What is a Hysterosalpingogram?

A hysterosalpingogram is a test which is used to to assess potential causes for female infertility. It is performed by injecting the uterine cavity with a contrast dye which will show on on x-ray, and then x-raying the site to see where the dye travels. If the dye fails to go up the fallopian tubes and out into the abdominal cavity, it suggests that the woman may have what is known as “tubal infertility,” which would make it hard for her to get pregnant. This test can also be used to diagnose certain gynecological conditions such as uterine polyps.

The test is usually performed in a radiology suite at a hospital or clinic, and the hysterosalpingogram procedure takes around five minutes. Typically an x-ray is taken first to ensure that nothing in the woman's intestines and colon is obscuring the image. After determining that the area of interest will be visible, the contrast dye is injected and a series of x-rays are taken, or the traveling dye may be monitored on a continuous fluoroscopy screen.

Ideally, a hysterosalpingogram should demonstrate what is known as “fill and spill,” meaning that the contrast dye flows through the uterus, up the fallopian tubes, and out into the abdominal cavity. If the dye fails to do this, it indicates that there is a tubal blockage which must be addressed. The hysterosalpingogram can also reveal health issues like scarring, polyps, fibroid tumors, and anatomical abnormalities.

If the test is normal, additional workups may be needed to determine why the woman is infertile. If the test results are abnormal, the woman can discuss her options with a doctor; treatments like in-vitro fertilization (IVF) may be possible, and there may be potential surgical options as well. In addition to being ordered for a fertility workup, a hysterosalpingogram may also be requested to explore the causes of other health complaints relating to the reproductive tract.

As you might imagine, a hysterosalpingogram is contraindicated for a woman who is pregnant, since it involves the use of radiation which could damage a fetus. For this reason, it is usually performed around a week after the woman's last period, when she is least likely to be pregnant, just in case. The risks of the procedure are relatively low, although most women experience some cramping and breakthrough bleeding afterwards. It is a good idea to disclose any medical conditions to the doctor who orders the test, along with the radiologist, as hysterosalpingograms are contraindicated for people with some conditions.