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A hysterosalpingogram (HSG) is a radiologic (X-ray) procedure in which dye is injected through the cervix into the uterus and fallopian tubes.

An HSG allows visualization of the uterus and fallopian tubes to be sure the uterine cavity is normal and the fallopian tubes are open. Abnormalities in the uterine cavity or fallopian tubes can make it more challenging to conceive or carry a pregnancy.

What is the process?

An HSG is performed between days five and 10 of the menstrual cycle. The procedure is performed in the X-ray department. A speculum is inserted into the vagina by the physician, and a small instrument is attached to the cervix. An iodine-based X-ray material is then injected slowly. The procedure is observed under fluoroscopy, and X-rays are taken. The entire procedure takes about 10 minutes.

No anesthesia is required for an HSG, however, you may experience some cramping (much like bad menstrual cramps). These usually disappear very quickly after the procedure, and any pain after the procedure is minimal.

If you and your physician have decided an HSG is necessary, follow these steps:

  1. On day one of your period (or Monday if you start on the weekend), call a Midwest Fertility office to schedule the procedure. If there is any doubt about the normalcy of your period, please notify the office so a pregnancy test can be performed. We must be certain you are not pregnant before doing an HSG.
  2. Take the prescribed antibiotic twice the day of the procedure.
  3. Take either 600 mg of Ibuprofen or 1000 mg of Acetaminophen 45 minutes before the procedure.
  4. Register at the outpatient desk at the surgery center 30 minutes before the scheduled time of your procedure.

If you are taking Metformin, Glucophage, Glumetza or Fortamet due to elevated insulin levels/polycystic ovaries, you will need to stop taking this medication two days prior to the HSG. You may resume taking this medication two days after the HSG.


An HSG is a very common test in the evaluation of infertility. Your physician may order this as part of the routine work-up, especially if you have any risk factors for blocked fallopian tubes. The results are real time, meaning your doctor will be able to tell you right away whether your tubes are open. The next steps will depend on the results of this test.

Are there risks?

Less than 1 percent of all patients undergoing an HSG may develop an infection as a result of the procedure. Should you develop a fever or unusual pain after the procedure, please notify your physician.

While very rare, allergic reactions to the X-ray dye can occur. If you are allergic to iodine, you should not have an HSG.