What You Need to Know About the HSG Test

If you’ve been trying to conceive without success, it’s completely normal to feel overwhelmed by all the testing options out there. One of the most common tools used to assess fertility is the HSG test, or hysterosalpingogram. It might sound intimidating, but understanding how and why it’s used can make the experience much easier and even empowering.

When Should You Consider a Fertility Evaluation?

Let’s start with the basics. Infertility is defined as the inability to conceive after 12 months of regular, unprotected intercourse if you’re under 35, or after six months if you’re 35 or older. That said, this assumes you have regular periods and are consistently having intercourse. If you’re not menstruating regularly or aren’t having intercourse, it’s wise to get evaluated sooner rather than later.

Also, just because you haven’t hit those exact timeframes doesn’t mean you can’t seek help earlier. Many people come in sooner simply because they want to get checked out and sometimes, we find something we can address early on.

What Happens to Fertility Rates Over Time?

Fertility naturally changes with time. If you're under 35 and just starting to try, you have about a 20% chance per month of conceiving. But after a year of trying, that chance drops to about 4–5% per month, and by two years in, it’s closer to 2–3%. This is why timely evaluation matters. It helps us figure out how to boost your chances of conception sooner.

What Does an HSG Test Actually Do?

The HSG (hysterosalpingogram) is a test used to evaluate the inside of your uterus and fallopian tubes. During the procedure, a thin catheter is inserted through the cervix, and dye is gently pushed into the uterus and through the fallopian tubes while X-rays are taken.

The goal? To see if the uterus is clear and if the fallopian tubes are open. Think of it as a road map. We want to know if there are any blockages, abnormalities, or areas the dye can’t pass through.

The Procedure: What to Expect

An HSG can be done in a radiology center or a fertility clinic. You’ll lie on a table while a speculum is placed (like a Pap smear), followed by a catheter. A small balloon might be inflated to hold the catheter in place. As the dye flows in, X-rays are taken.

You might feel some cramping, especially if a tube is blocked, but in experienced hands, the procedure is quick. If you’re concerned about pain, let your provider know. Taking ibuprofen or Motrin (around 800 mg) beforehand helps, and you’ll likely be prescribed a short course of antibiotics afterward to reduce infection risk.

What Can the HSG Test Tell You?

The HSG is great for identifying blockages in the fallopian tubes and spotting abnormalities in the uterus, like polyps, fibroids, or scar tissue. However, it’s not perfect. It can’t always distinguish between certain uterine shapes or abnormalities. Sometimes, further testing like a saline ultrasound or even surgery is needed for a clearer picture.

Blocked tubes, especially when dilated (a condition called hydrosalpinx), are particularly concerning. A landmark study found that the presence of a hydrosalpinx can cut IVF success rates in half. In those cases, removing the affected tube before IVF is often necessary to improve outcomes.

Timing Matters

To get the most accurate results, HSG tests should be done between days 6–10 of your cycle, when your uterine lining is thin. If you're on birth control pills, that’s usually fine too. They help keep the lining thin. Just make sure you’re not actively bleeding on the day of your test, as it can lead to false results.

Does it Hurt?

The most common complaint about the HSG is pain. While no one would call it fun, in most cases, it’s tolerable and over quickly. The key is preparation. Communicate with your provider, take anti-inflammatories beforehand, and don’t hesitate to ask questions.

Also, give your body some rest after the procedure. Avoid intercourse immediately afterward to reduce the small risk of infection, and take it easy the rest of the day if you can.

Are There Alternatives?

Yes. Other methods include a saline infusion sonogram (also called the "bubble test"), which uses water and air to check the uterus and, to some extent, the fallopian tubes. While less uncomfortable, it's not as reliable for checking tubal patency. There’s also laparoscopy, a surgical procedure that lets us see everything directly, but it’s much more invasive and not usually the first step.

Who Is at Higher Risk for Tubal Problems?

Certain health histories can increase your risk for blocked or damaged fallopian tubes. This includes past infections like chlamydia or gonorrhea, abdominal surgeries, ruptured appendices, endometriosis, and inflammatory bowel disease. If you’ve had any of these, you might want to get an HSG earlier in your fertility journey.

The Bottom Line

The HSG test is a valuable diagnostic tool that gives us insight into the structure of your uterus and tubes. It’s not perfect, but it’s a solid starting point. Being informed and prepared can make a huge difference.