If your doctor has recommended an HSG test, you probably have a lot of questions and maybe a little anxiety. That's completely normal. Most women have never heard of this test before they need one.
An HSG, or hysterosalpingogram, is one of the most common and most useful tests in fertility investigation. It tells your doctor whether your fallopian tubes are open, whether your uterine cavity is a normal shape, and whether there are any structural issues that could be affecting your ability to conceive.
In this article, I will walk you through exactly what happens during the test, what your results mean, and what typically happens next.
What Is an HSG Test?
HSG stands for hysterosalpingogram a mouthful, but the procedure itself is straightforward. It is an X-ray based test that examines the inside of your uterus and fallopian tubes.
During the test, your doctor passes a special dye (contrast medium) through a thin catheter into your uterus. As the dye fills the uterus and flows into the fallopian tubes, X-ray images are taken in real time. The dye should flow freely through both tubes and spill out at the ends this confirms that the tubes are open.
If the dye does not flow through, or stops at a certain point, this suggests a blockage at that location.
The HSG also shows the shape of your uterine cavity, which means it can detect issues like fibroids, polyps, scar tissue, or a uterine septum (a structural variation present from birth) all of which can affect fertility or pregnancy.
When is an HSG recommended?
Your doctor may recommend an HSG if:
You have been trying to conceive for 12 months without success (6 months if you are over 35)
You have a history of pelvic infection, STI, or pelvic inflammatory disease
You have had previous abdominal or pelvic surgery
You have had a previous ectopic pregnancy
You are being investigated before starting IVF or other fertility treatment
You have had recurrent miscarriages, to check for uterine structural causes
What to Expect: step by step
Timing. The test is usually scheduled between day 6 and day 12 of your menstrual cycle after your period has finished but before ovulation. This timing reduces the risk of disrupting an early pregnancy and gives the clearest view of the uterine cavity.
Before the test. Some doctors recommend taking a mild pain reliever (such as ibuprofen) about an hour beforehand. You do not usually need to fast or take any other special preparation. Let your doctor know if you have any allergies, particularly to iodine or contrast dye.
During the test. You will lie on an X-ray table in a position similar to a pap smear. A speculum is inserted, and a thin catheter is passed through the cervix into the uterus. The dye is then slowly injected while X-ray images are taken. The entire procedure typically takes 10 to 15 minutes, though the dye injection itself only takes a few minutes.
After the test. You may experience mild cramping and light spotting for a day or two afterward. Most women can return to normal activities the same day. [We cover what the test actually feels like, and how to manage discomfort, in our dedicated article on HSG pain.]
Understanding Your HSG Results
This is usually the part patients are most anxious about. Here is what different results typically mean:
Normal result bilateral tubal patency. This means both tubes are open and the dye spilled freely on both sides. The shape of your uterine cavity also appeared normal. This is reassuring, though it does not rule out all possible fertility issues tubal openness is just one piece of the puzzle.
Unilateral blockage. This means one tube is open and one is blocked. Many women with one open tube can still conceive naturally, though it may take longer. Your doctor will discuss whether further investigation or treatment is needed based on the cause.
Bilateral blockage. This means both tubes are blocked. Natural conception through the tubes is not possible in this case, and your doctor will likely discuss IVF as the most effective path forward, since IVF bypasses the fallopian tubes entirely.
Hydrosalpinx. Sometimes the HSG shows a tube that is dilated and filled with fluid rather than cleanly blocked. This is called a hydrosalpinx and has specific implications for fertility treatment, which we cover in detail in a separate article.
Uterine abnormalities. The HSG may also reveal fibroids, polyps, scar tissue (Asherman's syndrome), or a uterine septum. These findings are evaluated separately from tubal status and may need their own treatment plan.
It's worth noting: an HSG showing a blockage does not always mean a true, permanent blockage. Sometimes the tube goes into spasm during the procedure, creating a false appearance of blockage. This is one reason your doctor may recommend a repeat test or a different investigation, such as laparoscopy, before making a final diagnosis.
Whatever your HSG shows, I encourage you to see it as one important piece of information not the whole picture of your fertility.
If your tubes are clear, that is good news, but conception depends on many factors working together: ovulation, egg quality, sperm health, uterine receptivity, and hormonal balance. If your tubes show a blockage, that is significant information that helps guide next steps but it does not mean your body has failed you, and it does not mean parenthood is out of reach.
In my practice, I look at HSG results alongside your broader hormonal, metabolic, and inflammatory health. Addressing underlying factors such as insulin resistance, thyroid function, or chronic inflammation can support better outcomes alongside whatever structural treatment path you choose.
What Happens After an HSG?
Your next steps depend entirely on your results:
Normal tubes, still not conceiving: Your doctor will likely investigate other fertility factors ovulation, sperm analysis, hormone levels.
One tube blocked: Discussion of monitoring natural conception attempts, or moving toward fertility treatment depending on your age and other factors.
Both tubes blocked: A conversation about IVF, since this bypasses the tubes completely.
Hydrosalpinx detected: Further discussion about whether the affected tube needs treatment before IVF, as hydrosalpinx fluid can reduce IVF success rates if left untreated.
Uterine abnormality found: Possible referral for hysteroscopy to assess and treat the finding.
Key Takeaways
An HSG is an X-ray test using dye to check whether your fallopian tubes are open and your uterine cavity is normal
It is usually done between day 6 and 12 of your cycle
The procedure takes 10-15 minutes; mild cramping afterward is normal
Results range from fully normal to unilateral or bilateral blockage, hydrosalpinx, or uterine abnormalities
A blockage on HSG is not always permanent, tube spasm can cause false results
Your results are one important piece of your fertility picture, not the whole story
If you have an HSG coming up, try not to let anxiety take over. This test gives you and your doctor real answers and answers are the first step toward a clear plan forward.
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