How Is a Hysterosalpingography (HSG) Performed?

By BSc, MSc (embryologist) and BA, MA (fertility counselor).
Last Update: 02/17/2015

When a couple goes to an assisted reproduction clinic for the first time, their medical history is opened so that different aspects of their reproductive life can be assessed. One of them is a Hysterosalpingography or HSG, which is a type of X-ray used to detect if the Fallopian tubes of a woman are blocked.

There are alternative names for this test: hysterosalpingogram, uterosalpingography or uterotubography, but the best known is HSG.

Below you have an index with the 5 points we are going to deal with in this article.


A hysterosalpingography (HSG) is among the many tests that are usually requested. These tests contribute to the analysis of the architecture of the female uterus and fallopian tubes. This exam is usually requested along with an ultrasound and hormonal study that provide information about the ovulatory capacity of the woman.

The HSG is very similar to the X-ray test, during which a contrast liquid is necessary not only to evaluate the uterine morphology and verify that there are no conditions able to prevent the start of the assisted reproduction treatment, but also the permeability of the tubes. A blockage of both fallopian tubes impedes the natural fertilization process.


HSG should be performed after a special preparation of the body. The patient's period should have ended at least three days before, but never more than 10, so a pregnancy can be ruled out. Fasting is not necessary before the exam.

This test should not be performed if there is any type of genital infection. In case of an infection the gynecologist should prescribe an antibiotic for the patient to take before and after the exam so she has no infection either before or after the hysterosalpingography.

It is also not recommended in cases of pelvic inflammatory disease, inflammation, metrorrhagia, also known as bleeding between periods, or in the event of a radiological contrast study of the gastrointestinal tract done recently.

The HSG is very simple to perform. The position the patient should be on is the same as in during a gynecologic exam: the patient's feet should be placed in the stirrups as if a simple cytology was about to be performed. A speculum is placed on the patient to wash the area of the cervix and through a catheter, introduced in the cervix, the uterine cavity is slowly contrasted. The X-ray machine will take the necessary shots.

The exam can cause slight abdominal pain but the pain will only be felt during the introduction of the contrast medium and will not be too intense. The same doctor that prescribed the exam should interpret its results.

What to expect

If the result of the exam is abnormal, different conditions should be considered.

These conditions are, for example, disorders connected to the development of the structures of the uterus or Fallopian tubes, intrauterine adhesions, blocked fallopian tubes, foreign bodies, scarring, tubal adhesions, tumors or polyps.

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 Laura Gil Aliaga
Laura Gil Aliaga
BSc, MSc
Bachelor's Degree in Biology & Biochemistry from the Miguel Hernández University of Elche (UMH) and the University of Alicante (UA). Master's Degree in Biology of Human Assisted Reproduction. Embryologist at clinic UR Vistahermosa (Alicante, Spain). More information about Laura Gil Aliaga
Adapted into english by:
 Sandra Fernández
Sandra Fernández
Fertility Counselor
Bachelor of Arts in Translation and Interpreting (English, Spanish, Catalan, German) from the University of Valencia (UV) and Heriot-Watt University, Riccarton Campus (Edinburgh, UK). Postgraduate Course in Legal Translation from the University of Valencia. Specialist in Medical Translation, with several years of experience in the field of Assisted Reproduction. More information about Sandra Fernández

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