If you’re having trouble getting pregnant, your doctor might recommend a hysterosalpingogram (HSG) test to learn more about what might be causing the problem.

Here’s how the test can help you conceive, what to expect during and after the procedure, and what your results may mean.  

What is a hysterosalpingogram (HSG) test?

A hysterosalpingogram (HSG) is a test that checks a woman’s uterus and fallopian tubes for any blockages or scarring that could prevent conception.

These blockages can come from an infection like pelvic inflammatory disease, abdominal surgery or a condition like endometriosis, uterine fibroids or Asherman’s syndrome. 

Although an HSG is designed to detect a possible cause of infertility, the test itself may be able to improve fertility by flushing out blockages in the fallopian tubes, some research shows. But most doctors only use HSG tests for diagnostic purposes. 

When is the best time to do an HSG test?

You should ideally get an HSG test after your period ends but before ovulation occurs (between days five and 14 of your menstrual cycle).    

How to prepare for an HSG test

HSG tests can cause uncomfortable cramping, so many women opt to take an over-the-counter pain reliever about an hour beforehand. Just get the green light from your health care provider first. 

Speaking of meds, some women also take a prescribed course of antibiotics before an HSG test to reduce the risk of infection. If your doctor prescribes antibiotics, take them exactly as directed before your procedure.

Finally, consider asking someone to give you a ride home afterwards. While you’d probably be able to drive if you needed to, you might not feel your best and could have a lot on your mind. Some extra support is always a good thing!  

What happens during an HSG test?

HSG tests are usually performed in your doctor’s office. You’ll be awake and lying on an exam table with your feet up just like you would for a pelvic exam. The whole procedure usually takes less than 30 minutes.  

Your practitioner will use a speculum to open your vagina and clean your cervix. After that, he or she may inject a local anesthetic to numb the area, which can feel like a sharp pinch or tug.

Once the area is numbed, your OB/GYN will use a small, thin tube or catheter to insert liquid dye into your cervix, which is used to see the outline of your uterus and fallopian tubes (and any potential blockages) via X-ray. The injection can cause a sensation of pressure or cramping. In some instances, it’s possible that the flow of the dye could clear an existing blockage.  

Next, your health care provider will take X-ray images of your fallopian tubes and uterus. You might have to change positions so he or she can get a complete view. The catheter is removed after the images are taken and a radiologist reviews them. 

What to expect after an HSG test

You’ll probably feel mild to moderate cramping during the test itself. Some women find that the discomfort eases up a few minutes after the test ends, while others have abdominal discomfort or pain for several hours. 

It’s also normal to have some blood-tinged discharge as the fluid used during the procedure flows out of your uterus. Use a pad to absorb the discharge, but avoid using tampons (or having sex) until your practitioner says it’s okay to do so. 

Sometimes HSG tests can cause women to feel nauseous, dizzy or faint for a few minutes after the procedure. If that’s the case, take your time and stay lying or sitting down until you’re more stable. If you think a glass of water would help, ask for one.

HSG tests are routine procedures and they rarely cause complications. But let your doctor know if you experience worsening pain, fever, chills, foul-smelling discharge, heavy bleeding, fainting or vomiting in the days after your test, which could signal an infection or an allergic reaction to the dye.  

What do HSG test results mean?

The results of your HSG test can help your doctor determine if you have a blockage in your fallopian tube or uterus, which could make it harder for sperm to reach and fertilize an egg. 

It also helps your OB/GYN look at the shape of your uterus, which affects fertility as well.  

Here's what the various test results mean:

Normal HSG test results

Your HSG test results are normal if the liquid dye flows through your fallopian tubes and spills out, indicating that there aren’t any blockages. (The spilled dye flows into your abdomen and is absorbed by the body.)

Abnormal HSG test results

Your HSG test results are abnormal if the liquid dye encounters a blockage in one of your fallopian tubes or in your uterus. In some cases, surgery may help clear the blockage and improve your chances for conceiving. In other cases, particularly if a blockage has caused damage or scarring to the fallopian tubes, your health care provider might recommend trying to conceive via in vitro fertilization (IVF).  

Choosing to undergo surgery or try IVF is a personal decision. Your doctor can help you weigh the pros and cons to determine which option will give you the best chance at getting pregnant. 

Is an HSG test covered by insurance?

It can be, but it depends on your policy. Many insurance plans cover fertility diagnostics and treatment, but they can vary.

If you’re unsure about your coverage, call your insurance carrier to find out what they’ll pay for. 

As for how much an HSG test costs without insurance? You can expect to pay anywhere between $500 and $3,000. The exact total depends on your practitioner and where you live.  

HSG tests aren’t exactly fun, and they can be a little stressful. But very often, they can be a means to a very worthwhile end: successfully conceiving a baby.