Spoiler alert: – Yes! Absolutely. An HSG can help you get pregnant. Read on to find out why.

If you’ve ever been to a fertility clinic as a patient, you know the process is more involved than just beginning treatment as soon as you’re ready.

In most cases, your doctor will first recommend a series of preliminary tests, known as your infertility workup, that will help them better understand your particular fertility obstacle and how to best tailor your treatment plan to overcome it. In other words, your doctor needs information about your body before she can help you get pregnant.

The two first tests part of this workup – and the most straightforward ones, which you may even have done on your first visit to the clinic – are blood tests that check levels of several important reproductive hormones and a transvaginal ultrasound that tells your doctor the number of eggs in your ovaries.

Those tests give your medical team an idea of whether your ovarian reserve is good and whether your hormones are functioning normally, growing available eggs and releasing one egg during your period each month.

But a good egg supply is only one piece of the fertility puzzle. During a natural cycle, after an egg is ovulated from an ovary, it must travel through one of two fallopian tubes to meet the sperm before fertilization, implantation, and pregnancy can occur.

This is where the next important fertility test – an HSG – comes in.

What is an HSG?

An HSG – or a hysterosalpingogram – is a short procedure that checks for blockages in a woman’s fallopian tubes, as well as the shape and size of her uterus and the presence of fibroids, polyps or scarring inside the uterus.

Why is an HSG important?

This procedure is vital because it can identify a common cause of infertility – a blocked fallopian tube that does not allow the sperm and egg, coming from opposite ends of the female reproductive system, to meet and fertilize.

Though an HSG’s ability to map a woman’s uterus is also instrumental in helping doctors see any obstacles to implantation, such as large growths like fibroids or polyps, the primary purpose of the HSG is to ensure open fallopian tubes.

blocked fallopian tube diagram

Think of it as a bowling metaphor – if there is a big box in the middle of the bowling lane, your ball will never be able to make contact with the pins and knock them over; the box will need to be removed first or you’ll need to bypass the box entirely. Same with fallopian tubes – any blockage will prevent the egg (coming from the ovary) and the sperm (coming from the uterus) from meeting and fertilizing.

A negative HSG will give patients confidence there is no obstacle to fertilization in the tubes, while a positive HSG will provide women an infertility diagnosis and allow doctors to create an appropriate treatment plan.

How is the HSG test done?

An HSG can usually be done inside your fertility clinic by your doctor, and it usually lasts about 30 minutes or less.

  1. The actual procedure consists of a doctor placing a speculum inside your vagina (the way they do when you have a Pap smear), followed by a thin plastic tube through your cervix.
  2. Then, your doctor will insert an iodine dye into the plastic tube. The dye will travel into your cervix and your fallopian tubs, and if they are open, it will spill out of the tubes.
  3. If they are closed, the dye will stop traveling and stay still.
  4. Since iodine is viewable on an X-ray, your doctor will take X-rays to see what the dye is doing and whether your tubes are open.

hsg blocked fallopian tube

Does the HSG hurt?

Most women would describe the test as uncomfortable. Many women feel some cramping, especially when the dye is injected.

In addition, women who do have a blocked tube may also experience pain, which is why your doctor may prescribe over-the-counter pain medication to take before the procedure. It's not uncommon to have some spotting and feel achy after the procedure, so many women arrange a ride home from the clinic instead of driving themselves.

Finally, because there is a risk of an infection from the procedure, women are given antibiotics prophylactically to prevent infection.

What if the HSG shows I have a blocked tube?

For many women, a positive HSG is not bad because it finally gives them a cause for their infertility. Suppose the HSG shows a blocked tube, which could result from an anatomical abnormality or scarring from surgery or inflammation (including from endometriosis). In that case, your doctor will likely talk with you about two treatment options – In Vitro Fertilization (IVF) or surgery.

Blocked Fallopian Tube Surgery

In the case of surgery, a surgeon will remove the blockage from your tubes, ensuring they are open again and fertilization and implantation can occur. While most of these types of surgeries successfully remove the blockage, any kind of surgery comes with the risk of creating scarring, which can cause another blockage and again impede implantation.

IVF for Blocked Fallopian Tube

If you’re worried about creating additional scar tissue or aren’t interested in surgery, IVF will give you a good chance of achieving a pregnancy – even with a blocked fallopian tube. Because IVF consists of joining sperm and egg outside the female body, open fallopian tubes are not necessary for successful fertilization, implantation and pregnancy.

This is also true for mini-stim IVF, which is a more natural form of IVF because of its gentler impact on your body. Once a woman’s eggs are retrieved from her body and paired with sperm in a laboratory, the resulting embryo is inserted directly into a woman’s uterus for implantation and pregnancy.

So should I get an HSG?

It depends – if you've gotten pregnant in the past or have biological children already and never had a pelvic infection or surgery that could have affected your tubes, the chances are good that your tubes are open and you may not need an HSG.

Still, it's a good idea to confirm this is the case. However, if you’ve never gotten pregnant and are having issues conceiving, have had reproductive surgery or pelvic infection, or simply want to make sure your tubes are open and your uterus is free of major growths, an HSG is not only a good idea – it could give you an important diagnosis that will allow you to finally move forward with treatment and achieve pregnancy.