For those struggling to conceive, fertility testing is an essential first step of the process. A hysterosalpingogram (HSG) is one of the diagnostic procedures that helps evaluate the uterus and fallopian tubes for any abnormalities that might impede conception. 

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During this minor procedure, your doctor will be able to confirm whether your fallopian tubes are patent (open) or blocked. They will also make sure that the uterine cavity has a normal shape and size and be able to identify uterine malformations, adhesions, polyps, or fibroids.

All of these details are important pieces of the puzzle when it comes to determining (and even treating) the cause of your fertility issues. 

Why do I need an HSG before fertility treatment?

An HSG is one of the standard tests every female patient undergoes during the fertility testing process. It is an essential part of the diagnostic phase that precedes fertility treatment. 

Here’s why: Uterine or tubal abnormalities can cause issues like painful menstrual periods, repeated miscarriages, and even reduce your chances of pregnancy. If your fallopian tubes are blocked, sperm can’t even reach the egg to fertilize it!

Since a hysterosalpingogram (HSG) is a diagnostic procedure, many insurance companies do cover the cost. This will depend on your insurance policy, so read through it carefully, or call your insurance provider for help. 

If you don’t have insurance coverage for your HSG procedure, the out-of-pocket cost can be anywhere from $400 to $1,800 or more. 

While your fertility clinic’s Insurance & Billing Team should help confirm any insurance benefits and handle this for you, patients who wish to confirm coverage with their insurance provider directly should reference the following:

• 58340 is the code used for catheterization and introduction of contrast for hysterosalpingography
• 74740 is the code for radiologic supervision and interpretation, which consists of a professional component (for interpretation of the images) and a technical fee

Note: Current Procedural Terminology (CPT) codes are numbers used by healthcare providers to describe services and tasks. CPT codes are used to track and bill for medical, diagnostic, and surgical services.

Here at Illume Fertility, you will be instructed to call your Patient Navigator when you get Day 1 of your menses (full bleeding) to schedule your HSG at either our Norwalk, Stamford, or Trumbull, CT location. 

HSGs are typically scheduled between Days 5 to 9 of your menstrual cycle, unless otherwise instructed by your Care Team. This is the window of time between the end of your period and ovulation.

Important Reminders

• If you are currently taking Metformin, please skip your usual dose the day before and day of the HSG. You can resume your Metformin the day after your HSG.
• Please advise your Care Team if you are allergic to radiographic dyes.
• One hour before your HSG appointment, please take 400-800mg of ibuprofen (Advil or Motrin). If you are allergic to ibuprofen, take 1000mg of extra strength acetaminophen (Tylenol). This will help alleviate any discomfort during the procedure. 
• You will not be able to have anyone accompany you during the HSG procedure. 
• On the day of your HSG, you may be asked to provide a urine sample. 

While everyone’s pain tolerance and experience will be different, up to 80% of patients report mild to moderate pain during the procedure. An HSG can cause intense cramping while the contrast dye is being introduced to the uterine cavity, but it is very quick, lasting about 15-30 seconds.

Note: If you have a low pain threshold or are feeling anxious about your upcoming HSG, talk to your doctor – they can prescribe something to help you relax.

How long does an HSG take?

The HSG itself only takes around 10 minutes – from the moment your team steps into the room to the moment they step out. Your appointment will likely take around 30 minutes total. 

With that in mind, let’s walk through each step of the process together. If you have any additional questions or concerns prior to your appointment, don’t hesitate to tell your Care Team – they want you to feel as comfortable as possible. 

You will also be asked to sign a consent form acknowledging your understanding of the HSG procedure before it begins. Here’s what will happen next:

• Step 1: You will be positioned on an exam table (the same way you would be positioned for a gynecologic exam) with your back on the exam table, knees bent, and feet supported up on footrests.
• Step 2: A speculum will be placed into your vagina.
• Step 3: Your cervix will be prepped with a cleanser solution.
• Step 4: A thin, soft catheter will be inserted into your uterus through your cervix.
• Step 5: A radiology machine will be positioned over your abdomen.
• Step 6: Contrast dye will be connected to the catheter, then a small amount of this dye will be flushed into your uterine cavity and through your fallopian tubes. You may experience some cramping at this point from the introduction of the contrast dye.
• Step 7: After injecting the contrast dye, X-rays will be taken. The speculum will be removed from your vagina once this is complete.

After your HSG has been completed, your physician will discuss the results with you, including any significant findings about your uterus and fallopian tubes. If your tubes are blocked, or if you have a uterine polyp or fibroid, your physician will review these findings and discuss potential future treatment options with you.

Upon completion of the procedure, you will be able to resume normal activity.

Severe problems after an HSG are rare (only occurring in around 1% of cases). These include an allergic reaction to the contrast dye, injury to the uterus, or pelvic infection. Always call your Care Team if you have any fever, severe pain or cramping following after your HSG.

FAQs About Hysterosalpingogram (HSG) 

Now that you have a good idea of what to expect at your HSG, let’s cover a few more common questions we hear from fertility patients about the procedure.

The goal of a saline sonogram (SHG) is to evaluate the endometrial lining of your uterus, making sure you have no polyps, fibroids, or scar tissue that could affect the successful implantation of an embryo.

The primary goal of a hysterosalpingogram (HSG) is to identify whether your fallopian tubes are open or blocked.

Why do I have to have both an HSG and SHG?

We require both tests in most cases because they each provide important information that helps your physician develop the best treatment plan for you.

By making sure your uterine lining is free of any defects and your fallopian tubes are open for fertilization to occur, we can eliminate quite a few potential obstacles to conception.

Every Step of the Process Matters

While the diagnostic phase of any fertility journey can be time-consuming and frustrating at times, it is absolutely essential to your success. By carefully evaluating your uterus, fallopian tubes, hormone levels, and other factors, you and your physician will gain vital information that will allow you to plot the most efficient path towards achieving your goals.

If you’re feeling nervous about your upcoming HSG, remember that any potential discomfort or pain will only last around 30 seconds total, and your Care Team will be there to support you throughout the entire procedure. 

Each stage of the family-building process brings a unique challenge, but in the end, it’s all worth it – because you can be certain you’ve done everything you can to succeed!