Testing Essentials: HSG Test (Hysterosalpingogram)
A hysterosalpingogram (HSG) test is one of the most common fertility investigations. It checks the shape of your uterus and whether your fallopian tubes are open — two key factors in conception.
Author
Tassia O’Callaghan
Reviewed by
Kayleigh Hartigan
17 min read
Published 24 October 2025
Spotlight:
- An HSG is an X-ray that checks whether your fallopian tubes are open and whether your uterus looks the right shape for pregnancy.
- The test uses contrast dye so doctors can spot blockages, scarring, fibroids, or other changes.
- It’s often one of the first fertility investigations recommended if pregnancy isn’t happening.
- Some people experience a short-term fertility boost after the test thanks to a “flushing” effect that clears minor blockages.
- The procedure is quick — usually under 20 minutes — and you can normally go home the same day.
What is an HSG test?
A hysterosalpingogram (HSG) is a specialist X-ray that shows the inside of your uterus (womb) and fallopian tubes. It’s designed to check whether the tubes are open and whether the shape of the uterus looks typical for supporting a pregnancy. [1,2,3,4]
The test uses a special dye that makes these structures visible on X-ray. This allows doctors to see if there are any blockages, scarring, or changes such as fibroids, polyps, or adhesions that could make it harder to conceive.
Because it focuses on two of the most important parts of the female reproductive system, an HSG is often one of the first fertility tests recommended when pregnancy isn’t happening as expected.
An HSG test may be recommended if:
- You’ve been trying to conceive for over a year (or six months if you’re over 35).
- You’ve had a miscarriage or pregnancy loss and your doctor wants to investigate further.
- You’ve had pelvic infections (e.g. pelvic inflammatory disease) that may have damaged your fallopian tubes.
- You have endometriosis or previous pelvic surgery.
- You’re preparing for IVF, where knowing the condition of your fallopian tubes is essential. [5]
Fallopian tube blockages are a common cause of infertility — accounting for around 20–30% of cases. The HSG is often the first-line test to rule this out.
Is HSG important for IVF?
It depends on the clinic. Some fertility clinics ask for a tubal check before starting IVF, while others don’t. This is because IVF works by collecting eggs directly from the ovaries and transferring embryos into the uterus — so the fallopian tubes aren’t needed for the process itself. [6]
That said, blocked or damaged tubes (especially if fluid is present, known as hydrosalpinx) can reduce IVF success. In those cases, a clinic may want an HSG or another type of scan to check the tubes and decide if further treatment is needed first. [7]
Can an HSG test improve fertility?
Yes — for some people. The dye can act like a gentle “flush,” clearing tiny blockages or mucus from the fallopian tubes and sometimes easing mild adhesions. This effect can make it easier for sperm and egg to meet, with the biggest boost usually seen in the first few months after the test.
It’s not a guaranteed outcome, but many studies show slightly higher pregnancy rates after HSG, especially when the tubes are open or only partly narrowed. Think of it as a diagnostic test with a possible added bonus. [8,9]
How is an HSG test done?
An HSG is usually carried out in a hospital radiology department or a fertility clinic. When you arrive, you’ll be asked to change into a gown and the doctor or radiographer will explain the procedure and answer any questions before starting. [3]
You’ll then be helped onto the X-ray table, lying on your back in a similar position to a smear test. A speculum is gently inserted into the vagina so your cervix can be seen. The cervix is sometimes cleaned with an antiseptic solution before a very fine, flexible tube (catheter) is placed through the cervix into the uterus. In some cases, a tiny balloon may be used to keep the catheter in position. [1,10,11]
Once the tube is in place, a small amount of clear contrast dye is introduced into the uterus. Because the dye is visible on X-ray, the radiologist can take a series of images showing how it outlines the shape of the uterus and whether it flows freely through one or both fallopian tubes. If the tubes are open, the dye will spill into the pelvic cavity and then be absorbed naturally by the body, or will leak out (that’s why we recommend wearing a pad to absorb any leaking dye). [2]
How long does a hysterosalpingogram take?
The test itself is quick — the X-ray part usually takes under 20 minutes, though you should allow around 30 minutes in total for changing and preparation.
Is the cervix dilated during HSG?
No — full dilation isn’t part of the test. A very thin catheter is gently placed through the cervix to introduce the dye, and in some cases a tiny balloon is used to keep it in position. If the cervix is unusually tight or angled, your doctor may need to take extra steps, but for most people only minimal widening is needed. [12,13]
Are you put to sleep for a hysterosalpingogram?
