How a Hysterosalpingogram Helps Diagnose Fertility Issues

Editor: Maharshi Soni on May 16,2025

When couples start their parenthood journey, the emotional toll of trying to conceive can be overwhelming if they encounter challenges. Infertility affects millions of couples across the world, and many couples are not even aware of the reason. A couple will often start their infertility journey with some testing to investigate the cause of a couple's infertility and identify risk factors. One of the most common fertility diagnostic tools from obstetricians to GYNs to reproductive endocrinologists is the hysterosalpingogram (HSG) procedure. This procedure examines a woman’s reproductive health through imagery that evaluates the uterus and fallopian tubes.

What Is a Hysterosalpingogram?

The hysterosalpingogram (HSG) is considered an 'internal' radiologic procedure that provides a visualization of the uterus and fallopian tubes. The procedure involves introducing contrast dye and utilizing X-ray imaging to visualize a woman’s reproductive organs. The HSG protocol specifies obtaining the relevant information between days 6 and 11 of the menstrual cycle to minimize the risk of complications and to provide the clearest view of the reproductive structures. Day 6 would be after menstrual bleeding had completed, but before ovulation was to occur at or around day 14.

During the procedure, a catheter is placed through the cervix, and a dye is injected into the uterus. The dye flows through the uterine cavity and down the fallopian tubes, with real-time X-ray images to demonstrate the uterus's shape and whether the fallopian tubes are open and working. If the dye spills into the abdominal cavity, the tubes are patent (open); if not, there is likely a blockage or some other anatomical issue preventing conception.

Learn More: Helping Your Child Navigate Friendships: Social Skills

1. Identify Blocked Fallopian Tubes

The major reason for performing an HSG is to evaluate the condition of the tubes. Tubal blockages can make it impossible for the sperm and egg to meet and cause natural conception. A blockage can happen due to past infections, pelvic inflammatory disease (PID), endometriosis, or previous abdominal surgeries. The HSG can tell if one or both tubes are blocked. This is valuable information because, with bilateral tubal blockage, women may be candidates for in vitro fertilization (IVF), while with one blocked tube, they might still go through natural conception.

2. Identifying Uterine Abnormalities

The uterus plays a key role in not only implantation but also in sustaining a pregnancy. Any abnormality in its structure can increase the risk of infertility or miscarriage. The HSG test provides a detailed outline of the uterine cavity, helping doctors detect congenital or acquired abnormalities. Congenital issues may include a septate uterus, where a fibrous band of tissue divides the uterus, or a bicornuate uterus, which has two horn-like projections. Acquired abnormalities may involve fibroids, polyps, or adhesions that develop over time. By identifying these conditions through the hysterosalpingogram, physicians can recommend surgical corrections like hysteroscopic resection, significantly improving the chances of conception and a healthy pregnancy.

3. Detecting Scar Tissue and Asherman’s Syndrome

Asherman’s syndrome is a condition where scar tissue builds up inside the cavity of the uterus. Most commonly, patients will have acquired Asherman's syndrome from previous surgeries like dilation and curettage (D&C), infections, trauma, or a medical condition. Scar tissue can clog or limit the menstrual flow, lead to recurrent miscarriages, or even infertility. An HSG will show scarred areas as spots that unable to be filled with the dye or where the dye kinda creeps through. HSG results will show a visual map of the scarring extent which can be used for diagnosis. This condition would be expected to be treated with hysteroscopic surgery to remove the adhesions and allow for normal uterine lining to develop and for pregnancy to occur. 

4. Assessing for Possible Partial Tubal Obstruction or Dysfunction  

Even if the fallopian tubes do not show complete tubal blockages, they may be partly blocked or dysfunctional. These conditions can arise from infections, previous surgeries, or chronic inflammation causing either tubal stenosis (narrowing of the fallopian tubes) or congenital reduced mobility of the cilia that propel the egg. An HSG with the dye only partly or slow trickling along is an indication of partial tubal obstruction or dysfunction. The level of detail from the HSG helps fertility specialists decide and make recommendations of either surgical repair, medications, or assisted reproductive technologies (ART) such as IVF. Diagnosing and treating tubal dysfunction early in the fertility evaluation can save precious time and provide more timely or productive use of reproductive treatment options.

5. Uncovering Hydrosalpinx and Its Effects on Fertility

Hydrosalpinx is a condition where a fallopian tube becomes filled with fluid, often due to previous infections such as PID. The fluid buildup can block the tube and create a toxic environment that impairs embryo implantation. A hysterosalpingogram can clearly show the characteristic shape and dilation of a hydrosalpinx. These findings are important because the presence of hydrosalpinx can significantly lower the success rates of IVF. In many cases, removal or surgical sealing of the affected tube is recommended before proceeding with IVF to improve outcomes.

