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Hysterosalpingography – HSG Procedure Explained

Hysterosalpingography (HSG) is an X-ray imaging procedure used to examine the uterus and fallopian tubes. It is commonly performed to investigate infertility and related conditions.

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Things worth knowing about "Hysterosalpingography"

Hysterosalpingography (HSG) is an X-ray imaging procedure used to examine the uterus and fallopian tubes. It is commonly performed to investigate infertility and related conditions.

What is Hysterosalpingography?

Hysterosalpingography (HSG) is a specialized X-ray procedure used to visualize the inside of the uterus (womb) and the fallopian tubes. A contrast dye is introduced through the cervix into the uterine cavity, allowing detailed images to be captured on X-ray. HSG is a key diagnostic tool in gynecology, particularly in the evaluation of female infertility.

When is Hysterosalpingography Used?

HSG is indicated in a number of clinical situations:

Infertility evaluation: To check whether the fallopian tubes are open (patent) and able to allow egg transport.
Recurrent miscarriages: To identify anatomical abnormalities such as a uterine septum or other structural issues.
Suspected intrauterine adhesions: Detection of scar tissue within the uterus (Asherman syndrome).
Tubal blockage: Diagnosis of obstruction in the fallopian tubes, often caused by previous infections or inflammation.
Uterine fibroids or polyps: Identification of benign growths that may affect the uterine cavity.
Post-sterilization assessment: Verification of successful tubal ligation.

How is the Procedure Performed?

HSG is typically performed on an outpatient basis in a radiology or gynecology clinic. The best time for the procedure is during the first half of the menstrual cycle, after menstruation has ended and before ovulation.

Preparation

Prior to the procedure, a gynecological examination is usually conducted to rule out active infections. Prophylactic antibiotics may be recommended in some cases. Patients are often advised to take an over-the-counter pain reliever such as ibuprofen beforehand to reduce cramping.

The Procedure

The patient lies on an examination table in the lithotomy position.
A thin catheter is inserted through the cervix into the uterine cavity.
An iodine-based contrast dye is slowly injected through the catheter.
X-ray fluoroscopy is used to capture real-time images of the dye as it moves through the uterus and fallopian tubes.
If the tubes are open, the contrast dye will spill into the abdominal cavity, confirming normal patency.

The entire procedure usually takes between 15 and 30 minutes.

What Does Hysterosalpingography Show?

HSG provides important information about:

The shape and size of the uterine cavity
The patency of both fallopian tubes
The presence of congenital abnormalities, fibroids, polyps, or adhesions
Scar tissue resulting from previous surgery or pelvic infections

Possible Risks and Side Effects

HSG is generally considered a safe procedure, but it may be associated with the following side effects or risks:

Cramping and discomfort during and shortly after the procedure
Light spotting or bleeding from the cervix
Allergic reaction to the iodine-based contrast dye (rare)
Infection such as salpingitis or pelvic inflammatory disease – particularly if a pre-existing infection is present
Radiation exposure from X-rays (low level, but present)

Serious complications are uncommon. If a patient develops fever, severe pain, or unusual discharge after the procedure, medical attention should be sought promptly.

Alternatives to Hysterosalpingography

In certain clinical situations, alternative diagnostic methods may be considered:

Sonohysterography (SHG): Ultrasound-based examination using saline solution – no radiation involved
Hysteroscopy: Direct visualization of the uterine cavity using a small camera
Laparoscopy: Surgical examination of the external structures of the uterus and fallopian tubes
Pelvic MRI: Magnetic resonance imaging for complex structural abnormalities

References

American College of Obstetricians and Gynecologists (ACOG) – Female Infertility: Diagnosis and Treatment, Practice Bulletin No. 219, 2020.
Dreisler E. and Kjer J.J. – Asherman's syndrome: current perspectives on diagnosis and management. International Journal of Women's Health, 2019; 11: 191–198.
World Health Organization (WHO) – Infertility: a global public health concern. WHO Technical Report, 2023. Available at: https://www.who.int

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