Hysterosalpingography and how to prepare

Hysterosalpingography (HSG) is an X-ray of the uterus and fallopian tubes with contrast. The contrast goes in through the cervix and fills the uterus. If the tubes are open, it flows through them into the belly. The images show the shape of the uterine cavity and whether contrast passes through each tube. At the Women's Health Center of Oberig Clinic, we do it on a Toshiba Ultimax digital X-ray unit with local pain relief.

Who needs it and why

HSG is most often part of a fertility workup. If you have not conceived after a year of regular sex without contraception, or after six months if you are over 35, blocked tubes are a common cause. It makes sense to rule them out early, together with hormone tests and your partner's semen analysis. The test is also used before intrauterine insemination, after an ectopic pregnancy, after pelvic surgery or pelvic infections, and when uterine anomalies, polyps or adhesions are suspected.

It also checks results after treatment, for example after surgery to reopen a tube. Read more on the tubal recanalization page. A gynecologist or fertility doctor usually refers you after an exam and ultrasound.

Why tubes get blocked

A fallopian tube is a thin channel about 10-12 cm long. The egg meets the sperm inside it and travels to the uterus. Even a small adhesion can close the path. Common causes:

• past pelvic infections, including chlamydia and gonorrhea, sometimes with no clear symptoms
• pelvic or abdominal surgery that leaves scar tissue
• endometriosis, when tissue like the uterine lining grows outside the uterus
• an ectopic pregnancy or surgery on the tubes
• abortions and uterine procedures with complications

Blocked tubes usually cause no symptoms. A woman may not know for years, until she tries to get pregnant. A test is the only way to find out. Many women are surprised to learn that a single infection years ago, treated or not, can be enough to leave scarring.

How tubal patency is checked

There are several methods. X-ray HSG is the classic and most common one. It shows whether the tubes are open, the shape of the uterus and where a tube is blocked. Sono-HSG uses ultrasound with fluid or special foam. No radiation, but less detail. Laparoscopy with dye gives the most precise answer, but it is surgery under anesthesia, so it is not the first step. In most fertility workups, HSG comes first because it is quick, done without anesthesia and answers the main question in one visit.

HSG and metrosalpingography are two names for the same test. If your referral says either one, this is the procedure you need. Is there a reliable home test? No. Only a clinic test gives an answer. No blood test or cycle tracking can tell you if your tubes are open.

How to prepare

The test is done in the first half of your cycle, on days 7-10 from the first day of your period. Bleeding has stopped and ovulation has not happened yet. This makes sure you are not pregnant. Use barrier contraception in that cycle. Your gynecologist will usually ask for a vaginal swab first to rule out infection. If your cycle is irregular, call the contact center: they will help you pick the right day, and the doctor may ask for a pregnancy test on the morning of the procedure.

No bowel prep is needed. Come in the morning after a light breakfast. Empty your bladder right before the test. Bring earlier test results. Tell the doctor about any allergy to iodine, contrast or medicines, and about heart, kidney or thyroid disease or diabetes.

How the test goes

You lie on the X-ray table in the same position as on a gynecological chair. The doctor numbs the cervix with lidocaine spray or gel, places a thin balloon catheter in the cervical canal and takes a first image. Then, watching on X-ray, the doctor slowly injects contrast and takes 2-3 images as the uterus and tubes fill. It takes 15-20 minutes. The doctor stays with you the whole time, and you can ask for a short pause if you feel uncomfortable.

Afterward you stay 30 minutes under staff watch in case of a reaction to the contrast. Then you can go back to normal life. For a day or two you may have light discharge and mild cramping, like before a period. Use a pad, not a tampon, for these days. Call your doctor if you get a fever, strong pain or heavy bleeding, since these are signs that need a check.

Does it hurt?

It should not cause strong pain. That is why the cervix is numbed and the contrast goes in slowly. Most women describe a cramp or pulling pain like period pain. It lasts a few minutes and stops right after the test. If a tube is blocked and the contrast stretches it, the feeling may be stronger. You can take a painkiller 30-40 minutes before, if your doctor agrees. Slow breathing helps too. The worst part is usually over in under a minute, and the doctor talks you through each step, so nothing comes as a surprise.

What the result shows

Normally, contrast fills a triangle-shaped uterus evenly, flows through both tubes and spills into the belly. If contrast stops in a tube, the doctor notes where it is blocked. A swollen tube filled with fluid (hydrosalpinx), adhesions, polyps and uterine anomalies also show up. Sometimes a tube looks blocked because of a spasm caused by the contrast, but it is actually open. That is why the doctor reads a borderline result together with other data and may suggest a repeat or another method.

You can pick up the report the next working day, except Saturday, Sunday and holidays. Take it to your gynecologist. They plan the next steps: treatment, laparoscopy or assisted reproduction. Some women conceive more easily in the first cycles after HSG, as if the contrast flushed the tubes. Do not count on this as treatment, though.

Contraindications and safety

The test is not done in pregnancy, with active pelvic infection or uterine bleeding. The radiation dose is small and does not affect a future pregnancy, because the test is done before ovulation. Reactions to the contrast are very rare, and the clinic has everything for emergency care. Mild side effects such as cramping, spotting or a brief feeling of faintness pass on their own. Serious infection after HSG is uncommon, and checking the swab beforehand lowers the risk even further.

Common questions

HSG or ultrasound: which is better?

X-ray HSG shows more detail and finds the exact block. Ultrasound uses no radiation. Your gynecologist decides which one fits your case. Oberig Clinic offers X-ray HSG.

Can I try to conceive in this cycle?

Yes, after the test. Before it, use protection in that cycle, so the test does not fall on an early pregnancy you do not know about yet.

Do I need someone with me?

Not really. There is no anesthesia. After 30 minutes of observation you can go home on your own. Some women still like to have a partner along for support, and that is welcome.

What if one tube is blocked?

You can still conceive naturally, because the other tube works. Your gynecologist will look at your other results and advise whether to wait or move to treatment or insemination.

When can I have sex again?

Usually after 1-2 days, once the discharge stops. The doctor will tell you right after the test, based on how it went.

Hysterosalpingography price

The price covers the whole test, including local pain relief, images and the doctor's report. It does not depend on the number of images. A repeat test costs the same. Book by phone or online.

Prices are from the clinic price list as of 26.10.2026. They may change. Please check the current price with the contact center.

Why choose Oberig Clinic

• Toshiba Ultimax digital X-ray unit and experienced doctors of the Women's Health Center.
• Local pain relief and slow contrast injection for your comfort.
• Gynecologists, gynecologic surgery and a lab in one clinic: from tests to treatment.
• Report the next working day, and you keep the images.

Address: 3 Zoolohichna St, buildings G and V, Kyiv. Book online at https://my.oberig.ua/ua/appointment/ or call +38 044 521 30 03.