If you are navigating fertility testing, you may have heard your doctor mention an HSG.
HSG stands for hysterosalpingogram.
It is one of the most common diagnostic tests used during a fertility workup to check whether the fallopian tubes are open and to evaluate the shape of the uterus.
The procedure itself is usually brief, but the information it provides can be very important.
An HSG may help identify blocked tubes, uterine abnormalities, scar tissue, or other issues that could affect your ability to conceive naturally or choose the right fertility treatment.
It may also have a short-term “flushing” effect that improves pregnancy chances for some people in the months after the procedure.
Because of that, it helps to arrive prepared.
Here are seven important questions to ask your doctor before and after your HSG so you leave the appointment feeling informed, not overwhelmed.
Key Takeaways
An HSG is used to evaluate the uterus and fallopian tubes.
It can help detect tubal blockages, uterine shape concerns, adhesions, or scarring.
Some research suggests oil-based contrast may improve pregnancy rates after HSG in certain patients.
The test is usually scheduled after your period but before ovulation.
Mild cramping, spotting, or lightheadedness can happen afterward.
Your next steps depend on whether your tubes are open, partially blocked, fully blocked, or affected by spasm.
Asking the right questions can help you understand your results and fertility plan more clearly.
Disclaimer
This article is for educational purposes only and is not intended to provide medical advice. Always consult your OB-GYN, reproductive endocrinologist, fertility specialist, or qualified healthcare provider for guidance specific to your health, diagnosis, and fertility plan.
What Is an HSG?
A hysterosalpingogram, or HSG, is an imaging test that uses contrast dye and X-ray imaging to evaluate the uterus and fallopian tubes.
During the procedure, contrast dye is gently placed through the cervix into the uterus. X-ray images are then taken to see whether the dye fills the uterus and flows through the fallopian tubes.
If the dye spills out the ends of the tubes, that usually suggests the tubes are open.
If dye does not pass through one or both tubes, your doctor may suspect a blockage, spasm, scarring, or another issue.
An HSG May Help Evaluate:
Whether one or both fallopian tubes are open
Possible tubal blockages
Uterine cavity shape
Scar tissue or adhesions
Possible uterine abnormalities
Certain causes of infertility
Next steps for natural conception, IUI, IVF, or surgery
1. What Type of Contrast Will You Use: Oil-Based or Water-Based?
Why This Matters
During an HSG, your doctor uses contrast dye to help visualize the uterus and fallopian tubes.
There are two main types of contrast:
Water-based contrast
Oil-based contrast
Some studies suggest that oil-based contrast may be associated with higher pregnancy rates in the months after HSG, especially for certain patients with unexplained infertility or mild tubal concerns.
This does not mean oil-based contrast is best for everyone.
Your provider may choose based on your medical history, allergy risk, clinic protocol, imaging needs, availability, and safety considerations.
What to Ask
Ask your doctor:
Which type of contrast will be used?
Is it oil-based or water-based?
Why do you recommend that type for me?
Are there any added risks with oil-based contrast?
Could the type of contrast affect my chances of conceiving afterward?
Helpful Note
If you have a history of allergies, thyroid issues, pelvic infection, or other medical concerns, mention them before the procedure.
2. What Should I Do to Prepare for the HSG?
Why This Matters
An HSG is usually scheduled after your period ends but before ovulation.
Many clinics aim for cycle days 5 to 12, though the exact timing can vary.
This timing helps reduce the chance of doing the test during an early pregnancy and allows the provider to see the uterus more clearly.
Preparation May Include:
Scheduling during the correct cycle window
Taking a pregnancy test before the procedure
Taking ibuprofen or another approved pain reliever beforehand
Asking whether antibiotics are needed
Avoiding intercourse before the test, depending on clinic instructions
Arranging transportation if you are nervous or tend to feel lightheaded
Bringing a pad for spotting afterward
What to Ask
Ask your doctor or clinic:
What cycle day should I schedule the HSG?
Should I take pain medication before the test?
Should I take antibiotics?
Can I eat or drink beforehand?
Should I avoid intercourse before the procedure?
Can my partner or support person come with me?
Should I drive myself home or arrange a ride?
Helpful Tip
Some people feel only mild cramping.
Others feel more intense discomfort for a short time.
Knowing what to expect can make the experience feel less intimidating.
3. What Will You Be Looking For During the HSG?
Why This Matters
An HSG can provide several pieces of information.
It is not only checking whether the tubes are open.
It may also give clues about uterine shape, scarring, adhesions, or possible cavity issues.
Your Doctor May Be Looking For:
Open fallopian tubes
One blocked tube
Both tubes blocked
Partial blockage
Tubal spasm
Hydrosalpinx
Uterine cavity abnormalities
Scar tissue or adhesions
Fibroids or polyps affecting the cavity
Congenital uterine shape differences
What to Ask
Before the procedure, ask:
What are the main things you are checking during the HSG?
How will you tell if a tube is open?
How will you identify a partial blockage versus a full blockage?
What does tubal spasm look like?
Can an HSG detect uterine scar tissue, fibroids, or polyps?
Would I need additional testing if something looks abnormal?
Helpful Note
An HSG can be useful, but it does not diagnose everything.
If something looks unclear, your doctor may recommend follow-up testing such as saline sonohysterogram, hysteroscopy, laparoscopy, ultrasound, or MRI.
4. What Are the Potential Risks or Side Effects?
Why This Matters
Most HSGs are routine and low-risk, but it is still important to understand what is normal afterward and what is not.
