Hysterosalpingogram: A Key Test for Checking the Uterus and Fallopian Tubes
September 21, 2026When a couple is having difficulty conceiving, the fertility evaluation usually looks at several factors: ovulation, ovarian reserve, sperm, the uterus, and the fallopian tubes.
The fallopian tubes deserve particular attention because they are the pathway through which sperm and egg normally meet. If the tubes are blocked, fertilization may be prevented or the risk of ectopic pregnancy may be increased.
One of the established tests used to evaluate the fallopian tubes is a hysterosalpingogram, commonly called an HSG.
An HSG is an X-ray examination that allows the doctor to assess the shape of the uterine cavity and determine whether the fallopian tubes appear open.
What is an HSG?
A hysterosalpingogram is an imaging examination in which a contrast material is introduced through the cervix into the uterus.
X-ray images are then taken as the contrast moves through the uterine cavity and, if the tubes are open, travels through the fallopian tubes and spills into the pelvic cavity.
In simple terms, the test asks two important questions:
- Does the uterine cavity have a normal appearance?
- Are the fallopian tubes open?
This makes HSG particularly useful during the investigation of infertility.
Why is an HSG performed during a fertility evaluation?
An HSG may be recommended when a fertility specialist wants to assess tubal patency.
Tubal blockage can occur for several reasons, including previous pelvic infection, pelvic inflammatory disease, endometriosis, previous pelvic or abdominal surgery, or previous ectopic pregnancy.
Sometimes, however, there is no obvious history suggesting a tubal problem.
A woman may have regular periods, normal ovarian reserve and no symptoms at all, yet have a blocked or damaged fallopian tube.
That is why evaluating tubal patency can be an important part of the infertility work-up.
Current fertility guidance recognizes HSG as an established method for evaluating tubal patency. In women without known pelvic pathology, NICE recommends HSG as a reliable test for ruling out tubal occlusion and considers HyCoSy an effective alternative when appropriate expertise is available.
What does an HSG show?
An HSG can provide information about both the uterus and the fallopian tubes.
The uterine cavity
The test may reveal abnormalities affecting the shape or outline of the uterine cavity, including some congenital uterine anomalies and acquired abnormalities such as intrauterine adhesions, polyps or submucosal fibroids.
However, HSG is not a complete examination of the uterus. A transvaginal ultrasound, saline sonography or hysteroscopy may be more appropriate for evaluating particular uterine abnormalities.
The fallopian tubes
The main purpose of HSG in infertility evaluation is often to determine whether the tubes are patent.
If contrast passes through a tube and spills into the pelvis, that tube is considered patent.
If the contrast does not pass through, the test may suggest tubal obstruction.
Importantly, an HSG result showing blockage does not always mean that the tube is permanently and completely blocked. Particularly when blockage appears close to the uterus, tubal spasm or technical factors can sometimes mimic obstruction.
The result therefore needs to be interpreted in the context of the patient's history and the rest of the fertility evaluation.
How is an HSG performed?
The examination is usually performed in the first part of the menstrual cycle, after menstruation and before ovulation, according to the clinic's protocol.
The exact timing may vary depending on the patient's cycle and circumstances.
During the procedure:
- The patient lies on an examination table.
- A speculum is inserted into the vagina to visualize the cervix.
- The cervix is gently prepared.
- A thin catheter is placed through the cervix into the uterus.
- Contrast material is slowly introduced.
- X-ray images are taken as the contrast fills the uterus and passes through the tubes.
The procedure itself is generally relatively short.
Some women experience cramping when the contrast is introduced. The level of discomfort varies considerably from one person to another.
Does an HSG hurt?
This is one of the most common questions patients ask.
The honest answer is: it can be uncomfortable, but the experience varies.
Some women describe mild period-like cramps. Others experience stronger but usually short-lived cramping when the uterus and tubes are distended.
Anxiety can also affect how a procedure feels.
Your fertility specialist may discuss appropriate pain relief or other measures before the procedure, depending on your medical history and the clinic's protocol.
If you are particularly anxious about the examination, tell your doctor beforehand. Knowing what to expect can make the experience considerably easier.
Is HSG safe?
HSG is generally considered a safe procedure when performed appropriately.
Possible complications are uncommon but may include:
- pelvic infection
- bleeding or spotting
- cramping
- dizziness or fainting
- an allergic reaction to the contrast material
- very rarely, other complications
The procedure should not be performed if pregnancy is possible, and active pelvic infection should be excluded.
Patients should follow the specific preparation instructions given by their fertility specialist or radiology team.
Can an HSG improve fertility?
There is an important point that patients sometimes hear about HSG: some women may conceive more easily in the months following the procedure.
There is evidence that tubal flushing, particularly with certain oil-based contrast agents, may be associated with an increased chance of pregnancy in selected women. However, HSG should primarily be considered a diagnostic examination rather than a fertility treatment.
The type of contrast used and the clinical circumstances matter, so this should be discussed with the treating physician rather than assuming that every HSG has a fertility-enhancing effect.
