Hysterosalpingogram
One of the most common diagnostic tests for female infertility is a hysterosalpingogram (HSG). 
This simple test is basically an x-ray that can help determine the health of your fallopian tubes.
How is the Test Done?
Because a hysterosalpingogram is an x-ray, the test is generally done between day 7 and 10 of your menstrual cycle to ensure that you are not currently pregnant. The test itself shouldn’t take more than five minutes. Although a gynecologist can perform an HSG, the majority of the time a radiologist will perform the test. As a result, you will most likely to go the radiology department in a hospital to have the test done.
Before the test, the specialist will review any medications you are currently taking as well as your health history. Be sure to disclose any allergies you may have. This is important because allergies to iodine, seafood or certain dyes can make it unsafe to have a hysterosalpingogram. If an HSG is not possible for you, you will be encouraged to have a sonohysterogram instead.
Once your medical history has been reviewed, you will undress and get into essentially the same position as you would for a PAP smear, reclining back on the table with your feet in stirrups. After a speculum is placed in your vagina to open it a little, a catheter is inserted and passed through the vagina into the cervix. The catheter is used to slowly inject a special dye, known as a radiographic contrast dye, which will give the specialist a better view of your uterus and fallopian tubes. Usually this dye is water-based but some specialists may use an oil-based dye. If there is no blockage in your fallopian tubes, then the dye will spill out from the ends of your fallopian tubes into your abdominal cavity.
As the dye is injected, a number of x-rays will be taken. You may be asked to move slightly from side to side in order for the radiologist to obtain additional images, thereby allowing for a more accurate assessment of your reproductive organs. However, if digital images have been taken, then it will be easier to manipulate the x-ray itself for better views. During the standard HSG test, as many as 50 to 60 images can be taken.
Because the images are produced right away, you can receive your results almost instantly and review them with the radiologist or gynecologist during your visit.
What an HSG Will Find
A hysterosalpingogram is generally used to assess the quality of your fallopian tubes; whether they are open or blocked. Since dye is used during the test, it is easy to locate just where a blockage may be. Blockages that occur where the fallopian tube and uterus meet are known as proximal, while blockages located near the end of the fallopian tube are known as distal.
In addition to blockages, a hysterosalpingogram can also help identify:
Women who are seeking a tubal reversal may have an HSG performed in order to asses where the tubes have been blocked, clamped or cut, thereby aiding in planning the reversal surgery.
After Effects of the Test
The most common side effects of a hysterosalpingogram are cramping, which can last for a few hours after the test is complete, a sticky vaginal discharge for several days as the dye leaves your body, and light bleeding. If you experience heavy bleeding, increasing pelvic pain or a fever in the days after an HSG, contact your doctor.
Complications can occur from a hysterosalpingogram, although they are rare, affecting about 1% of female patients. These complications include:
- Allergic reaction to the dye
- Pelvic infection
- Fainting
- Puncturing the uterus
In order to reduce the risk of infection, some specialists may prescribe antibiotics to their patients following the procedure.
Interestingly, studies have shown that women have a higher rate of a natural pregnancy occurring after having a hysterosalpingogram. It is thought that the dye may help to resolve a partial blockage or to flush out some debris in the fallopian tubes that had been hindering conception. Although an HSG may be helpful for those people trying to conceive, it is important to remember that it is first and foremost a diagnostic test, not an infertility treatment.
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