HSG Test for Fertility: Why It Is Done, What It Shows and What to Expect
If you are undergoing a fertility evaluation, your doctor may recommend a test called an HSG, or hysterosalpingogram. It is commonly used to assess the uterus and, importantly, whether the fallopian tubes are open.
For many women, being advised to undergo an HSG immediately raises questions: Will it be painful? Why do I need it? What happens during the test? And what does a blocked tube mean for pregnancy?
This guide explains the HSG test in simple terms, including what it can show, how it is performed, what the results mean, and what may happen next.
Quick answer: An HSG is an imaging test that uses contrast material and X-rays to examine the shape of the uterine cavity and check whether the fallopian tubes are open. It is one of the standard tests used to evaluate tubal patency during fertility assessment.
What Is an HSG Test?
HSG stands for hysterosalpingogram.
It is a specialised X-ray examination in which contrast material is introduced through the cervix into the uterus. The contrast outlines the uterine cavity and, if the fallopian tubes are open, passes through them and spills beyond the ends of the tubes.
This allows the doctor to assess two important areas:
- The shape and outline of the uterine cavity
- Whether the fallopian tubes are open or blocked
HSG is particularly useful because problems involving the fallopian tubes may not cause obvious symptoms. A woman may have regular periods and otherwise feel well while a tubal problem is affecting her ability to conceive.
Why Is HSG Done During Fertility Evaluation?
Fallopian tubes play an important role in natural conception because they provide the pathway through which sperm and egg meet.
If one or both tubes are blocked or damaged, it can make conception more difficult.
An HSG may therefore be recommended when your doctor is evaluating possible tubal-factor infertility. ASRM recommends HSG or sonohysterography as tests for evaluating tubal patency.
Your doctor may particularly consider tubal evaluation if you have a history of:
- Difficulty conceiving
- Previous pelvic infection
- Endometriosis
- Previous ectopic pregnancy
- Certain pelvic surgeries
- Suspected tubal disease
- Previous fertility treatment
However, fertility testing is not identical for every woman. The evaluation should be based on your age, medical history, menstrual pattern, reproductive history and your partner’s fertility factors as well.
What Can an HSG Test Show?
An HSG can provide useful information about both the uterus and fallopian tubes.
1. Whether the Fallopian Tubes Are Open
This is one of the main reasons an HSG is performed.
If contrast passes through the fallopian tubes and spills freely, the tubes appear patent, meaning open.
If the contrast does not pass through a tube, the HSG may suggest a blockage.
However, an apparent blockage—particularly near the beginning of the tube—does not always mean that the tube is permanently blocked. Temporary contractions or technical factors can sometimes produce a false-positive result. Further evaluation may therefore be needed before a final conclusion is made.
2. The Shape of the Uterine Cavity
HSG can also show the size and shape of the uterine cavity and may suggest certain structural abnormalities.
It can sometimes identify findings such as:
- Uterine cavity abnormalities
- Certain congenital uterine differences
- Polyps
- Submucosal fibroids
- Intrauterine adhesions
HSG does not provide a complete evaluation of every uterine condition. If an abnormality is suspected, your doctor may recommend another investigation such as 3D ultrasound, saline sonography, MRI or hysteroscopy.
How Is an HSG Test Performed?
The exact process can vary slightly depending on the facility and your individual circumstances.
Generally, the procedure involves the following steps:
Step 1: Positioning
You will lie on an examination table in a position similar to that used during a pelvic examination.
Step 2: Speculum Examination
A speculum is gently inserted into the vagina so that the cervix can be seen.
Step 3: Introducing the Contrast
A small catheter is placed through the cervix, and contrast material is slowly introduced into the uterus.
Step 4: X-Ray Imaging
As the contrast moves through the uterus and fallopian tubes, X-ray images are taken.
The doctor observes how the contrast travels and whether it passes through the tubes.
The procedure itself is generally relatively brief, although the exact duration can vary.
Is an HSG Test Painful?
This is one of the most common concerns.
Some women experience cramping or discomfort during an HSG, while others experience only mild discomfort. The experience can vary depending on factors such as individual sensitivity, cervical passage, uterine or tubal conditions and the circumstances of the procedure.
You may feel cramping when the contrast is introduced, somewhat similar to menstrual cramps.
Your doctor may advise you about pain-relief options before the procedure. If you have concerns about pain, anxiety or a previous difficult pelvic procedure, discuss them with your doctor beforehand.
It is also important not to assume that severe pain is necessary for an HSG. If you experience significant discomfort during the procedure, tell the healthcare team.
How Should You Prepare for an HSG?
Your doctor or imaging centre will give you specific instructions because preparation can vary.
Depending on your circumstances, you may be advised about:
- The appropriate timing of the procedure within your menstrual cycle
- Whether you should take a pain-relief medicine beforehand
- Whether any infection screening or treatment is needed
- Whether you should avoid intercourse around the time of the procedure
- When you can resume normal activities
Because the timing of an HSG matters in relation to pregnancy, follow the specific instructions provided by your treating doctor or the centre performing the procedure.
If you have a history of pelvic infection, allergies or previous reactions to contrast material, tell your doctor before the test.
What Happens After an HSG?
