Since Clomid and the injectables did not work for me the previous month, my gynae scheduled for me to go for the HSG test at Mt Elizabeth Orchard once my period cleared this cycle. This is to rule out any blockages in my fallopian tubes before deciding on the next step (IUI vs IVF). As this procedure also helps to clear our tubes of debris that might be hanging around, some women had reported that having the HSG test actually made them more fertile and that they were able to get pregnant after that.

hsg test for tubal infertility
X-ray image of a normal HSG (Photo:

What is the HSG test?

HSG, which stands for hysterosalpingogram, is procedure that is usually done in the radiology department of a hospital or outpatient radiology facility. By going through the test, one is able to know whether the fallopian tubes are open or blocked and whether a blockage is occurring at the junction of the tube and uterus or at the other end of the tube.

How is the HSG test done?

The entire test took all but 5 minutes, but it is highly recommended that you reach the hospital ahead of your appointment time for registration procedures and for you to change into the hospital gown.

As there seem to be a few women getting their HSG test done on the day I was there, I had to wait quite a while for the doctor to arrive. But the nurses were there with me all the way, firstly to prep me on what will happen during the test, followed by settling me down on the x-ray table and taking my blood pressure. I was a nervous wreck as I had been reading too much about this online prior to the appointment, and was afraid that it will hurt. Of course, this caused my blood pressure to skip to the high end. The nurses were very reassuring and did they best to calm me down.

So, here’s what will happen during the test:

  • You will lie on the table on your back, with your feet brought up in a “frog leg” position
  • The doctor places a speculum into the vagina and visualises the cervix (This is quite similar to getting your pap smear done)
  • A soft, thin catheter is placed through the cervical opening into the uterine cavity
  • Contrast (which is basically a water-based dye) is slowly injected through the catheter into the uterine cavity. An x-ray picture is taken as the uterine cavity is being filled up and additional contrast is injected so that the tubes should fill and begin to spill into the abdominal cavity. More x-ray pictures are taken as this “fill and spill” occurs.
  • When both tubes spill dye, you will be asked to roll to one side slightly (with the speculum and catheter still intact to your vagina) to give a slightly oblique x-ray image
  • And with that the procedure is now complete. The doctor will be able to tell you on the spot if there is any blockage to your tubes, but it takes a couple of hours for the x-ray images to be ready (this will be usually despatched to your gynae’s clinic)

What else can the HSG test reveal, besides whether or not the tubes are open?

The HSG test can reveal other factors such as:

  • The presence of congenital uterine anomalies, polyps, fibroid tumours or uterine scar tissue in the uterine cavity
  • Defects within the fallopian tubes
  • Evidence of pelvic scar tissue in the abdominal cavity near the tube

Does the HSG test improve one’s chance of getting pregnant?

Some studies have reported slightly increased pregnancy rates in the first months following a HSG test. This could be due to the flushing of the tubes which opens a minor blockage or cleaning out some debris that was preventing a women from conceiving.

There are studies that suggest that using oil-based contrast provides a slightly higher pregnancy success rate than that of water-based contrast. But do take note that most HSG tests are done with the water-based contrast.

Things to take note:

1. The insertion of the speculum might feel a bit uncomfortable, but it does not hurt. It’s exactly the same as the one used for pap smear.

2. While the contrast is injected into the uterine cavity, you might feel some cramping which can be likened to period cramps. So again, nothing to worry about – after going through childbirth, period cramps now seem minor.

3. After the test, you will be given a panty liner as there will be discharge. It is normal to have clear discharge or even tinged with some blood – but make sure that this does not go on beyond a couple of hours after the test. If the bloody discharge persists or if your discharge turns a weird colour, call your gynae immediately as this could be a sign of infection.

4. You will be perfectly fine after the HSG test and can go on with life as per normal. In fact, I went back to work after getting it done.