No — an HSG is done while you’re awake. Sedation or a general anaesthetic isn’t part of the standard procedure, which means you can usually go home shortly afterwards without needing recovery time. That’s one of the key benefits: it’s quick, low-risk, and avoids the need for a hospital stay. [2]
Can someone be in the room with you during HSG?
You can usually bring a friend, partner, or relative along for support, but they won’t be able to stay with you during the X-ray itself because of radiation exposure rules. [10]
Fertility Test: What It Is, What It Costs, and What It Tells You
From hormone checks to sperm analysis, we break down the most common fertility tests — plus where to get tested and how to understand your results.
What does an HSG test detect?
An HSG does more than simply check whether your fallopian tubes are open. It can also reveal important details about the shape and health of your uterus, which are key for implantation and pregnancy. [14]
The test can pick up:
- Blocked fallopian tubes: Either one or both, which can stop eggs and sperm from meeting.
- Uterine fibroids or polyps: Growths that may change the shape of the womb or interfere with implantation.
- Scarring or adhesions: Often from previous infections, surgery, or conditions like endometriosis.
- Irregularities in uterine shape: For example, a septum or distortion caused by fibroids.
Fibroids in particular can appear on HSG in different ways depending on their size and location. They may displace or distort the cavity, or show up as smooth or irregular filling defects. These findings aren’t always conclusive on their own — other imaging, such as ultrasound or MRI, is often used to confirm the diagnosis — but spotting them on HSG can be the first step in identifying why pregnancy hasn’t been happening.
This makes HSG a useful first-line investigation, giving your doctor the bigger picture they need to guide next steps, whether that’s surgery, IUI, IVF, or continuing to try naturally.
Here’s how it compares with other tubal tests:
Test
How it’s done
What it shows
Time and recovery
Cost
HSG (Hysterosalpingogram)
X-ray with contrast dye injected through the cervix
Blocked/open tubes, uterine cavity shape
10–20 minutes, back to normal activities same day
NHS free (with referral); £275–£620 privately
Ultrasound with contrast fluid (foam or bubbles).
No X-rays
Blocked/open tubes, uterine cavity. Less detail than HSG for scarring/adhesions
15–30 minutes, minimal recovery needed
£408–£800 privately (rarely NHS)
Laparoscopy and dye test
Keyhole surgery under general anaesthetic; dye injected through cervix while surgeon views tubes directly
Blocked/open tubes, pelvic organs, endometriosis, adhesions — most detailed view
1–2 hours procedure, recovery up to 2 weeks
NHS funded in some cases; £3,000–£5,000 privately
Can HSG detect ovarian cysts?
No — an HSG only shows the uterus and fallopian tubes. It can’t assess the ovaries or diagnose cysts. If cysts are suspected, an ultrasound or MRI is the test of choice. HSG may also miss fibroids that sit within the muscle wall or outside the uterus. [6]
Will an HSG show endometriosis?
No — an HSG can’t diagnose endometriosis directly. What it can show are the effects endometriosis may cause, like scarring, adhesions, or blocked fallopian tubes that make conception harder. [6]
Can HSG detect uterine fibroids?
Sometimes, yes — particularly fibroids that grow into or press on the uterine cavity, as these can appear as filling defects or changes in the shape of the womb. However, HSG is less reliable for fibroids that sit deeper in the muscle wall or on the outside of the uterus. In those cases, an ultrasound or MRI is usually needed for a clearer diagnosis. [2,6,14,15]
Can I ask my GP for an HSG test?
Yes — your GP can refer you for an HSG on the NHS, but you’ll usually need to meet certain criteria first. In many areas, this means you and your partner need to have been trying to conceive for 12 months (or 6 months if you’re over 35). Sadly, if you’ve had a pregnancy that ended in loss, the NHS often resets this timeframe. Waiting times also vary widely depending on your local service, and it can sometimes take months to be seen.
If you’d prefer not to wait, most private fertility clinics across the UK offer HSG testing and can often arrange it within a few weeks. This gives you faster answers and more control over when the test happens.
How much does an hysterosalpingogram test cost?
The cost of an HSG test can vary depending on where you have it, whether you’re referred through the NHS, and if your clinic includes follow-up scans or consultations as part of the package.
