HSG Test for Infertility: What to Expect Before, During, and After
Medical writer: Judith Ewere Ojerahi RN, RM, RPHN, BNSC
Medical Reviewer: Azuka Chinweokwu Ezeike, MBBS, FWACS, FMCOG, MSc (PH)
Highlights:
- HSG is an X-ray test used to assess fertility in women.
- It checks if the fallopian tubes are open or blocked.
- The procedure also helps detect uterine abnormalities.
- It is usually done after menstruation and before ovulation.
- Some women may experience mild cramping during the test.
- The results help guide infertility treatment and management.
Introduction
Infertility means having at least 12 months of unprotected sexual intercourse without getting pregnant. For most couples battling with infertility, the journey to parenthood is not always easy. The disappointment of month after month of negative pregnancy tests can be emotionally draining, leaving many people searching for answers.
Infertility affects millions of couples worldwide, and one of the common causes in women is a problem with the fallopian tubes, such as a blockage that prevents the egg and the sperm from meeting.
Studies suggest that fallopian tube blockage accounts for approximately 30-40% of female infertility cases, making it a significant factor in difficulty getting pregnant. One of the most commonly used tests to detect fallopian tube blockage is the hysterosalpingography test (HSG). It is done to find out the cause of infertility in a woman. This test allows doctors to have a clear view of your womb and fallopian tubes. It helps detect any blockage or abnormalities in your womb or fallopian tubes.
If your doctor recommends an HSG test, understanding what to expect can help ease anxiety and help you feel prepared. This article explains what the HSG test involves and what you should expect before, during, and after the procedure.
What Is an HSG Test?
Hysterosalpingography (HSG) is a test done to check the state of your womb (uterus) and fallopian tubes (i.e., the tubes by which your eggs are carried to your womb for fertilisation). It is usually done between days 7- 12 of your menstrual cycle in order not to interfere with a possible early pregnancy.
During hysterosalpingography, a dye is usually passed through your cervix into the womb. This dye makes it easier to visualise the inner parts of your womb and tubes when images are taken using X-ray. The X-ray shows if the shape of your womb and fallopian tubes is normal, with no obstruction or abnormalities [1].
Why Is the HSG Test Done?
Your doctor can conduct a hysterosalpingography based on one of the following reasons:
- Suspected blockage of the fallopian tubes. This test is used to check the structure of your fallopian tubes and how open they are. The fallopian tubes should appear thin, smooth, and free from any obstruction.
- Reduced menstrual flow (Hypomenorrhoea). This may be due to adhesions (gumming of the walls of the womb)
- Suspected abnormality in the shape of the womb
- Suspected fibroid on the lining of the womb [1,2].
How to Prepare for an HSG Test
Hysterosalpingography is usually done 7 to 12 days after the first day of your period. This is because, during these days, the lining of your womb is thin, and it makes it easier to view during the test. Once the day of the test is scheduled, your doctor will:
- Advise you to abstain from sexual intercourse during this period. This reduces the chance of you being pregnant during the time the test is done.
- Carry out a pregnancy test to be sure that you are not pregnant
- Give you some pain relief medications before and after the test
- Prescribe antibiotics only if you have had pelvic inflammatory disease before, are at risk of getting an infection, or have an infection before the test.
It is advisable to take the test with someone. This is because you may need someone to drive you back home, in case you feel uncomfortable drive [3].
What Happens During the HSG Procedure?
During the test, you would be asked to lie down on the bed used for X-ray with your back on the bed, your knees spread apart, and your feet raised and supported. Once you are made comfortable on the bed, your doctor will do the following:
- Clean your perineum (the area between your thighs where your vagina and anus are located) with an antiseptic
- A sterile instrument called a speculum would be inserted into your vagina to allow the doctor to have a clear view of your uterus
- An instrument called a tenaculum will be used to grasp the opening of your uterus (cervix) while the doctor cleans it
- A metallic instrument called a Leech Wilkinson cannula is passed through into your uterus
- A metallic marker would be placed on one side of your lower abdomen to help the doctor differentiate the left and right sides
- An image of your uterus will be taken before the dye is injected
- Once the dye is injected, several X-ray pictures are taken to have a clear view of your uterus and fallopian tubes for any abnormalities
- Your doctor will also check how freely the dye flows through your fallopian tubes [3].
Is the HSG Test Painful?