Most women can return to their usual activities relatively soon, depending on how they feel and the instructions given by their healthcare provider.
You may experience mild cramping or light vaginal spotting afterward.
Your doctor may provide specific instructions about:
- Sexual activity
- Pain relief
- Signs of infection to watch for
- When to contact the clinic
- When to proceed with trying to conceive
Contact your healthcare provider if you develop concerning symptoms such as fever, severe or worsening pain, heavy bleeding, foul-smelling vaginal discharge or feeling significantly unwell after the procedure.
What Do HSG Results Mean?
Your HSG report may indicate that:
Both tubes appear open
This means contrast passed through both tubes. It is reassuring regarding tubal patency, but it does not by itself guarantee pregnancy.
Fertility depends on several factors, including ovulation, egg and sperm factors, the uterus, age and other reproductive or medical conditions.
One tube appears blocked
Pregnancy may still be possible if the other tube is open and functioning, but your doctor will interpret the result alongside your overall fertility evaluation.
Both tubes appear blocked
This may indicate tubal-factor infertility, but the location and nature of the apparent blockage matter.
A suspected proximal blockage may sometimes require further assessment because HSG can produce false-positive results in this area.
Your doctor may discuss additional evaluation or treatment options depending on the location of the blockage, your age, ovarian factors, sperm factors and other fertility considerations.
What If the HSG Shows Blocked Tubes?
A blocked tube does not automatically mean that there are no options for pregnancy.
Depending on the situation, your specialist may consider:
- Further testing to confirm the blockage
- Tubal cannulation in selected cases of proximal obstruction
- Laparoscopic assessment or treatment in selected patients
- Assisted reproductive techniques such as IVF
The appropriate option depends on where the blockage is, whether one or both tubes are affected, the condition of the tubes and other fertility factors.
ASRM notes that HSG is a standard first-line assessment of tubal patency but also recognises its limitations, particularly with apparent proximal tubal blockage.
Is HSG the Only Test Needed for Infertility?
No.
An HSG answers specific questions about the uterus and fallopian tubes. It does not provide a complete fertility assessment.
Depending on your situation, your doctor may also evaluate:
- Ovulation and menstrual cycles
- Ovarian reserve when clinically indicated
- Uterine anatomy through ultrasound
- Hormonal or metabolic factors when appropriate
- Semen analysis for the male partner
- Other reproductive or medical factors
ASRM recommends evaluating the relevant fertility factors rather than focusing on only one test. When a male partner is contributing to pregnancy, evaluation of both partners should generally begin in parallel.
HSG vs. Hysteroscopy: Are They the Same?
No.
Although both can provide information about the uterus, they are different procedures.
HSG uses contrast and X-ray imaging to evaluate the uterine cavity and particularly the openness of the fallopian tubes.
Hysteroscopy involves using a small camera to directly examine the inside of the uterine cavity. It can also allow certain abnormalities to be treated during the procedure.
ASRM considers hysteroscopy the definitive method for diagnosing and treating intrauterine pathology, while HSG is particularly useful for assessing tubal patency.
Can HSG Improve Fertility?
There has been research suggesting that tubal flushing during HSG may temporarily improve the chance of conception in some circumstances, particularly depending on the contrast medium used.
However, HSG should primarily be understood as a diagnostic test, not a fertility treatment. Any potential fertility benefit should be discussed with your fertility specialist rather than expected as an outcome of the procedure.
When Should You Discuss HSG With a Fertility Specialist?
HSG may be appropriate when your doctor needs to assess whether your fallopian tubes are open as part of a fertility evaluation.
It can be especially relevant when there is a history suggesting possible tubal disease, such as previous pelvic infection, ectopic pregnancy, endometriosis or pelvic surgery.
At the same time, not every woman trying to conceive automatically needs an HSG. Your doctor will decide whether it is appropriate based on your individual fertility history and other findings.
Frequently Asked Questions
No. HSG is used when evaluation of the fallopian tubes and uterine cavity is clinically appropriate. Your doctor will consider your history and other fertility factors before recommending it.
Sometimes an HSG may be associated with improved tubal patency, particularly in certain types of blockage, but it should not be considered a treatment for every blocked tube. A suspected blockage may require further evaluation.
The imaging procedure itself is generally brief, although preparation and recovery at the facility can add time. Ask your imaging centre how long you should plan to be there.
In many situations, couples can resume trying to conceive after the procedure, but follow the specific advice given by your doctor or the facility performing your HSG.
Not necessarily. If only one tube is affected and the other is functioning, natural conception may still be possible. If both tubes are affected, your fertility specialist can discuss appropriate options based on the location and severity of the blockage and your overall fertility profile.
A Final Word
An HSG can provide important information when doctors are trying to understand why pregnancy has not occurred. It can show whether the fallopian tubes appear open and provide useful information about the shape of the uterine cavity.
But an HSG is only one part of a fertility evaluation. A result showing a blocked tube does not always mean permanent blockage, and an HSG showing open tubes does not guarantee pregnancy.
The most useful approach is to interpret the HSG together with your medical history, ovulation, uterine assessment, ovarian factors and, when applicable, your partner’s fertility evaluation.
If your doctor has recommended an HSG, understanding why it has been advised—and what the possible results could mean—can make the process much less stressful.