A hysterosalpingogram or HSG is an X-ray procedure in which a special iodine-containing dye is injected through the cervix into the uterine cavity. The aim of this procedure to illustrate and examine whether the inner shape of the uterus (womb) is normal or not and if the fallopian tubes are open, narrowed or completely blocked.   

A patient is prescribed to examine the uterine cavity and patency of fallopian tubes in the following cases:

• If a patient is unable to get pregnant after trying for six months. A physician will test the woman’s hormone levels, reproductive organs function (ovaries, fallopian tubes, and uterus) and the partner’s sperm.
• Check for a blocked fallopian tube. An infection may cause severe scarring of the tubes and block them. Sometimes the dye used during the HSG may push through this region and open a blocked tube.
• In the case of repeated miscarriages, a doctor will check the urine cavity to test, whether there are some injuries, polyps, fibroids, adhesions or foreign bodies.
• Check if tubal implants for a permanent birth control block the inlet.
• After tubal ligation surgical procedure, a doctor makes sure whether fallopian tubes are completely closed.

An HSG is not the only procedure, which is used to evaluate the urine cavity. A vaginal ultrasound, sonohysterogram, and hysteroscopy are also used.

HSG is a simple technique that usually takes 5-10 minutes. The procedure is usually done after the menstrual period ends but before ovulation begins (the 14th day in the case the cycle lasts 28-30 days). It’s done so to make sure that no pregnancy develops.

A woman is invited to the special room, where all equipment for the procedure are already prepared. A radiologist or gynecologist uses a fluoroscope, X-ray imager that takes pictures during the procedure. A patient is positioned under the fluoroscope on a table. The doctor or nurse places a speculum in the vagina, clean the cervix and places a device into the opening of the cervix. After that, a water- or oil-based liquid, which contains iodine (contrast that is usually used in X-ray), fills the cavity and fallopian tubes. As the dye enters the tubes, it outlines the length of the tubes and spills out their ends, if they are open.

A normal HSG result means that the dye flows free through the uterus and tubes; no scaring, blockages or abnormalities are found. If there are any signs of irregular flow (some injuries, polyps, fibroids, adhesions or foreign bodies or obstructed tubes), the result is registered as abnormal.

The procedure is mostly very safe, only in several cases, some complications may occur:

• Infection, in the case of the previous tubal disease.
• Radiation exposure. This is a reason why the procedure should not be done if pregnancy is suspected.
• Iodine allergy
• Light vaginal bleeding

The HSG usually causes mild or moderate uterine cramping for about 5-10 minutes or sometimes for several hours. To reduce or avoid these uncomfortable feelings a woman takes medications for menstrual cramps before the procedure or when they occur.  The HSG is an outpatient procedure, so a woman can go home. It will be better if members of family or friends will carry her. In the absence of cramping, a woman can immediately return to normal activities, although some doctors ask to refrain from intercourse for a few days.