It is important to note that pain is different for everybody. Mild to moderate pain during and after the test is very common. While some people may feel little pain, others with low pain tolerance may experience a lot of pain.
However, if your fallopian tubes are not open or if there is any obstruction, you may feel more pain. Overall, the pain is tolerable. Some people may feel like vomiting, weakness, or tubal spasm. Your doctor would prescribe some drugs to relieve pain. You may be asked to stay at the hospital for an hour or so to observe and attend to any discomfort you may experience [4].
What to Expect After the HSG Test
After the Hysterosalpingography test, you will have to wear a sanitary pad. This is because some of the dye used during the test might leak out, and wearing a pad will prevent it from staining your clothes. A small amount of blood may also leak out.
You may also experience:
- Mild to moderate pain
- Weakness or dizziness
- Vomiting.
These symptoms usually stop a few hours after the test is done.
Risks and Complications of HSG
Generally, hysterosalpingography is a very safe procedure. However, some complications that may happen include:
- Pain in your lower abdomen
- Little bleeding from the vagina, which may last for a few days after the test.
- Allergy to the dye used during the test
- Vasovagal reactions, such as fainting due to pain
- Pelvic infection
- A tear in the uterus
- Injury to your womb or the opening of your womb (cervix)
- Dye enters your blood circulation through the uterus. This complication is very rare [1,5].
When an HSG Test may not be Recommended
A HSG test will not be done if:
- You are on your period
- You are pregnant
- You have a pelvic infection
- You have any heart or kidney issues
- You are sensitive to the dye used for the test
- You have had any recent surgery in your uterus or fallopian tubes [3,6].
When to Contact Your Doctor After HSG
You should see your doctor immediately when you notice any of the following symptoms after a hysterosalpingography test:
- Discharge from the vagina that smells really bad
- Vomiting
- Heavy vaginal bleeding
- Fever
- Very serious pain in your abdomen
- Fainting
Conclusion
Hysterosalpingography is a simple and important investigation tool used by doctors to understand the condition of the uterus and fallopian tubes. This helps them to provide better care and offer solutions to your infertility. While pain is a common side effect of this test, it is generally safe. Pain relief drugs will be given to you to help reduce the pain you may feel during and after the procedure.
Having a clear understanding of what HSG is, what to expect before, during, and after the test, can reduce anxiety and fear. For many women, the HSG test is not just a diagnostic tool, but also a step closer to understanding their fertility and moving forward on the journey to conception.
Frequently Asked Questions
Is it okay to eat or drink before the HSG test?
Yes, it is okay to eat or drink before and after your HSG test.
Is the HSG test painful?
Different individuals experience pain differently, but your doctor will administer pain relief medications before the procedure.
How long does the HSG test take?
The test usually takes about 10 to 20 minutes.
When is the best time to do the test?
The test is usually done between the time your period ends and before your ovulation.
References
- Cue L, Mayer C, Martingano DJ. Hysterosalpingogram. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan–. Updated 2024 May 6. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572146/
- Schankath AC, Fasching N, Urech-Ruh C, Hohl MK, Kubik-Huch RA. Hysterosalpingography in the workup of female infertility: indications, technique, and diagnostic findings. Insights Imaging. 2012;3:475–483. Available from: https://doi.org/10.1007/s13244-012-0183-y
- Ranjan P, Ranjan R. Hysterosalpingography: a re-emerging study with current application. J Evol Med Dent Sci. 2015;4(99):16457–16463. Available from:https://share.google/OOzxtvxOf0zZOGLJZ
- Jiang S, Gao S, Tan Y, Yang Q, Zhou T, Zheng S, et al. Severe pain and postoperative effects during hysterosalpingography: a meta-analysis. Iran J Public Health. 2024;53(2):268-279. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11182462/
- Gebresilassie MY, Midekso ND, Mehammed AH, Beshir HB, Midekso HD, Gidena EK, et al. A rare complication of hysterosalpingography: a case report of venous intravasation. Radiol Case Rep. 2026;21(5):2056-2058. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC12938092/
- Ahmadi F, Zafarani F, Shahrzad G. Hysterosalpingography in the assessment of uterine cavity: a wide spectrum of acquired structural pathology. Kuwait Med J. 2019;51(1):3-15. Available from:https://applications.emro.who.int/imemrf/Kuwait_Med_J/Kuwait_Med_J_2018_51_1_3_15.pdf
Disclaimer:
The information provided on this website is for general educational and informational purposes only. It is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
Published 20, 2026