HSG: What to Expect


If you’re just getting started with fertility treatment, chances are your doctor wants you to have an HSG.  Short for Hysterosalpingogram,is a key part of the initial fertility workup done at most fertility clinics.


Knowing that it’s a standard procedure doesn’t mean you might not be anxious about it, though.  I remember when I was having mine I was really nervous.  I didn’t know what to expect, I’d never had major medical procedures before, and I’d heard it could be painful.  I can handle pain, I knew I had to have medical procedures if I wanted to have a baby (after all, the simple act of having a baby is a medical procedure!), but the fear of the unknown was hard to deal with.  Here’s a look at what happens during an HSG to help dispel some of the mystery around it for you.


What is an HSG and why is it done?


A hysterosalpingogram is a kind of x-ray to look at the inside of a woman’s uterus.  The test helps to evaluate the condition of both the uterus and fallopian tubes.


Hystero = uterus


Salpingo = tubes


Gram = x-ray


The HSG will show if one or both of the fallopian tubes are blocked.  If the tubes are blocked this could impede the ability of the ovulated eggs to be fertilized and for an embryo to travel to the uterus for implantation.


The HSG also shows the shape and overall condition of the uterus.  It also shows if there are any obstructions that could affect implantation or overall carrying of a pregnancy, such as fibroids, polyps or scars.  The information that can be gleaned from an HSG gives tremendous insight as to the uterus’ overall ability to carry a pregnancy.


So the HSG is a very important test.  As previously stated, it, along with a Cycle Day 3 blood test, gives a doctor significant insight to female fertility and informs a patient’s treatment protocol.


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When is an HSG done?


An HSG is done during the follicular phase of your cycle – after your period and before ovulation. Typically, it’s scheduled for anytime from Day 10 through Day 12 of your cycle.  The reason for this is to reduce the risk of having the test while you’re pregnant.  Since the HSG is an x-ray procedure, it’s important that it not be done while you’re pregnant.



What happens during an HSG?


In some ways, having an HSG done is a similar experience to having your annual gynecological exam. You’re laying on your back on an exam table with your feet in stirrups.  You’re awake during the entire procedure, and you don’t need to fast the night before.


One key difference between an HSG, however, is that the latter involves an x-ray machine.


The first thing that happens during the procedure, after you lay on the table and put your feet in the stirrups, is that the doctor performing the procedure does a quick pelvic exam (much like your annual exam).  Then a speculum is inserted in your vagina – again, like your annual exam, so up until this point you can expect basically the same as your annual exam.


Next, your cervix will be cleaned, to prevent infection, and then a catheter will be inserted into your cervix.  Once the catheter is inserted, dye will be inserted through it.  This may feel warm.  The dye moves through your uterus and your fallopian tubes, and spill out into your pelvic bowl.  If one or both of your tubes are blocked, the dye will not spill into your pelvic cavity, which gives the doctor some important information.   The x-machine will take pictures of both your uterus and tubes with the dye.


After the pictures are taken, the catheter and speculum are removed, and the HSG is completed.  The entire procedure takes no more than 30 minutes.



Will an HSG be painful?


The answer to this question is different for everyone.  I’ve heard some women say that their HSGs were extremely painful, while others have said they experienced no pain at all.   It’s important to remember here that any pain you may experience will be bearable, and it willbe short-lived.


When I had my HSG it was on the less painful side.  It felt very much the same as having my annual exam and pap smear done.  It was mildly uncomfortable (and awkward!), and I felt some twinges, but it didn’t hurt.


If you typically experience pain during your annual exam or pap smear, you might experience similar pain during an HSG.  If your tubes are blocked, you may experience pain as the injected dye reaches your tubes. If you feel pain, inform your doctor immediately.


Another way to deal with pain is to focus on your breath.  Keep breathing.  Don’t hold your breath.  Not only will taking deep breaths help you keep calm, which is essential for getting through the immediate difficulty you may be experiencing with the procedure, the focus on the breath will help keep you mind off any pain or discomfort you may be having.


If you feel pain, it’s a good idea to take it easy and rest following the procedure.



Are there any medications involved with having an HSG?


While there are no medications that are needed to actually conduct an HSG, your doctor typically prescribes an antiobiotic to protect against infection during the procedure.   The antibiotic is taken the night before the procedure.  When I had my HSG performed I was prescribed the antibiotic Zithromax.


You can also take, about an hour before your HSG, an over-the-counter pain reliever like ibuprofen, to help stave off any pain or discomfort during the procedure.



Can you have intercourse after an HSG?

Since you may experience spotting after an HSG (again, it’s different for everyone), or excess dye may spill out for a brief period of time after the procedure, it’s best to wait about 2 days before having sexual intercourse.



Can an HSG help you get pregnant?


Sometimes your tubes aren’t actually blocked but can have some mild obstructions that can have an impact on your ability to conceive.  When the dye is inserted during an HSG, it can actually flush out these obstructions, essentially cleaning your tubes and making them clearer which can help facilitate both fertilization and the journey to the uterus.  I’ve heard many stories of women successfully conceiving after an HSG.


It’s important to note, however, that an HSG is a diagnostic test.  It gives your doctor important information to inform your treatment.  It can help pinpoint if your fertility issue lies with your tubes or uterus, or rule that out.  The procedure itself will not actually correct any underlying issue.


Final Thoughts


It’s normal to feel anxious about having an HSG, especially if the world of fertility is new to you, or if you’re not accustomed to having medical procedures done.  Share with your doctor or nurse how you are feeling, and they will help you through it.


If you are feeling anxious, remember how important the test is for learning about the condition of your ovaries and tubes, and it will help you and your doctor determine the best course of treatment for you to help you achieve your pregnancy goal faster. That’s the most important thing.


To Your Fertility,

Steph xo

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