Medically reviewed by Dr. Shweta Agarwal, MBBS, DGO. Last updated: June 2026.
Information on this page is educational and does not replace a medical consultation. Individual findings and next steps depend on clinical factors.
HSG answers two questions that standard ultrasound cannot answer reliably: are the fallopian tubes open, and is the uterine cavity structurally normal? Both questions are directly relevant to whether conception can happen naturally or with assisted reproduction. In Marathi, this test is known as गर्भनलिका तपासणी (fallopian tube examination). It is a standard part of the complete fertility workup offered at Aansh Hospital & IVF Center, serving patients across Vidarbha and northern Telangana.
When is an HSG test recommended?
An HSG is ordered when the fertility evaluation needs to assess whether the fallopian tubes are open and whether the uterine cavity is normal. It is typically part of the initial female fertility workup and is specifically indicated in the following situations:
- Unexplained infertility — when ovulation and semen analysis results are normal but conception has not occurred; tubal blockage may be the hidden factor.
- Suspected tubal damage — after a pelvic infection (PID), appendicitis, prior ectopic pregnancy, or abdominal surgery that could have caused adhesions or scarring.
- Recurrent miscarriage — to check for uterine structural problems (e.g. septum, polyps, fibroids inside the cavity) that may interfere with implantation or early pregnancy.
- Before IUI — confirming that at least one tube is patent is a prerequisite for intrauterine insemination, since IUI relies on natural fertilisation in the tube.
- Workup before IVF — to understand the uterine cavity before embryo transfer; abnormalities found at HSG may be corrected with hysteroscopy before a cycle begins.
- Prior endometriosis or PCOS history — pelvic pathology can affect tubal architecture or the cavity, warranting imaging.
HSG is a diagnostic test. It identifies anatomical problems that then guide treatment choices — it does not in itself treat infertility. Where further evaluation of the uterine lining is needed, hysteroscopy provides a direct visual view, and laparoscopy can assess the outer surface of the uterus, ovaries, and tubes.
When in the menstrual cycle is HSG scheduled?
HSG is scheduled in the early follicular phase — typically between Day 6 and Day 11 of the menstrual cycle (Day 1 = first day of period). This window is chosen for two specific reasons:
- After menstrual flow has fully stopped — so the uterine cavity is clear and the X-ray image is not obscured.
- Before ovulation — so the procedure is performed when there is no possibility of a fertilised egg being present, which is important given that the procedure involves X-ray imaging.
When scheduling, inform the team of the date your last period started. Depending on cycle regularity, the exact appointment date will be confirmed to fall within this window. If your cycle is irregular, the team will advise accordingly.
How is an HSG performed, step by step?
HSG is an outpatient procedure carried out in a radiology or fluoroscopy suite. No sedation or general anaesthesia is required, though a mild oral pain reliever is often recommended approximately one hour before the appointment to reduce cramping.
Step 1 — Positioning You lie on an X-ray table, similar to the position for a pelvic examination. A sterile speculum is placed to visualise the cervix.
Step 2 — Catheter placement A thin, flexible catheter (tube) is gently passed through the cervix into the uterine cavity. This step takes a minute or two and is the most likely point of momentary discomfort.
Step 3 — Dye injection A small volume of iodine-based, water-soluble contrast dye is slowly introduced through the catheter. As it fills the uterus and moves into the fallopian tubes, live X-ray (fluoroscopy) images are captured.
Step 4 — Reading the images If the tubes are open, the dye travels through the full length of each tube and spills into the abdominal cavity — visible on the X-ray as a "free spill." If a tube is blocked, the dye stops at the point of obstruction. Uterine shape, contour and cavity size are also assessed on the images.
Step 5 — Completion The catheter is removed. You are observed briefly and can go home the same day. The procedure itself (dye injection and imaging) typically takes 5–15 minutes; total time in the procedure room, including preparation, is usually 20–30 minutes.
Results are reviewed by Dr. Shweta Agarwal and a follow-up consultation is arranged to discuss findings and next steps.
Does HSG hurt? What will I feel during and after?
Most patients describe the sensation as menstrual-like cramping — a feeling of pressure or pulling in the lower abdomen when the dye is injected. This typically lasts only for the minutes the dye is being introduced and usually eases quickly once the catheter is removed. The intensity varies from person to person:
- Mild cramping — the most common experience; manageable, similar to a period pain.
- Moderate cramping — occurs in some patients, particularly if there is any tubal spasm or narrowing at the point the dye meets resistance.
- Brief sharp sensation — occasionally felt at the moment of catheter insertion through the cervix.
