Date issued: August 2021
Review date: August 2023
What is a Hysterosalpingogram (HSG)?
A hysterosalpingogram or HSG is an x-ray procedure using dye. It is performed to see if the fallopian tubes are open and if the inside of the womb is a normal shape. A HSG is an outpatient procedure that takes less than 30 minutes to perform.
The HSG must be performed before day 10 in your cycle (day 1 is the first day of your period)
• You must NOT have sex before or after the HSG unless you use contraception
• It may seem strange that we are asking you to stop trying to get pregnant the month of this test but the dye used is very harmful for an early pregnancy
• The month after this test you are safe to try for a pregnancy again
The procedure is undertaken in X-ray west at University Hospitals Plymouth NHS. No anaesthetic is necessary, but some women do experience a degree of discomfort when the dye is introduced. This should last no more than a few minutes. You may wish to take a painkiller such as paracetamol or Ibuprofen 30 minutes prior to your test.
How is a Hysterosalpingogram done?
You will be positioned under a fluoroscope (a real-time x-ray imager) on an x-ray table. The fertility clinician will pass a speculum into your vagina. The cervix (the opening to the womb) is cleaned and a catheter is placed into the cervix. The clinician doing the test will gently fill the womb with a liquid containing iodine contrast (the x-ray dye) through the catheter. The contrast then enters the tubes, out-lines the length of the tubes and spills out of their ends if they are open. Any abnormalities in the womb or fallopian tubes will be visible on a monitor. The HSG is not designed to look at the ovaries or diagnose endometriosis. Frequently, side views of the womb and tubes are taken by asking you to change your position on the table. After the HSG, you can immediately resume normal activities.
The HSG is carried out during the first 10 days of your cycle. However, your period must have stopped 24 hours before the HSG. It is important that you must avoid a pregnancy during this cycle. Therefore, please avoid sexual intercourse or use barrier contraception.
Is it uncomfortable?
A HSG usually causes mild to moderate period cramping for about five minutes. However, some women may experience cramps for several hours. The symptoms can be greatly reduced by taking analgesia (pain relief) prior to the examination. We would suggest on the day of your investigation you bring a family member or a friend who can travel home with you.
What are the risks and complications of HSG?
A HSG is considered a very safe procedure. However, there is a set of recognized complications, some serious, which occur less than 1% of the time.
Infection: The most common problem with HSG is pelvic infection. This usually occurs in the presence of previous tubal disease. In rare cases, infection can damage the fallopian tubes or necessitate their removal. A woman should call the unit or her GP if she experiences increasing pain, vaginal discharge or a fever within one to two days of the HSG. To try and prevent this we will give you antibiotics after the HSG. The antibiotics are called doxycycline and you will take 2 a day for 7 days. They can make you feel sick and can cause blotchy skin if you spend time in the sun, so it is best to avoid sunlight whilst you are taking them.
Fainting: Rarely, you may get light-headed during or shortly after the procedure.
Radiation Exposure: Radiation exposure from a HSG is very low, less than a kidney or bowel study, and there have been no demonstrated ill effects from this radiation. The HSG should not be performed if pregnancy is suspected.
Iodine Allergy: Rarely, a patient may have an allergy to the iodine contrast used in an HSG. You should inform your doctor if you are allergic to iodine, intravenous contrast dyes or seafood. Patients who are allergic to iodine may need an alternative test. If you experience a rash, itching or swelling after the procedure, you should contact your doctor.
Spotting: Spotting commonly occurs for one to two days after the HSG. Unless instructed otherwise, if you experience heavy bleeding after the HSG please contact your doctor.
How to book the HSG?
Call the x-ray department on 01752 439284 on the first day of your period. Currently HSGs are performed on Tuesdays and Thursdays. If you cannot get the HSG within 5 months of first calling, then call the fertility secretary so we can time the HSG according to your cycle.
Following your hysterosalpingogram a report will be sent to your fertility clinician. An appointment will then be sent to you to discuss the outcome.