A short X-ray examination performed with contrast medium to evaluate the uterine cavity and the patency of the fallopian tubes. It is most often used in the investigation of infertility.
Indication
- Failure to achieve pregnancy after one year or more of unprotected intercourse (infertility evaluation)
- Recurrent pregnancy loss (assessment of structural abnormalities of the uterus)
- Suspected tubal blockage or a history of prior pelvic infection
- Suspicion of congenital uterine anomalies (septate or bicornuate uterus)
- Pre-procedural assessment before tubal recanalization following tubal ligation
Preparation
- The procedure is usually scheduled within the first 7-10 days after the end of menstruation
- It is postponed in case of active vaginal infection, suspected pregnancy, or pelvic inflammatory disease
- A pain reliever (NSAID) may be recommended 30-60 minutes before the procedure
- Any history of contrast allergy must be reported
- If needed, antibiotic prophylaxis is planned by the physician before the procedure
How it's performed
- The patient is positioned on the gynecological table; the vaginal area is sterilized
- A speculum is inserted, and a thin catheter is passed through the cervix into the uterine cavity
- Contrast medium is slowly injected; some women may feel cramp-like pain at this stage
- Filling of the uterine cavity and the tubes is observed under fluoroscopy (continuous X-ray)
- It is assessed whether the contrast medium spills from the tubes into the abdominal cavity
- Images are recorded, the catheter is removed; the procedure usually takes 10-20 minutes
Post-procedure
- A short rest after the procedure is sufficient; most women return to daily activities the same day
- Mild cramping and spotting that may last a few days can occur
- Contact a physician in case of high fever, severe abdominal pain, or foul-smelling discharge
- Use of pads instead of tampons is recommended for 1-2 days
- The physician evaluates the results and plans further investigation or treatment if needed
Risks
- Transient abdominal cramping and mild bleeding
- Risk of pelvic infection (especially with a history of prior infection)
- Allergic reaction to the contrast medium (rare)
- Low-dose radiation exposure
- Fainting sensation (vasovagal reaction)
FAQ
Is HSG a very painful procedure?
Most women describe cramp-like pain similar to menstrual cramps as the contrast is injected. The pain usually lasts a few minutes. A pain reliever may be recommended before the procedure; mild sedation is rarely used.
Does the chance of pregnancy increase after HSG?
Some studies suggest a temporary increase in pregnancy rates in the months following HSG, particularly when oil-based contrast is used. No guarantee can be given; planning and treatment of the underlying cause are always carried out by the physician.
When can I have intercourse after the procedure?
Unless the physician advises otherwise, intercourse is usually safe once the bleeding and cramping subside (within a few days). If there is concern for pelvic infection, the physician may recommend waiting 1-2 weeks.
Does HSG guarantee that my tubes are completely healthy?
No. HSG evaluates the patency of the tubes but may not fully reveal certain structural or functional problems (such as adhesions or micro-damage). When needed, it is supplemented with laparoscopy or other tests.
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