Below is a general overview of what to expect in the UK:
- NHS HSG test: Free of charge if referred by your GP or fertility specialist.
- Private HSG test (basic): Around £275–£400 — usually includes the X-ray and contrast dye.
- Private HSG test (with consultation or additional imaging): £400–£620 — higher costs typically reflect specialist-led clinics, hospital settings, or more detailed reporting.
Prices can differ between regions and providers, so it’s worth confirming exactly what’s included — for example, whether follow-up results are discussed in a separate appointment or shared directly with your fertility consultant.
Find the right clinic for you
Choosing a clinic is one of the biggest decisions you’ll make. We’ll find the best options for you and arrange your pre-treatment tests, empowering you from this point onwards.
How should I prepare for an HSG test?
Preparation is important — both for your comfort and to make sure the test is safe and accurate. [10,11,16]
- Avoid sex after your period until the test. This ensures you aren’t pregnant when the X-ray is taken, which is essential for your safety.
- Timing matters. The HSG is usually done in the first 10 days of your cycle (after bleeding stops, but before ovulation). You’ll often be asked to book the appointment once your period starts.
- Take pain relief an hour beforehand. Paracetamol or whatever you normally use for period cramps can help reduce discomfort.
- Follow any antibiotic instructions from your doctor. Some clinics prescribe antibiotics to lower the risk of infection.
- Bring a pad or liner. It’s common to have a small amount of spotting or discharge from the dye afterwards — tampons aren’t recommended straight after the procedure.
- Pregnancy test. Some clinics will ask you to do a test on the morning of your appointment to confirm you aren’t pregnant.
A nurse or healthcare assistant will be with you throughout the procedure, so you won’t be on your own — and you can bring someone with you to wait nearby if that feels supportive.
What to wear for an HSG test
Choose loose, comfortable clothing that’s easy to change out of, as you’ll usually be asked to wear a hospital gown during the procedure. A skirt or dress can make it easier to undress from the waist down, but anything you feel relaxed in is fine.
Bring a sanitary pad or liner for afterwards, as a small amount of the contrast dye — and sometimes light spotting — can leak out once the test is finished. Tampons aren’t recommended straight after the procedure.
Flat shoes or trainers can also help you feel steady and comfortable when walking to and from the radiology room.
How do I relax during an HSG test?
Feeling nervous before an HSG is completely normal — many people do. Simple steps can make it easier:
- Take pain relief beforehand. Paracetamol or what you’d usually use for period cramps can take the edge off any discomfort.
- Use breathing techniques. Slow, deep breaths or focusing on counting can help ease tension during the procedure.
- Ask the team to talk you through it. Knowing what’s happening in real time can reduce anxiety and help you feel in control.
- Bring support. While a partner or friend can’t be in the X-ray room, they can wait for you nearby, and a nurse or assistant will be there with you throughout.
- Plan something gentle afterwards. Even if you feel fine, having a calm activity to look forward to — like a quiet walk or rest at home — can help you feel more at ease going in.
Remember, the test itself is quick, and most people are back to their usual routine the same day.
Are there any risks to getting a hysterosalpingogram?
An HSG is generally very safe, but like any medical procedure there are some small risks to be aware of. [1,2,3,10,17]
- Infection: This is the most common complication, though it still affects fewer than 1 in 100 people. If you develop pelvic pain, fever, or an unusual discharge in the days afterwards, contact your doctor — antibiotics usually clear this quickly.
- Allergic reaction: Very rare. The contrast dye used contains iodine, so it’s important to tell your team if you’ve ever reacted to iodine or contrast dye before.
- Radiation exposure: The X-ray dose is very low — similar to a chest X-ray or a few months of natural background radiation — and not considered harmful to fertility.
- Discomfort or faintness: Some people feel cramping or lightheaded during or after the procedure. This usually passes within minutes, but you may be asked to rest before leaving the clinic.
- Test limitations: Occasionally the dye doesn’t flow as expected, either due to a temporary spasm of the tubes or difficulty placing the catheter. If this happens, you may be offered a repeat test or an alternative investigation such as laparoscopy.
Your clinical team will always weigh these small risks against the benefit of getting clear information about your fertility — and most people recover quickly and return to normal activities the same day.
Is a hysterosalpingogram painful?
