What is a Hysterosalpingogram (HSG)?

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The specific causes of infertility can be difficult to diagnose and many are hormonal or anatomical issues that go undiagnosed until trying to conceive. And that ambiguity can put pressure on everyone involved in the infertility struggle.

Practically speaking, a common step doctors take to better understand a woman's struggle with infertility involves a specific procedure: a hysterosalpingogram. About 40% of female infertility is related to tubal factor infertility. In order to get an official diagnosis, your doctor may want to perform a hysterosalpingogram (HSG). This procedure can help diagnose tubal occlusion or obstruction, as well as uterine malformations, pelvic inflammatory disease, and Asherman’s syndrome. Once confirmed, you’ll have a clearer understanding on the next steps to take in order to build your family.

What is a hysterosalpingogram?

Also called a uterosalpingography, the HSG test is a procedure that looks at your fallopian tubes and uterus. HSG allows your doctor to more accurately investigate the shape of the fallopian tubes and uterine cavity by inserting a radio-opaque material, often a dye, into the cervical canal. If the tubes are blocked the dye will spill into the abdominal cavity. Undergoing an HSG has also been seen to improve chances of conception for a short period following the procedure.

It will also indicate if the blockage is distal, at the end of the fallopian tube, or proximal, located at the junction of the tube and the uterus. If the fallopian tube is blocked somewhere, the sperm can’t reach the egg or the fertilized egg can’t get to the uterus – meaning you can’t get pregnant. A partially blocked tube could cause an ectopic pregnancy.

Should I have an HSG?

If you’re wondering why a hysterosalpingogram is recommended, it’s typically one of the first tests ordered if you’ve had trouble conceiving. It’s also recommended if you’ve had more than two miscarriages. 10 to 15 percent of recurrent pregnancy losses are due to an abnormally shaped uterus. If it shows tubal blockage, your doctor will likely perform a laparoscopy. Depending on the severity, in vitro fertilization may be recommended, because this can help you conceive by completely bypassing the fallopian tubes.

Interestingly, some women actually do have greater success getting pregnant naturally after HSG – in fact, the chances can increase as much as 25% for up to three months after the procedure. It may be due to tubal flushing from the oil-based contrast fluid, or even the dye solution enhancing the lining of the uterus.

How soon after HSG can you start trying to conceive?

You’ll want to follow your doctor’s instructions, but generally, it’s safe to try within several days.

While HSG can boost your chances of conceiving, it’s important to remember that the primary purpose is to serve as a diagnostic test. Learn more about ways to find support in your family building journey, or contact our team to learn all about your options.

If your HSG results show that you are unable to perform natural conception, there are still many ways to start building your family. Connect with our team of experts to determine next steps and the possibility of using a surrogate mother to bring your family home.

How long does it take to do an HSG?

The actual procedure only lasts about five minutes and you may be administered pain medication as well as an antibiotic to reduce the risk of infection. You’ll be able to leave shortly after, though it’s recommended to have someone there with you to help you get home and settled.

Afterward, a radiologist will review the x-ray images and send a full report to your doctor. Because it’s a diagnostic test, it is often covered by insurance; the out-of-pocket cost for HSG generally ranges anywhere from $200-$900.

How is HSG performed?

Your doctor will recommend that the HSG is done during the first half of your cycle, between days 1 and 14. This is after your period, but before you ovulate to ensure there’s no chance of pregnancy. HSG should never be performed on a pregnant woman as the procedure and x-ray exposure can lead to serious complications or miscarriage.

An outpatient procedure, HSG can be completed in your gynecologist’s clinic with an x-ray imager called a fluoroscope. After inserting a speculum, your doctor will clean the cervix and insert a thin tube called a cannula. The uterus will then be filled with a liquid containing iodine before the speculum is removed so that your doctor can take x-ray images. The dye will contrast with the uterus and fallopian tubes, showing an outline and how the fluid moves through them.

Are there side effects to HSG?

Some women report light spotting after the procedure; minor cramps, stomach discomfort, and dizziness are also common. Other more serious side effects to watch for include:

  • Vaginal discharge
  • Fainting
  • Severe abdominal pain or cramping
  • Vomiting
  • Heavy vaginal bleeding
  • Fever

Contact your doctor right away if you experience any of these issues. HSG is considered a very safe procedure, but it is possible to develop a pelvic infection, injury to the uterus, and even an allergic reaction to the dye in the fluid. Embolization or blockage can also occur if oil-based materials are used.

Calling All Surrogates

And, are you a woman who enjoyed a healthy and successful pregnancy? Do you have friends or family who have suffered from infertility or need assistance from someone else to build their family? Have you ever considered the role you could play in helping someone else build their family - as a surrogate? Learn more about the process of helping someone else's dream of building a family come true. We would love to talk with you.

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Dr. Anate Brauer of Shady Grove Fertility offers her own perspective on one of the most important, and perhaps difficult, things to consider at this time: trust.