What is HSG?
💡 HSG = hysterosalpingography. X-ray dye test to assess fallopian tube patency and uterine cavity. Normal: dye fills both tubes and spills into peritoneal cavity. Blocked tube: dye does not pass. Shows: cornual blocks, hydrosalpinx, uterine septum, polyps, Asherman syndrome. Performed Day 5–10. Mild-to-moderate cramping. Results guide IUI vs IVF decision.
HSG (hysterosalpingography) is an X-ray imaging procedure that evaluates the uterine cavity and fallopian tube patency by injecting radio-opaque contrast dye through the cervix under fluoroscopy. It is the standard first-line investigation for tubal factor infertility and provides simultaneous assessment of the uterine cavity shape. HSG is typically performed on Day 5–10 of the menstrual cycle and is a core component of the female fertility workup.
🇮🇳 India Context: HSG is widely assessed and treated across major Indian fertility centres including Chennai, Mumbai, Bangalore, Delhi, and Hyderabad.
What are the key characteristics of HSG?
- Procedure: water-soluble contrast injected through cervix via catheter; fluoroscopic X-ray images captured as dye fills uterine cavity and fallopian tubes
- Normal result: dye fills uterine cavity (triangular outline), both tubes opacify and show "spillage" into the peritoneal cavity (free spill = patent)
- Proximal (cornual) block: dye does not enter the tube at the uterine junction; may be true block or tubal spasm (false positive in 15–30%) — confirm with laparoscopy or selective salpingography
- Distal block: dye fills tube but pools at fimbrial end without spilling — hydrosalpinx pattern; requires salpingectomy before IVF
- Uterine cavity findings: triangular cavity normal; filling defects suggest polyps, submucosal fibroids, or synechiae (Asherman syndrome); irregular outline suggests uterine septum or bicornuate uterus
- Therapeutic effect: HSG may improve pregnancy rates in the 3–6 months after the procedure — proposed mechanism is mechanical flushing of tubes + anti-inflammatory effect of oil-based contrast (HYCOSY-H RCT: 40% higher pregnancy rate with oil vs water contrast)
- Oil vs water contrast: oil-soluble contrast (lipiodol) — higher post-procedure pregnancy rates in RCTs; water-soluble — faster excretion, less cramping; choice varies by centre
- TB caveat (India): pelvic TB causes bilateral proximal cornual blocks on HSG — resemble spasm; TB-LAMP or endometrial biopsy TB PCR mandatory before HSG in high-risk patients; missed TB causes IVF failure
How does HSG work?
Why does HSG matter in fertility?
HSG is the most clinically decisive tubal investigation — its result directly determines whether IUI is a viable treatment option. Bilateral patent tubes: IUI and natural conception are physically possible; proceed with fertility workup and appropriate treatment. Unilateral block: IUI possible via patent tube; fertility reduced. Bilateral block: IUI and natural conception impossible; direct to IVF pathway. Hydrosalpinx on HSG: salpingectomy/occlusion mandatory before IVF. The single most important clinical caveat: proximal (cornual) blockage on HSG has a 15–30% false-positive rate due to tubal spasm — always confirm with laparoscopy or selective salpingography before telling a patient her tubes are permanently blocked, as this changes her life trajectory and drives major treatment decisions.
What are related terms to HSG?
HSG Test (Hysterosalpingography)
HSG (Hysterosalpingography) is a diagnostic X-ray procedure. A contrast dye is i…
Tubal Patency
Tubal patency refers to whether the fallopian tubes are open (patent) and functi…
Hysterosalpingogram
Hysterosalpingogram is the full medical name for the HSG test — a fluoroscopic X…
Laparoscopy (Keyhole Surgery)
Laparoscopy is a minimally invasive surgery, also called keyhole surgery. A thin…
IUI (Intrauterine Insemination)
IUI (Intrauterine Insemination) is a fertility treatment where washed, concentra…
FAQs about HSG
What is an HSG test in fertility?
HSG (hysterosalpingography) is an X-ray procedure where radio-opaque dye is injected through the cervix to outline the uterine cavity and fallopian tubes under fluoroscopy. It is the standard first-line test for tubal patency — checking whether the tubes are open or blocked. Normal result: dye spills freely from both tubes into the peritoneum. Blocked tube: dye pools and does not spill. It also outlines the uterine cavity to detect polyps, fibroids, septa, and adhesions.
How painful is an HSG?
HSG causes moderate cramping — similar to strong period pain — during and immediately after dye injection, typically lasting 2–5 minutes. The degree varies by cervical anatomy and individual pain sensitivity. Pre-medication with ibuprofen 400–600mg 1 hour before significantly reduces discomfort. Some centres apply local cervical anaesthesia. Post-procedure: mild cramping and spotting for a few hours. Most women can return to normal activities the same day, though rest is recommended.
Can I get pregnant after an HSG?
Yes — and the HSG itself may boost your chances. Multiple RCTs confirm a 20–40% higher pregnancy rate in the 3–6 months after HSG, particularly with oil-soluble contrast (lipiodol/Ethiodol). Proposed mechanisms: mechanical flushing of mucus plugs and debris from tubes; anti-inflammatory effect of contrast medium. This post-HSG fertility boost is why some fertility specialists recommend HSG before IUI cycles even when tubal blockage is not suspected — the diagnostic and therapeutic benefits justify the procedure.
What does a blocked tube on HSG mean?
Blocked tube on HSG: (1) Proximal/cornual block (dye does not enter the tube at all): 15–30% false-positive rate due to tubal spasm — must be confirmed with laparoscopy or selective salpingography before concluding permanent blockage. (2) Distal block (tube fills but dye does not spill): more likely a true block, often hydrosalpinx — requires salpingectomy before IVF. (3) Unilateral block: IUI still possible via open tube. (4) Bilateral confirmed block: IVF is the only option.
Is HSG or laparoscopy better for checking tubes?
Laparoscopy with chromopertubation (dye instilled through cervix, directly visualised at fimbriae) is the surgical gold standard — it definitively confirms patency and simultaneously assesses the pelvis for endometriosis, adhesions, and other pathology. However, laparoscopy requires general anaesthesia, theatre, and recovery. HSG is first-line: outpatient, 15–20 minutes, no anaesthesia. Clinical algorithm: HSG first → if abnormal, laparoscopy to confirm and treat. HyCoSy/HyFoSy is an acceptable radiation-free HSG alternative at experienced centres.
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