Most people describe an HSG as uncomfortable rather than painful. As the contrast dye is introduced, you may feel cramping that’s a lot like period pain — usually mild to moderate and short-lived. For some, the cramps last only while the dye is flowing; for others, they can linger for a few hours afterwards. [10]
Taking over-the-counter pain relief such as paracetamol or ibuprofen about an hour before your appointment can make the procedure easier. You might also want to bring a pad for any spotting or leakage of dye afterwards. [1,2]
A small number of people feel faint during or just after the test, so it can be reassuring to have someone with you to take you home, even though most people are able to get back to their usual routine the same day. [3]
What happens after a hysterosalpingogram appointment?
Once the test is done, you can usually go home the same day and get back to normal activities, including sex, work, or driving if you feel comfortable. It’s common to have some light spotting or leakage of the dye for a day or two afterwards, so bring a pad or liner (tampons aren’t recommended straight after the procedure). Mild cramps may also linger, but these should settle with simple pain relief. [1,3,10,11,16]
How soon will I get HSG results?
Often immediately, as the radiologist can see the dye on screen. Your images are reviewed in more detail after your appointment, and a written report is sent to your referring doctor — this can take anywhere from a few days up to two weeks depending on the clinic. [10,16]
Do you need rest after an HSG test?
You can usually return to normal activities straight after, though light cramping may make you want to rest for the day.
Can I drive myself home after an HSG?
Yes — most people feel well enough to drive themselves home after an HSG, as sedation isn’t usually part of the procedure. You might have mild cramping or feel a little lightheaded straight afterwards, so it’s a good idea to rest in the clinic for a short while before leaving.
If you’re worried, or know you sometimes feel faint after medical procedures, you may prefer to arrange for someone to come with you or drive you home. But for the majority, it’s safe to resume normal activities — including driving — the same day.
What do HSG results mean?
Unlike a blood test, an HSG doesn’t give you numbers — it gives your doctor images to interpret. The focus is on how the dye moves and what the outline of your uterus and fallopian tubes looks like. Your results will usually fall into one of these categories:
- Normal result: The dye flows freely through both tubes into the pelvic cavity, and the uterus looks typical in shape. This suggests there’s no structural reason preventing conception.
- One tube blocked: The dye passes through one fallopian tube but not the other. Fertility is reduced, but natural pregnancy is still possible. Sometimes surgery or IVF is recommended depending on your situation. [10,16]
- Both tubes blocked: The dye doesn’t move through either tube. This usually means natural conception isn’t possible, and IVF or tubal surgery would be the next steps to explore. [18,19]
- Uterine abnormality: The X-ray shows an unusual outline — such as fibroids, polyps, adhesions, or scarring. These can sometimes interfere with implantation or increase the risk of miscarriage. Further tests (like hysteroscopy or ultrasound) may be suggested. [20]
Hysterosalpingogram FAQs
When is the best time to do an HSG test?
The HSG is usually scheduled between days 7 and 12 of your cycle — after your period has finished but before ovulation. This timing follows the “10-day rule”, which ensures you aren’t pregnant when the X-rays are taken and that the uterus and tubes are easiest to assess. [3]
If your cycles are irregular, very long, or you don’t have periods, your doctor will help decide the safest window to book the test. In all cases, you’ll be advised to avoid sex from the start of your period until after the HSG to remove any risk of early pregnancy being exposed to radiation.
Can I get pregnant immediately after an HSG test?
Yes — it’s possible to conceive in the same cycle as your HSG. Research suggests the test may have a “flushing effect”, clearing mucus or tiny blockages from the fallopian tubes, which may temporarily improve fertility. Some studies even show slightly higher pregnancy rates in the months following an HSG, particularly within the first 6 months. [8,9,21]
It’s safe to start trying straight away unless your doctor gives different advice. Just keep in mind that while the test can sometimes boost your chances, it isn’t a treatment on its own — and what happens next will still depend on other fertility factors. [3]
Will my period skip after an HSG test?
Unlikely. HSG doesn’t change your hormones, so your cycle should carry on as normal. Light spotting for a day or two is common and isn’t a period shift. If your period is late, it’s usually stress, cycle variation, or (occasionally) pregnancy — do a test if you’re a few days over. Seek medical advice if you develop fever, worsening pelvic pain, or unusually heavy bleeding.
Sources
- NHS North Bristol, NHS Trust. Hysterosalpingogram (HSG).
- NHS, The Leeds Teaching Hospitals, NHS Trust. Hysterosalpingography (HSG).
