Hysterosalpingography: The diagnostic test to understand your fertility


When starting a family becomes a desire, every step in the assisted reproduction process is crucial. Hysterosalpingography, known as HSG, stands out as one of the most essential tests in the quest for fertility.

In this article, along with Dr. Elena Santiago, we explain what it is, indications, the procedure, and more about this important fertility test.

Fertility Tests

Before delving deeper into hysterosalpingography, it is crucial to understand its role in the world of fertility tests. At Vida Fertility, we recognize the importance of these tests in determining and overcoming obstacles that may be affecting your ability to conceive.

>> These are the tests you should undergo before any fertility treatment <<

What is Hysterosalpingography?

Hysterosalpingography is a diagnostic test that uses X-rays to examine the uterus and fallopian tubes. This examination visualizes possible blockages or abnormalities in these crucial areas for reproduction.

In the case of an obstruction in both fallopian tubes preventing the connection between the egg and sperm, natural pregnancy cannot occur.

Hysterosalpingography, therefore, enables the evaluation of both the anatomical structure of the female reproductive system and the functioning of the fallopian tubes, as it provides details about tubal patency.

Types of HSG

There are two types of hysterosalpingography: conventional and virtual. Both provide detailed images of your reproductive organs but differ in their technical approach.

A recent innovative variation is called hysterosalpingosonography (HSSG), which, as the name suggests, uses ultrasounds to obtain images instead of X-rays, which presents a significant advantage.

Moreover, the different types of HSSG are distinguished by the contrast medium used:

  • HyCoSy: This stands for Hysterosalpingo-Contrast-Sonography, a type of HSSG that uses either saline solution or a galactose solution as the contrast agent. This agent is introduced through the cervix and is tracked through transvaginal ultrasound as it progresses through the uterus and fallopian tubes.
  • HyFoSy: This is the abbreviation for Hysterosalpingo-Foam-Sonography, an even more innovative type of HSSG that does not use contrast agents. Instead, a foamy gel is injected vaginally, which fills the uterine cavity and moves into the fallopian tubes, offering clearer and more precise images through ultrasound.

When Is Hysterosalpingography Appropriate? Indications for HSG

This fertility test is used to evaluate various conditions that may affect fertility. At Vida Fertility, we consider the indications on an individual basis.

This test is also recommended in the study of women with menstrual irregularities, pelvic pain, pelvic tumors, and congenital abnormalities. Additionally, it can be performed to assess the effectiveness of tubal ligation.

What Abnormalities Does HSG Detect?

According to Dr. Elena Santiago, “HSG is capable of detecting a series of abnormalities, such as blockages in the cervix, fallopian tubes, uterine abnormalities, and more. This allows us to identify issues and determine an appropriate treatment plan for each patient.”

Hysterosalpingography plays a crucial role in identifying the cause of infertility, which makes it easier to select the most appropriate assisted reproduction technique with the best chances of success, whether it’s artificial insemination (AI) or in vitro fertilization (IVF).

How Is the Hysterosalpingography Fertility Test Done?

  • Preparation: Before the test, some preparation steps are recommended. These range from scheduling the test between days 8 and 10 of the cycle to the need to abstain from sexual intercourse beforehand.
  • Procedure: The HSG procedure is relatively quick and does not require anesthesia. Similar to a Pap smear, it involves the introduction of a contrast medium into the uterus, followed by X-rays to observe how this fluid flows through the reproductive system.
  • Post-HSG Care: After the test, it is essential to consider some care steps to ensure your well-being and optimize the results: avoid heavy activities and follow the specialist’s recommendations.

Hysterosalpingography Result

Once the images are obtained, they are carefully interpreted to determine the state of your reproductive system.

  • Positive Cotte’s Sign: Indicates that the fallopian tubes are patent, meaning the contrast flows through both tubes and is expelled into the abdominal cavity. This suggests that the patient has no abnormalities in this aspect.
  • Negative Cotte’s Sign: Whether in one fallopian tube or both, it indicates an obstruction in one or both tubes, preventing the contrast from passing through their structure. This can cause inflammation in the tubes. It is also possible that the fallopian tubes are not visible due to a possible malformation in the tubes or uterus.

As mentioned earlier, these results will influence the choice of the most suitable assisted reproduction technique for you.

Patient Questions about Hysterosalpingography

What are the preparations before Hysterosalpingography?

It is important to follow the recommendations of your specialist, which will include aspects like the timing of the cycle for the test.

According to Dr. Santiago, Hysterosalpingography generally does not require any special preparation on the part of the patient, except for emptying the bladder before the procedure. In some cases, the use of a laxative or an enema a few hours before the study may be suggested for sharper and more precise radiological images.

Dra. Elena Santiago, Vida Fertility Team

What does Hysterosalpingography involve? Is it painful?

To conduct the diagnostic test, a plastic tube containing a balloon is used, which is positioned in the region of the uterine cavity. Once in place, using X-rays and with the help of contrast injected into the balloon, it is possible to assess the condition of the tubes and uterine cavity.

Hysterosalpingography is generally not painful, but in certain cases, some women may experience discomfort. Therefore, it is advisable to have the test performed with local anesthesia. This not only helps prevent any discomfort but also promotes relaxation in the patient.

tratamientos de fertilidad

Can Hysterosalpingography Affect Premenstrual Symptoms and/or Menstruation?

Hysterosalpingography should generally not alter the menstrual cycle because the ovaries are not affected.

However, on some occasions, some women may experience brief premenstrual discomfort due to the minimal passage of contrast fluid in the abdominal cavity. This fluid is safe but could make the menstrual period after the study slightly more uncomfortable than usual.

If any uterine abnormality or injury is found through this study, it could influence the subsequent menstrual cycle. In any case, if these symptoms persist, it is important to consult a fertility specialist for a more detailed evaluation.

What are the benefits and risks of Hysterosalpingography?

Advantages and benefits of hysterosalpingography

  • This procedure is minimally invasive and generally does not present significant complications.
  • It can provide valuable information about fertility or pregnancy-related problems.
  • In some cases, it may have the potential to unblock the fallopian tubes, which could increase the chances of a future pregnancy.
  • After the examination, your body does not retain radiation.
  • The X-rays used in this procedure are typically within a common diagnostic range and usually do not have significant side effects.

Risks of HSG

  • Slight possibility of cancer due to radiation exposure. It is important to emphasize that the amount of radiation used in medical procedures is minimal. Furthermore, this small risk is considered justifiable compared to the valuable benefits it offers in terms of accurate diagnosis and medical treatment.
  • Pelvic infections, inflammatory disorders, or untreated sexually transmitted diseases can exacerbate the situation.
  • Pregnant women should communicate their status to the doctor and the radiology technician.

Do you still have questions about Hysterosalpingography? Consult with our Vida Fertility specialists to get all the information you need.