Common Side Effects
After an HSG, you may experience:
Mild to moderate cramping
Light spotting
Watery discharge from the contrast
Lightheadedness
Pelvic pressure
Temporary discomfort
These symptoms often improve the same day or within a short period of time.
Less Common Risks
Rarely, an HSG may be associated with:
Infection
Allergic reaction to contrast
More significant pain
Fever
Heavy bleeding
Vasovagal reaction, such as feeling faint
What to Ask
Ask your doctor:
What symptoms are normal afterward?
How long should cramping last?
How much spotting is expected?
What symptoms should prompt me to call the office?
Is infection a risk for me?
Should I avoid tampons, sex, swimming, or baths afterward?
Do I need antibiotics?
When to Call Your Doctor
Call your provider if you experience:
Fever
Severe pelvic pain
Heavy bleeding
Foul-smelling discharge
Worsening pain after the first day
Dizziness that does not improve
Signs of an allergic reaction
Anything that feels concerning
5. How Soon Will I Get the Results?
Why This Matters
Some doctors review HSG findings immediately after the procedure.
Other clinics send images to a radiologist and discuss results later.
Knowing when and how you will receive results can help you plan your next steps.
What to Ask
Ask your care team:
Will someone explain the results right after the procedure?
Will I receive a written report?
Can I get a copy of the images?
Will a radiologist review the test?
Do I need a follow-up appointment?
When should I expect a call or message?
What happens if the results are unclear?
Helpful Note
Ask your doctor to explain the results in plain language.
For example:
Are both tubes open?
Is one tube blocked?
Is there any sign of hydrosalpinx?
Does the uterus look normal?
Is further testing needed?
6. If My Tubes Are Blocked, What Happens Next?
Why This Matters
An HSG can show whether dye passes through the tubes, but it does not always explain why a tube is blocked.
It also does not always confirm whether a suspected blockage is permanent.
Sometimes the tube may appear blocked because of spasm.
Sometimes mucus, debris, scar tissue, endometriosis, infection history, or hydrosalpinx may be involved.
Possible Next Steps
Depending on your results, your doctor may recommend:
Repeating the HSG
Additional imaging
Saline sonohysterogram
Laparoscopy
Hysteroscopy
Tubal cannulation for certain proximal blockages
Surgery in select cases
IVF if both tubes are blocked or severely damaged
Treating or removing hydrosalpinx before IVF
What to Ask
Ask your doctor:
Are the tubes fully blocked or partially blocked?
Could this be a spasm instead of a true blockage?
Is the blockage near the uterus or near the end of the tube?
Is hydrosalpinx present?
Are blockages always permanent?
Can this be treated surgically?
Would IVF be a better option?
Should I get a second opinion?
Helpful Note
The location and cause of the blockage matter.
A mild proximal blockage may be approached differently than severe distal tubal damage or hydrosalpinx.
7. What Can I Do in the Next 1 to 3 Months to Optimize Fertility?
Why This Matters
Some people experience a short-term fertility boost after an HSG.
This may happen because the contrast helps flush mucus or minor debris from the tubes.
The effect is not guaranteed, but your doctor may encourage trying naturally or timing treatment strategically in the months after the test, depending on your results.
What to Ask
Ask your doctor:
When is it safe to start trying after the HSG?
Can we try this same cycle?
Should we time intercourse differently?
Should we use ovulation predictor kits?
Would IUI make sense after this test?
Should we move straight to IVF based on the results?
How many cycles should we try before changing plans?
Does oil-based contrast change the expected fertility window?
Helpful Tip
If your tubes are open and no major uterine issues are found, your provider may suggest making the most of the next few cycles.
This may include tracking ovulation, timing intercourse, reviewing partner sperm results, optimizing thyroid or hormone labs, and deciding whether IUI or IVF should be considered.
Quick Recap: Questions to Print or Screenshot
Bring this list to your appointment:
What type of contrast will you use, oil-based or water-based?
What should I do to prepare for the HSG?
What will you be looking for during the HSG?
What are the potential risks or side effects?
How soon will I get the results?
If my tubes are blocked, what happens next?
What can I do in the next 1 to 3 months to optimize fertility?
How to Prepare Emotionally for the HSG
The HSG can bring up anxiety.
That is completely understandable.
You may be worried about pain, results, blocked tubes, next steps, or what the test might mean for your fertility plan.
A little preparation can help.
Before the Appointment
Consider:
Writing down your questions
Asking your clinic what to expect
Taking approved pain relief if recommended
Planning a light schedule afterward
Bringing a pad
Asking whether a support person can come
Practicing slow breathing before and during the procedure
After the Appointment
Give yourself time to process.
Even if the test is quick, the emotions can be big.
You may feel relieved, disappointed, confused, hopeful, or overwhelmed.
All of those reactions are valid.
Final Thoughts
An HSG may be just one step in your fertility journey, but it can be an important one.
It can help clarify whether your fallopian tubes are open, whether your uterus looks normal, and what next steps may make the most sense.
It may also create a short window where pregnancy chances improve for some people, especially if the tubes are open and the test helps flush them.
The best way to feel more in control is to ask clear questions before and after the procedure.
Ask what contrast will be used.
Ask how to prepare.
Ask what your doctor is looking for.
Ask what side effects are normal.
Ask when you will get results.
Ask what happens if tubes are blocked.
And ask how to optimize the next few months.
The goal is not just to get through the test.
The goal is to leave with clarity.
You deserve to understand your results, your options, and your next best step.