HSG Test — What to Expect and How to Read Your Results

The HSG — hysterosalpingogram — is the X-ray test that answers one of fertility’s most fundamental questions: are your fallopian tubes open? If they’re blocked, IUI can’t work, natural conception is unlikely, and IVF becomes the path forward. It takes 10–15 minutes, costs ₹2,000–5,000, and should be done before any treatment plan is finalised. Here’s what to expect.

The Procedure — Step by Step

Timing: scheduled between day 6 and day 12 of your cycle — after your period ends but before ovulation, to avoid disrupting a potential early pregnancy.

In the room: you lie on an X-ray table in a position similar to a pelvic exam. A speculum is placed, and a thin catheter is inserted through the cervix into the uterus. Contrast dye (a liquid visible on X-ray) is slowly injected.

The images: as the dye fills the uterine cavity, the radiologist takes X-ray images. If the tubes are open, dye flows through them and spills freely into the pelvic cavity — the radiologist can see this happening in real time. If a tube is blocked, the dye stops at the point of obstruction.

Duration: the actual dye injection and imaging takes 5–10 minutes. You’ll be in the room for 15–20 minutes total.

Does It Hurt?

Honestly: it ranges from mildly uncomfortable to moderately painful, and the variation between women is large. Most describe cramping similar to period pain during the dye injection — particularly as the dye fills the uterine cavity. The cramping usually subsides within minutes of the catheter being removed. Many clinics recommend taking ibuprofen or a similar painkiller 30–60 minutes beforehand to reduce discomfort.

For some women it’s barely noticeable; for others it’s the worst ten minutes of their fertility workup. Neither experience means anything about your results — pain intensity doesn’t correlate with whether tubes are open or blocked.

Reading Your Results

“Bilateral spillage” / “Bilateral patent”: both tubes are open. Dye flowed through and spilled freely on both sides. This is the result you want — it means IUI and natural conception are physically possible, and the investigation moves to other factors.

“Unilateral spillage”: one tube open, one blocked. Natural conception and IUI can still work through the open side, though per-cycle odds are somewhat reduced. IVF bypasses tubes entirely and remains an option.

“No spillage” / “Bilateral block”: both tubes blocked. IUI cannot work. IVF is the definitive treatment — it retrieves eggs directly from the ovaries and fertilises in the lab, making tubes irrelevant. This result is disappointing but provides a clear, actionable answer.

“Cornual block” or “proximal block”: blockage near the uterus. This can sometimes be a false positive from tubal spasm during the procedure. If bilateral proximal block is found, a repeat test or a different method (sonosalpingography with contrast) is often recommended before concluding the tubes are truly blocked.

Uterine cavity findings: the dye also outlines the shape of the uterine cavity. Filling defects may suggest fibroids, polyps, or a uterine septum — findings that merit further investigation with hysteroscopy.

After the Test

Mild cramping and spotting for a day are normal. Most women resume normal activity immediately. There’s an interesting footnote: some studies suggest slightly improved conception rates in the 2–3 months after HSG — possibly because the dye flush clears minor debris from the tubes. It’s not a treatment, but the observation is consistent enough that trying naturally in the months after a normal HSG is reasonable before escalating.

Alternatives

Sonosalpingography (SSG): ultrasound-based, using saline or foam contrast instead of X-ray dye. No radiation exposure, performed in the clinic rather than a radiology suite. Slightly less detailed for complex tubal anatomy but adequate for confirming patency.

Diagnostic laparoscopy: direct visualisation of the tubes under anaesthesia. More invasive, but also allows treatment of endometriosis or adhesions found during the procedure. Usually reserved for cases where HSG is inconclusive or endometriosis is suspected.

The HSG is a foundational test — cheap, fast, and decisive. If it hasn’t been done and you’re planning IUI or trying naturally, insist on it. An IUI through a blocked tube is money spent on a procedure that physically cannot work. Full female fertility assessment guide.