Check This Out: Babyproofing Checklist: Keep Your Baby Safe and Secure

6. Supporting Individualized Treatment Plans

The findings from an HSG test can guide a physician in the customization of fertility treatment. For example, if the uterus and fallopian tubes appear normal then a physician may recommend less invasive treatments such as timed intercourse, ovulation induction, or intrauterine insemination (IUI). On the other hand, if the HSG results indicate abnormalities, then more invasive options may be required. As a diagnostic tool, if the physician uses the HSG to navigate the path to treatment, this will likely help improve efficiency in the area of fertility care (avoid unnecessary detours), and will be directed towards options that would provide a better chance of success rather than a trial-and-error approach. The goal is to provide the best outcome for couples and to lessen the emotional and financial toll associated with fertility treatment.

7. Confirmation of the Status of Tubal Ligation or Reversal 

Women who have had tubal ligation (surgical sterilization) and are considering tubal reversal surgery to restore fertility, must verify whether or not their tubes are open. The hysterosalpingogram is the gold standard test for this process. After tubal ligation, the HSG test can be used to confirm the successful nature of the ligation by demonstrating that there is complete blockage. Post-reversal, the HSG would evaluate whether or not a woman's tubes are open and functionally capable of allowing the egg to be fertilized. This will help to determine whether or not she is capable of attempting a natural conception, or would be better suited for assisted reproduction options.

8. Assessing Uterine Health Before IVF

Before initiating an IVF cycle, it's essential to ensure that the uterine environment is conducive to embryo implantation. Even the highest-quality embryos cannot implant successfully in a compromised uterus. The hysterosalpingogram helps identify subtle abnormalities such as polyps, fibroids, or uterine septa that might interfere with implantation. Once identified, these issues can often be corrected surgically or managed medically before starting IVF. As such, the HSG test serves as a critical quality check to maximize the chances of success with assisted reproduction.

9. The HSG as a Fertility Enhancer

It is fascinating that some women experience a pregnancy in the months following a hysterosalpingogram. Although the test is primarily a diagnostic tool, it can have a therapeutic effect. Sometimes when dye is injected, it can wash away small blockages, cellular debris, or mucus plugs that may have been blocking the travel of the egg or sperm. Some studies have shown a slight increase in pregnancy rates, particularly if an oil-based contrast dye is used. Again, not all women will have this experience with the test, but it can provide a nice bonus to the procedure. For most couples trying to conceive, this temporary "fertility" bump can sometimes be the surprise they need.

10. Rule Out Other Infertility Causes

There are many other causes of infertility. Although the HSG test will not address the endocrine components of the female reproductive system, it helps rule out some possibilities by clearly visualizing the internal reproductive anatomy. Therefore, if a woman has a normal uterine shape, that is both echogenic and vascular, and open tubes, then doctor's may then decide to focus on other causes of infertility such as ovulation dysfunction, endometriosis, diminished egg quality, or male factor infertility. If structural defects are ruled out early on in the assessment of infertility issues, the doctors can quickly narrow down other testing options to get an early diagnosis. The HSG test is typically ordered as one of the very first tests in an overall fertility work-up due to the quick and effective diagnostic information it provides.

What to Expect During a Hysterosalpingogram Procedure

Although the idea of undergoing a hysterosalpingogram may cause anxiety, the procedure is relatively straightforward. It is usually performed in a radiology department and takes about 15 to 30 minutes from start to finish. Patients should take an over-the-counter pain reliever before the test to ease potential discomfort. After changing into a gown, the patient lies on an exam table like a pelvic exam. A speculum is inserted into the vagina to visualize the cervix. A thin catheter is then inserted through the cervix into the uterus. Once positioned, contrast dye is slowly injected while X-ray images are captured in real time.

Understanding the Hysterosalpingogram Cost

The price of a hysterosalpingogram can vary widely depending on geographic location, insurance benefits, and the location services are performed. The average hysterosalpingogram service in the United States is going to cost between $300-$1,000. That price may include radiologist fees, cross dye, imaging, and consult prior to the procedure. Some health insurance plans are eligible for coverage if determined medically necessary, especially for infertility assessments. Benefits vary widely, so patients should contact their insurance provider to confirm coverage. Some clinics may offer payment plans or package pricing options.

Also Read: Understanding Sucking Reflex in Babies and Its Role

Conclusion

The hysterosalpingogram offers a flexible and usable technique. Whether it's diagnostic (to determine blocked tubes), uncovering uterine anomalies, or guidance in treatment planning, the HSG findings provide information needed to plan a couple's reproductive career. The procedure may not be pain-free, but it often provides enough clarity leading to a successful pregnancy. If you are in pursuit of parenthood by asking your fertility specialist if an HSG could provide answers and possibly open the avenue to possibilities for the future.

This content was created by AI