To reduce discomfort: take an over-the-counter pain reliever (e.g. ibuprofen or mefenamic acid) approximately 60 minutes before the procedure, unless medically contraindicated. Inform the team in advance of any allergy to iodine or contrast agents.
After the procedure: you may notice light spotting or a small amount of dye-coloured vaginal discharge for a few hours. Mild cramping may continue for a few hours. Most patients feel comfortable enough to return to normal activities the same day.
How to read HSG results — what do the findings mean?
Results are typically discussed by Dr. Shweta Agarwal at a consultation after the test:
| Finding | What it means | Typical next step |
|---|---|---|
| Bilateral free spill (dye flows freely through both tubes) | Both tubes are open; tubal factor is not the cause of infertility | Evaluation of other factors; IUI may be appropriate if other results are normal |
| Unilateral blockage (one tube blocked, one open) | One tube is not patent; natural fertilisation is still possible through the open tube | Monitor; surgery (laparoscopy) or IVF may be discussed depending on other findings |
| Bilateral blockage (dye cannot pass through either tube) | Both tubes are closed; natural conception and IUI are not possible via tubal route | IVF is typically the recommended path, as IVF bypasses the tubes entirely |
| Cornual/proximal block (blockage at the uterine end) | May be a true structural block or tubal spasm (a transient contraction that mimics blockage) | Repeat HSG or hysteroscopic assessment to confirm; spasm resolves without treatment |
| Uterine filling defect (irregularity in the cavity) | May suggest a polyp, fibroid, septum, or adhesion inside the cavity | Hysteroscopy for direct visualisation and, if needed, surgical correction |
| Abnormal uterine shape | May suggest a congenital uterine anomaly (e.g. bicornuate or septate uterus) | Hysteroscopy ± further imaging (3D ultrasound or MRI) |
A single HSG image is interpreted in the context of your full fertility history. A "blocked" finding on HSG does not necessarily mean surgery — the clinical picture determines the recommendation.
The "therapeutic" or "flushing" effect
Some patients conceive in the cycles immediately following an HSG. This is attributed to the mechanical flushing of the tubes by the dye, which may dislodge minor mucus debris or thin adhesions. The effect is modest and not reliable enough to treat as therapy — but it is a documented observation in fertility literature and is one reason HSG is sometimes scheduled early in the workup.
What are the risks and contraindications of HSG?
HSG is a widely-used, generally safe diagnostic procedure. Serious complications are uncommon. Known risks include:
- Mild infection (rare): Bacteria already present in the reproductive tract can occasionally be pushed upward during the procedure. This risk is mitigated by prescribing a short course of prophylactic antibiotics, which is clinically recommended for patients with a history of pelvic infection or if tubal abnormalities are found (per ACOG 2018). Seek medical attention promptly if you develop fever, increasing pelvic pain, or abnormal discharge in the days after the test.
- Contrast dye reaction (very rare): An allergic reaction to the iodine-based dye is possible. Inform your team of any known iodine or contrast allergy before the procedure so an alternative protocol can be arranged.
- Uterine perforation (extremely rare): Possible in theory with catheter insertion; the soft, flexible catheter used today makes this exceedingly uncommon.
- Radiation exposure: HSG involves a low dose of X-ray radiation, comparable to a standard chest X-ray. The procedure is not recommended during pregnancy. The follicular-phase timing of HSG is specifically chosen to avoid the possibility of irradiating an existing pregnancy.
Contraindications: HSG is not performed if a current pregnancy is suspected; if there is an active pelvic infection; or if there is a known iodine allergy without prior preparation.
What is the cost of an HSG test?
See /costs-emi for current pricing information.
The cost of an HSG test varies depending on the facility, imaging technology, and whether a consultation is included. At Aansh Hospital & IVF Center, HSG is performed as part of the structured fertility workup; the test cost is provided at the time of booking and can also be reviewed at the costs & EMI page. Financing options are available.
What happens after an HSG?
HSG results inform the treatment path forward:
- Open tubes + normal cavity + other results normal: IUI may be a suitable next step; Dr. Shweta Agarwal will discuss the clinical picture.
- Uterine abnormality detected: Hysteroscopy is typically recommended to directly visualise and, if indicated, correct the finding before any assisted conception.
- Blocked tubes confirmed: IVF is the established route, as it bypasses the fallopian tubes entirely; blocked-tube infertility is one of the clearest indications for IVF.
- Inconclusive or suspected spasm: A repeat HSG or hysteroscopic assessment may be recommended before concluding that a true structural block is present.
All findings are integrated into a personalised treatment plan. If surgery is recommended, laparoscopy at Aansh can treat peritoneal adhesions, endometriosis deposits, or hydrosalpinx (fluid-filled blocked tube) that may improve the prospects of natural or assisted conception.