What happens if the HSG shows blocked tubes?
The next step depends on several factors:
- whether one or both tubes appear blocked
- where the blockage appears to be located
- whether there is a history of pelvic disease or surgery
- the patient's age
- ovarian reserve
- sperm parameters
- whether hydrosalpinx is present
- the overall fertility picture
A finding of tubal blockage does not automatically mean that IVF is required.
Sometimes further evaluation is appropriate, particularly when the result is uncertain or suggests proximal obstruction.
In other situations, treatment may be recommended based on the complete clinical picture.
If both fallopian tubes are confirmed to be severely damaged or blocked, IVF can bypass the fallopian tubes because fertilization takes place in the laboratory and the resulting embryo is transferred directly into the uterus.
What if only one tube is blocked?
Having one blocked fallopian tube does not necessarily prevent natural conception.
If the other tube is healthy and ovulation occurs from either ovary, pregnancy may still occur naturally.
However, the significance of a unilateral blockage depends on where the blockage is located and whether the remaining tube is genuinely healthy.
Your fertility specialist will interpret the HSG together with your age, ovarian reserve, ovulation, sperm analysis and other findings.
Is HSG always necessary?
Not every woman undergoing fertility treatment needs exactly the same investigations.
The decision to evaluate the tubes depends on the patient's history and treatment plan.
Tubal assessment is particularly relevant when natural conception or treatments such as ovulation induction with intercourse or intrauterine insemination are being considered.
For IVF, the situation is different because IVF bypasses the fallopian tubes. Nevertheless, knowing whether a hydrosalpinx or significant tubal disease is present can still be clinically important because certain tubal conditions can affect reproductive outcomes and may influence treatment planning.
HSG versus other tubal tests
HSG is not the only way to evaluate fallopian tube patency.
Another established method is hysterosalpingo-contrast sonography, or HyCoSy, which uses ultrasound rather than X-rays to assess whether contrast passes through the tubes.
In selected patients, laparoscopy with chromopertubation may also be used, particularly when pelvic pathology is suspected or laparoscopy is already being performed for another reason.
The appropriate test depends on the patient's medical history, the expertise available and the clinical question being asked.
What should you remember about HSG?
An HSG is not simply an X-ray.
For a woman being evaluated for infertility, it can answer an important question: are the fallopian tubes open enough to allow the egg and sperm to meet naturally?
At the same time, an HSG is only one part of a fertility evaluation.
A fertility diagnosis should never be based on a single test in isolation.
The most useful approach is to interpret the HSG alongside the patient's age, medical and reproductive history, ovarian function, ovulation, uterine assessment and partner's semen analysis.
At Azoury IVF Clinic, tubal assessment is considered within the context of the complete fertility picture, because the purpose of testing is not simply to find an abnormality, but to understand what it means for that particular patient.
Frequently Asked Questions
1. Is an HSG painful?
HSG can cause cramping or discomfort, particularly while the contrast is being introduced. The intensity varies from woman to woman, and your doctor can advise you about appropriate pain relief.
2. When is an HSG performed?
It is generally scheduled after menstruation and before ovulation, when pregnancy is not possible. Exact timing depends on the patient's cycle and the clinic's protocol.
3. Can an HSG detect blocked fallopian tubes?
Yes. HSG is an established method of assessing whether the fallopian tubes are patent. However, an apparent blockage, particularly near the uterus, may sometimes require further evaluation.
4. Can I become pregnant after an HSG?
Pregnancy may occur after an HSG, and some evidence suggests a possible temporary fertility benefit associated with tubal flushing in selected circumstances. However, HSG itself should primarily be regarded as a diagnostic test.
5. What happens if both tubes are blocked?
The treatment depends on the location and severity of the blockage and the overall fertility picture. In cases of significant bilateral tubal disease, IVF can bypass the fallopian tubes.
6. Is HSG better than HyCoSy?
Neither test is universally better for every patient. Both are established methods for evaluating tubal patency. The choice depends on the clinical situation, expertise, availability and individual patient factors.
Conclusion
A hysterosalpingogram can provide valuable information during a fertility evaluation by assessing the uterine cavity and, most importantly, whether the fallopian tubes appear open.
For many patients, the most stressful part is simply not knowing what to expect. Understanding how the examination works, why it has been recommended and what the possible results mean can make the process much easier.
If an HSG has been recommended for you, the result should always be interpreted as part of a complete fertility assessment rather than on its own.
At Azoury IVF Clinic, we believe fertility investigations should answer meaningful clinical questions and lead to a clear, individualized treatment plan.
References
- American Society for Reproductive Medicine. Fertility Evaluation of Infertile Women: A Committee Opinion.
- National Institute for Health and Care Excellence. Fertility Problems: Assessment and Treatment.
- European Society of Human Reproduction and Embryology. Guideline on Female Infertility.
- World Health Organization. Guideline for the Prevention, Diagnosis and Treatment of Infertility.
