What should I expect during a Hysterosalpingogram (HSG)?

A hysterosalpingogram (HIS-teh-roh-sal-PING-oh-gram) (HSG) is a test that lets your doctor examine the inside walls of your uterus and fallopian tubes.  This minor procedure is designed to provide information about the shape and contour of the endometrial cavity (uterus) or to document the presence of endometrial polyps, leiomyomata (fibroids), or scarring. In addition the procedure will determine whether the fallopian tubes are patent (open).


Having a blocked fallopian tube or a growth in your uterus can reduce your chances for pregnancy. If your fallopian tubes are blocked, the sperm can’t reach the egg. A hysterosalpingogram (HSG) is a test that uses x-rays and a special dye to detect scar tissue, polyps, fibroids, and other growths that may be blocking your tubes or preventing a fertilized egg from implanting properly in your uterus. Another test, called a sonohysterogram (SAHN-oh-HIS-tehroh-gram), uses ultrasound and a special solution to detect abnormalities inside the uterus. However, the sonohysterogram cannot be used to detect blocked fallopian tubes.  An HSG is routinely performed as part of an infertility workup.

What to expect during the HSG

The HSG is usually done in a radiology lab and takes between 10 and 30 minutes. Your doctor will insert a speculum into your vagina (like when you have a Pap smear), and then place a thin plastic tube inside your cervix that will lead to your uterus and fallopian tubes. A special dye will be injected through the plastic tube. The dye should fill your uterus and fallopian tubes and spill out of each fallopian tube. Next, x-rays will be taken, and your doctor can evaluate your uterus and fallopian tubes.

Is the HSG procedure painful?

Many women feel some cramping, especially when the dye is injected.  Women who have a blocked fallopian tube may feel intense pain. Over-the-counter pain medicines such as ibuprofen can help relieve this pain or discomfort.  Speak to your doctor about taking a pain medicine 30 to 60 minutes before the procedure to prevent or reduce pain during the test.

Is it OK to drive home by myself after the test?

Many women have no pain after the HSG, but you may feel crampy or achy after the procedure, so it’s a good idea to have someone else drive you home.

What are the risks of a hysterosalpingogram?

The risks of the HSG include pain or discomfort, infection, and vaginal spotting or bleeding. Contact your doctor if you develop a fever or continue to feel pain for more than a few days.  Contact your referring physician if you experience any of the following symptoms after the HSG: heavy bleeding, lower abdominal pain, foul smelling discharge or temperatures over 100ºF.

When is the best time during my cycle to schedule the HSG?

The test should be scheduled after your period ends, but before you expect to ovulate, usually between day 6 and 10 of your menstrual cycle. To figure out the days of your cycle, count day 1 as the day your period begins.

How should I prepare for the HSG procedure?

Antibiotics are given prophylactically to prevent infection. It should be taken the day prior, the day of, and the day after the HSG.  Your referring physician should prescribe Doxycyline 100mg tablets (antibiotic), to be taken twice daily for 3 days.  If you are allergic to doxycycline then Zithromax (Z-Pak) can be used as an alternative.

On rare occasions, a woman may have an allergy to the iodine contrast used in an HSG. Patients with documented allergies to iodine, intravenous contrast dyes, or shellfish should make that know to the physician prior to the procedure. Other risks associated with an HSG include pain or discomfort, infection, and vaginal spotting or bleeding. Contact your referring physician if you develop a fever or continue to feel pain for more than a few days.  Patients should also call their referring physician if they experience any of the following symptoms after the HSG: heavy bleeding, lower abdominal pain, foul smelling discharge or temperatures over 100ºF.


Scheduling: HSG’s are currently performed in our Basking Ridge office location. Call on day 1 of your menses to schedule the HSG. Appointments can be made by calling the office at 973-656-2089 Monday through Friday 7:00AM-5:00PM. Any calls made after hours will be returned the following day. When scheduling an HSG, you will be asked to provide your name, date of birth, social security number and insurance information.

Referral/Authorization: Contact your insurance provider to determine if you have coverage for the test and whether they require a referral and/or a prior authorization. You can provide them with the following codes:
CPT codes: 74740, 58340 (procedure code)
Dx code: V26.21 (diagnosis code)

Please note: It is the responsibility of your referring physician to obtain a referral or a prior authorization from your insurance provider.

Rita Gulati, MD, FACOG

Reproductive Medicine Associates of New Jersey

Reproductive endocrinologist at Reproductive Medicine Associates of New Jersey (RMANJ). View more blogs by Dr. Gulati.