Fertility test: X HSG (hysterosalpingogram)

Becoming pregnant is not a given for all women. About ten percent of women take longer than a year to become pregnant. Additional research is often needed to find out why it takes so long. An HSG (hysterosalpingogram) is one of the possible tests that a woman can undergo.

What is an HSG?

An HSG is an X-ray examination of the uterus and fallopian tubes. The purpose of the examination is to find out whether the fallopian tubes are properly patent. Any abnormalities in the shape of the cervix can also be discovered. During the examination, contrast fluid is injected through the cervix into the fallopian tubes. X-rays are taken while the fluid is being injected.

Preparation for the examination

The examination generally takes place between the 7th and 12th day of the cycle. The examination must be done after menstruation, but before the next ovulation. There may be a chance of a pregnancy because it could be disrupted by the injection of the contrast fluid and by the X-rays. No special preparations usually need to be made on the day of the examination. Depending on the hospital, you may be advised to take a number of painkillers beforehand. It can also be nice to wear comfortable clothing and ‘normal’ underpants with a sanitary towel inside (to prevent light bleeding). If there are any complaints of the genitals or fever and/or abdominal complaints on the day of the examination, it is important to report this to the doctor. It is advisable not to go to the examination alone, because the intensity of the examination is experienced as varying.

The course of the investigation

The examination is carried out by a physician assistant/gynecologist in collaboration with a radiologist. Lying on a bed, with the knees drawn up and outwards, a duckbill is inserted after which a plastic cap is placed on the cervix. Placing the plastic cap may feel a bit painful. A tube is inserted into the uterus through this plastic cap. This can give a ‘strange’ feeling, but is generally painless. Contrast fluid is injected through the tube. This injection is experienced differently. Most women only feel some cramping, similar to menstruation. In some cases, the injection may cause a stabbing pain. Injecting the liquid takes only a few seconds. During the injection, you can watch on a screen while the x-rays are being taken. The screen will then clearly show whether the contrast fluid can pass through the fallopian tubes. The entire examination takes approximately ten to fifteen minutes.

After investigation

You may still experience mild pain in the lower abdomen for a few days and there will usually be slight bleeding. Furthermore, the contrast fluid that still leaves the body may feel sticky. In case of severe pain and/or fever, the treating physician should be contacted immediately. The results are generally discussed immediately after the examination. Agreements will then be made about the follow-up. If abnormalities are found, for example non-patent fallopian tubes, the next step is usually keyhole surgery.

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