James Silberzweig, MD
Interventional Radiology, P.C.
200 West 57th Street, Suite 407
New York, NY 10010
Tel: (212) 246-2063
Why do I need an HSG exam?
During ovulation, one of your ovaries releases an egg that travels down one of your fallopian tubes where the sperm and egg will meet, and fertilization can occur. Once an egg is fertilized, an embryo will develop and continue through the fallopian tubes until it reaches the uterus, where it will implant into the uterine lining.
The hysterosalpingogram is performed routinely for patients having difficulty conceiving because it is an excellent test that not only can confirm that a woman’s fallopian tubes are open but can also evaluate whether the uterus has a normal shape. It can also make sure the cavity is not affected by fibroids, polyps or scar tissue. Tubal factors cause 25-35% of female infertility.
How does the HSG exam work?
HSG test is a radiology exam to look at the structure of the uterine cavity and to determine if the fallopian tubes are unobstructed and are of normal size. HSG is a quick, 5-minute office procedure. The exam result will be immediately available!
When is the best time during my cycle to schedule an HSG?
The test should be scheduled after your period ends, but before you expect to ovulate – usually between days 5 and 12 of your menstrual cycle. This timing reduces the risk of having the test when you’re pregnant.
Should I take antibiotics?
Antibiotic use is not routinely required. Ask your doctor whether you should take antibiotics before the procedure. In some cases, depending on your medical history, your doctor may suggest a course of antibiotics before your HSG test to reduce the risk of infection.
This procedure should not be performed if you have an active inflammatory condition. Notify your physician if you have a chronic pelvic infection or an untreated sexually transmitted disease before scheduling an HSG.
What if I am allergic to HSG contrast?
Make a list of any allergies you may have. Allergic reactions to the HSG contrast are rare but can occur. HSG contrast is the same as intravenous computed tomography (CT or CAT scan) contrast. Gadolinium hysterosalpingography is a safe alternative to iodinated contrast medium for HSG in patients at increased risk for iodinated contrast hypersensitivity.
What should I bring to my HSG appointment?
Bring your insurance card, personal identification, the prescription for the exam, and any prior HSG studies and reports. Bring a pad with you. A small amount of spotting is normal after an HSG test, and there can also be leakage of the contrast dye. Wearing a pad for the rest of the day will help protect your clothing.
What will happen during the examination?
You will be asked to change into a gown and lie on the examination table. A speculum is placed into the vagina, and then a small catheter is inserted into the uterine cavity. A small balloon on the catheter is inflated to hold it in place and make a seal.
Contrast is then injected slowly and flows into the uterine cavity and out through the tubes into the pelvis. The flow of the dye is monitored via fluoroscopy (x-ray) images.
Is the HSG painful?
You may briefly experience uterine cramping during the procedure. Some women experience new cramping approximately 3-4 hours after the procedure. Taking over-the-counter pain medications before and after the HSG can help. The HSG is performed while you are awake and does not involve anesthesia. You won’t need to fast the day of or night before.
What to expect after the exam
Immediately after your HSG test, you can resume normal activities.
Bring a pad with you. A small amount of spotting is normal after an HSG test, and there can also be leakage of the contrast dye. Wearing a pad for the rest of the day will help protect your clothing. You may need to wear a pad for a few days as the dye is slowly expelled from the uterus.
You may experience new cramping approximately 3-4 hours after the HSG. Don’t hesitate to take over-the-counter pain medications and drink lots of liquids after the exam.
Immediately following the examination, the doctor will discuss the HSG results and provide you with a written report for your records. We will also fax your HSG report to your referring physician.
After the exam, we will send you a text message confirming you are doing well after the procedure and have an opportunity to ask any additional questions.
Heavy bleeding, severe pain, or fever are not normal side-effects and should be investigated immediately.
Many patients ask if they should refrain from intercourse after having an HSG. No, you should not. Pregnancy after an HSG may be more likely, depending on the cause of your infertility.
Can the HSG increase my chances of pregnancy?
While the HSG is primarily for diagnostic purposes, it has been observed that the number of natural pregnancies after HSG tests is higher in women with unexplained infertility. The pregnancy rate after an HSG test is believed to be around 2 to 3 times higher than those infertile women who have not undergone this test before.
The test itself is not a treatment for infertility; it is done to understand the reasons for infertility. However, it is a fact that a lot of infertile women got pregnant after the test, the exact reasons are unknown, though. Getting pregnant after the HSG, therefore, may be a coincidence, or due to some unknown reason in the procedure of carrying out the test.
While HSG tests are not a treatment for infertility, women with unexplained infertility may have a greater chance of getting pregnant after conducting this test.
Can an HSG evaluate my ovaries?
No, hysterosalpingography is designed to evaluate only the uterine cavity and fallopian tubes; it cannot be used to evaluate the ovaries or to diagnose endometriosis or fibroids.
Can you unblock fallopian tubes?
Fallopian tube recanalization (FTR), also referred to as Selective Salpingography, is a minimally invasive, non-surgical procedure used to reopen blockages in one or both of the fallopian tubes. This low-risk procedure is recommended as the first intervention for patients with blockage of the proximal fallopian tube – where the uterus meets the fallopian tube.
Oil-based contrast (Lipiodol flush)
Although HSG is not a new procedure, recent research has shown significant benefits for fertility linked with the use of Lipiodol, an oil-based contrast, compared to water-based HSG contrast. A recent landmark study, published in the New England Journal of Medicine, confirms significant fertility benefit from Lipiodol.
We begin the HSG exam with water-soluble contrast to confirm that your fallopian tubes are open and are of normal size. If your fallopian tubes are normal, the exam can be followed with the injection of the oil-soluble contrast.
Discuss with your doctor if the use of the oil-soluble contrast may be of benefit for you.
Minimizing radiation exposure
Dr. Silberzweig has performed over 30,000 HSG exams and has also completed research with multiple publications on minimizing radiation exposure and improving patient comfort, ensuring that your treatments will be safe and effective with minimal discomfort. Special care is taken during HSG examinations to use the lowest radiation dose possible while producing the best images for evaluation.
Are there alternatives to HSG?
Other procedures that can give your doctor some of the same information as HSG:
Laparoscopy —This surgical procedure requires general anesthesia.
Hysteroscopy —This procedure can give a detailed view of the inside of the uterus. However, it cannot show whether the fallopian tubes are blocked.
Sonohysterography —This technique uses ultrasound to show the inside of the uterus. Like hysteroscopy, it does not give complete information about the fallopian tubes.
Hysterosalpingography versus sonohysterography for intrauterine abnormalities. Acholonu UC, Silberzweig J, Stein DE, Keltz M. JSLS. 2011;15:471-4.
Hysterosalpingography with selective salpingography. Vardhana PA, Silberzweig JE, Guarnaccia M, Sauer MV. J Reprod Med. 2009;54:126-32.
Hysterosalpingography with use of mobile C-arm fluoroscopy. Phillips J, Cochavi S, Silberzweig JE. Fertil Steril. 2010;93:2065-8.
Cesarean section scar diverticulum: appearance on hysterosalpingography. Surapaneni K, Silberzweig JE. AJR Am J Roentgenol. 2008;190:870-4.
Gadolinium for hysterosalpingography. Silberzweig JE, Khorsandi AS, Caldon M, Alam S. J Reprod Med. 2008;53:15-9.