- NHS, Milton Keynes University Hospital, NHS Foundation Trust. Hysterosalpingogram (HSG).
- Human Fertilisation Embryologist Authority. A-Z fertility glossary.
- Human Fertilisation Embryologist Authority. Preparing for IVF.
- American Society for Reproductive Medicine. Hysterosalpingography (HSG). Revised 2023.
- D’Arpe S, Franceschetti S, Caccetta J, Pietrangeli D, Muzii L, Panici PB. Management of hydrosalpinx before IVF: a literature review. J Obstet Gynaecol. 2015;35(6):547-50. doi: 10.3109/01443615.2014.985768. Epub 2014 Dec 1. PMID: 25436898.
- Goldenberg, R.L., White, R. and Magendantz, H.G., 1976. Pregnancy during the hysterogram cycle. Fertility and Sterility, 27(11), pp.1274-1276.
- Ling L, Chen M, Shen T, Yang F, Jin Y, Liang Y. Effect of interval time between hysterosalpingography and intrauterine insemination on the pregnancy outcome of infertile patients. Front Endocrinol (Lausanne). 2023 Oct 24;14:1175278. doi: 10.3389/fendo.2023.1175278. PMID: 37964968; PMCID: PMC10641380.
- NHS, Cambridge University Hospital, NHS Foundation Trust. Hysterosalpingogram (HSG) – information for patients. 11 May 2023.
- NHS, University Hospital Sussex, NHS Foundation Trust. Your Hysterosalpingogram (HSG). Page last reviewed: Page last reviewed: 11 Dec 2023.
- Zafarani F, Ahmadi F, Shahrzad G. Hysterosalpingographic features of cervical abnormalities: acquired structural anomalies. Br J Radiol. 2015 Aug;88(1052):20150045. doi: 10.1259/bjr.20150045. Epub 2015 May 29. PMID: 26111269; PMCID: PMC4651374.
- Li, Y.T., Chen, T.H. and Kuo, T.C., 2007. Cervical softening with vaginal misoprostol before hysterosalpingography. European Journal of Obstetrics and Gynecology and Reproductive Biology, 134(1), pp.130-131.
- Ahmadi F, Hosseini F, Javam M, Pahlavan F. Hysterosalpingography findings of leiomyomas and how they look in artistic eyes: new diagnostic signs. Br J Radiol. 2021 May 1;94(1121):20200019. doi: 10.1259/bjr.20200019. Epub 2021 Jan 27. PMID: 33502912; PMCID: PMC8506183.
- Kumar S, Awasthi RT, Gokhale N. Assessment of Uterine Factor in Infertile Women : Hysterosalpingography vs Hysteroscopy. Med J Armed Forces India. 2004 Jan;60(1):39-41. doi: 10.1016/S0377-1237(04)80156-4. Epub 2011 Jul 21. PMID: 27407576; PMCID: PMC4923448.
- NHS Gateshead Health, NHS Foundation Trust. Hysterosalpingogram. Page last updated: 27 Aug 2025.
- NHS South Tees Hospitals, NHS Foundation Trust. Hysterosalpingogram (HSG). Page last updated: 05/09/2024.
- NHS. Treatment: Infertility. Page last reviewed: 09 August 2023.
- Ambildhuke K, Pajai S, Chimegave A, Mundhada R, Kabra P. A Review of Tubal Factors Affecting Fertility and its Management. Cureus. 2022 Nov 1;14(11):e30990. doi: 10.7759/cureus.30990. PMID: 36475176; PMCID: PMC9717713.
- Bosteels J, Kasius J, Weyers S, Broekmans FJ, Mol BW, D’Hooghe TM. Treating suspected uterine cavity abnormalities by hysteroscopy to improve reproductive outcome in women with unexplained infertility or prior to IUI, IVF, or ICSI. Gynecol Surg. 2013 Aug;10(3):165-167. doi: 10.1007/s10397-013-0798-0. Epub 2013 May 7. PMID: 23894233; PMCID: PMC3718997.
- Matsumoto H, Fukuda A, Mizuno S, Hashimoto S, Morimoto Y. Effect of X-ray exposure during hysterosalpingography on capabilities of female germ cells. J Assist Reprod Genet. 2021 Dec;38(12):3233-3242. doi: 10.1007/s10815-021-02347-2. Epub 2021 Nov 9. PMID: 34751833; PMCID: PMC8666400.