An egg and sperm usually meet in a fallopian tube, so doctors sometimes check that the tubes are open. The most common test is a hysterosalpingogram (HSG), a short X-ray with contrast dye. This page explains how it works as a related test; it is not a DBN service.
What it is
An HSG is an X-ray of the womb and fallopian tubes. A contrast liquid that shows up on X-ray is gently passed through the cervix, outlining the inside of the womb and showing whether it spills out of the ends of the tubes.
| Test | How it works | Notes |
|---|---|---|
| HSG | X-ray with iodine-containing dye | Most widely used tube test; low radiation dose |
| HyCoSy | Vaginal ultrasound with saline and air bubbles | No X-rays or iodine dye |
| Laparoscopy with dye | Coloured dye seen through keyhole surgery | Needs general anaesthetic |
ASRM notes that ultrasound with saline and air is considered inferior to HSG for checking the tubes, so the choice of test depends on your situation and your doctor's advice.
Who it's for
A tube test is one of several fertility investigations. It may be suggested when a couple has had trouble conceiving, especially if there is a history of pelvic infection, surgery or endometriosis, or before some treatments.
- An HSG also shows the shape of the inside of the womb.
- It is an outpatient test; you go home the same day.
- Results are reviewed with your other fertility tests.
MedlinePlus says HSG should not be done if you have pelvic inflammatory disease or unexplained vaginal bleeding. It is done in the first half of the cycle partly to make sure you are not pregnant.
Step by step
- TimingIt is booked after your period ends and before ovulation, often before about day 10 of the cycle.
- PositionYou lie on the X-ray table and a speculum is inserted, as for a smear test.
- Thin tubeThe cervix is cleaned and a thin tube is placed in its opening.
- Dye and X-rayDye flows into the womb and tubes while X-ray pictures are taken; you may be asked to change position.
- FinishThe tube is removed; fluid may leak from the vagina. Most people resume normal activities straight away.
MedlinePlus notes you can usually eat and drink normally beforehand. Some people are given antibiotics before and after, or a sedative on the day.
What it feels like
ASRM notes the X-ray part of the test itself usually takes less than five minutes, although the whole appointment is longer.
No anaesthetic is usually needed. Mild to moderate period-like cramps are common for about 5 to 10 minutes, though some people have cramps for several hours. Spotting may last a day or two.
MedlinePlus compares the speculum to having a smear (Pap) test. Cramping can be stronger if the dye spills from the tubes or if a tube is blocked.
HyCoSy is often well tolerated. In one study of 632 women, 59% felt no pain and about 6% reported severe pain.
How to prepare
- Ask whether to take ibuprofen or a similar period pain reliever beforehand.
- Tell staff about any allergy to iodine or contrast dye.
- Use pads, not tampons, for spotting afterwards.
- Arrange a ride home in case of cramps.
- Take a home pregnancy test beforehand if your periods are irregular.
- Don't have the test if you could be pregnant; follow advice on avoiding sex before it.
- Don't book it while you are actively bleeding.
Risks and side effects
HSG is considered very safe. Infection risk is under 1%, slightly higher if tubes are blocked. Allergy to the dye is rare. The radiation dose is very low. Call a doctor for fever, increasing pain or heavy bleeding in the following days.
| Risk | What sources say |
|---|---|
| Infection of the womb or tubes | Under 1%; antibiotics may be given |
| Allergy to the dye | Rare; tell staff about past reactions |
| Hole in the womb wall | Listed as a possible risk |
| Radiation | Very low dose |
HyCoSy avoids X-rays and iodine dye. In the study of 632 women, about 4% had mild fainting-type reactions and none had infection or bleeding complications.
If you are allergic to iodine, a non-iodine contrast can be used. If a blockage is found, antibiotics may be given to lower the infection risk.
MedlinePlus advises contacting your provider straight away for smelly discharge, pain or fever after the test, as you may need antibiotics.
ASRM adds that the radiation dose is low enough that it is not considered harmful if you conceive in the same cycle. Do not have the test if you think you might already be pregnant.
How DBN does it
DBN does not list HSG as a service. Your doctor will advise whether a tube test is needed and where it can be arranged. The first consultation is free.
Bring any previous tube test report to your consultation so the doctor can review it with your other results.
When to see a doctor
- You have been trying to conceive for some time without success.
- You have had a pelvic infection, chlamydia or an ectopic pregnancy.
- You have had abdominal or pelvic surgery, or have endometriosis.
- You get fever or worsening pain after a tube test.
Questions & answers
Does DBN do HSG?
No. Your DBN doctor will advise whether a tube test is needed and where it can be arranged.
Is it safe if I conceive that month?
ASRM states the radiation dose is very low and considered safe even if conception happens that month. The test is not done if pregnancy is suspected.
What if a tube is blocked?
Your doctor will discuss next steps, which may include laparoscopy or IVF, depending on your situation.
Can an HSG improve fertility?
This is debated. ASRM notes some studies show a slight increase for about 3 months afterwards, but the test is done mainly to diagnose.
Related DBN services
Related articles
Sources
- Hysterosalpingogram (HSG) patient education fact sheet — ASRM ReproductiveFacts
- Hysterosalpingogram (HSG) - information for patients — Cambridge University Hospitals NHS
- Hysterosalpingocontrast sonography (HyCoSy): evaluation of the pain perception, side effects and complications — BMC Medical Imaging (2013) / PubMed Central
- Hysterosalpingography — MedlinePlus (U.S. National Library of Medicine)