage.
• Evaluating tubal patency after surgery or fertility treatments.

Important: While hysterosalpingography helps diagnose problems, it does not treat them. If a blockage is found, your doctor will recommend other procedures to correct it.

If you’ve never had this test before, it’s normal to feel uncertain. Here’s what the procedure is like:

Before the exam

• It is scheduled within the first 10 days of the menstrual cycle (but after your period has ended).
• You may be prescribed an anti-inflammatory or antibiotics before the exam.
• Anesthesia is not required.

During the exam

“When my gynecologist told me I needed a hysterosalpingography, I was worried about the pain. He explained it only lasted a few minutes and reassured me. On the day of the exam, I was a bit nervous, but the doctor walked me through every step.”

1. You lie on a table with your legs in gynecological position.
2. A speculum is inserted (like during a Pap smear).
3. A catheter is placed into the uterus, through which the contrast liquid will be injected.
4. The contrast flows into the fallopian tubes, showing whether they are blocked.
5. X-ray images are taken.

“When the liquid passed through my tubes, I felt a mild cramp, like a menstrual cramp, but it was manageable and lasted only a few seconds. Afterward, the doctor removed the catheter and let me rest for a few minutes.”

After the exam

• You may experience slight bleeding and cramping.
• It’s recommended to use a sanitary pad (not tampons) in case there’s some contrast residue.
• In some cases, the doctor may prescribe antibiotics to prevent infection.

Interesting fact: Some women get pregnant after hysterosalpingography because the contrast liquid may “clear out” minor blockages.

Does HSG hurt?

This is the most common question. The answer varies from woman to woman.

• Some feel only slight discomfort.
• Others describe moderate pain, like a strong menstrual cramp.
• Rarely, it may be more painful if blockages are present.

“In my case, I felt pressure when the catheter was inserted and a mild cramp when the liquid flowed through my tubes. But the test was quick and totally bearable.”

Tip: If you're worried about pain, take ibuprofen one hour before the test to reduce discomfort.

HSG Results

The radiologist will interpret the images and send a report to your gynecologist. There are three possible results:

1. Normal: The contrast flows freely through the tubes and the uterus has a normal shape.
2. Tubal obstruction: If the liquid doesn’t pass, there may be a blockage in one or both tubes.
3. Uterine anomalies: Polyps, fibroids, or malformations may be detected.

“In my case, the result was normal, which gave me peace of mind and allowed me to move forward with my pregnancy plan.”

Side Effects and Risks

Hysterosalpingography is safe, but like any procedure, it may have side effects:

• Mild or moderate cramping.
• Light bleeding for 1–2 days.
• Feeling dizzy or nauseated.
• Very rare: infection or allergic reaction to the contrast.

If you experience fever, intense pain, or foul-smelling discharge after the test, contact your doctor.

What to Do After the Test

After your HSG, follow these recommendations:

• Rest if you feel discomfort.
• Drink water to help flush out the contrast medium.
• Avoid sexual intercourse for 24–48 hours.
• Contact your gynecologist if you have any questions.

Frequently Asked Questions

• How much does an HSG cost?
  It depends on the country and clinic.
• How long does the test take?
  Around 15–30 minutes.
• When can I have sex after the test?
  It’s recommended to wait 24–48 hours to avoid infections.
• Is it possible to get pregnant after an HSG?
  Yes. Some women conceive in the months following the test, as it may help “unclog” partially blocked tubes.

Sonohysterography at Fertility Madrid: A Less Discomforting Alternative

If you’re looking for a less uncomfortable alternative to hysterosalpingography, at Fertility Madrid we offer sonohysterography.

How is it different?

Instead of using X-rays and iodine contrast, sonohysterography uses a saline solution and ultrasound to assess the uterine cavity and tubal patency.

Advantages:

• Less discomfort than HSG.
• No radiation.
• Provides more detailed views of the uterine interior.

If you're considering a fertility assessment, consult with our specialists at Fertility Madrid to find out which test is best for you.

Is it worth having a hysterosalpingography?

If you're having difficulty getting pregnant, this test can give you key insights about your fertility. While it may cause some discomfort, it’s quick, effective, and safe.

“At first, I was scared, but in the end, I’m glad I did it. Now I know my tubes are clear, and I can keep trying with more confidence.”

If your doctor has recommended an HSG, don’t hesitate to ask all your questions and prepare for the test with peace of mind.

Would you like to speak with one of our specialists in Assisted Reproduction?

Schedule a consultation with us at Fertility Madrid and discover how we can help you.

Do you have any questions or need more information?

At Fertility Madrid, we specialise in treatments such as egg donation, in vitro fertilisation and artificial insemination, among others.

Please do not hesitate to contact our professionals at our fertility clinic and they will answer all your questions without obligation.