What is HSG (Hysterosalpingogram)?

HSG is a test done as a part of Female Infertility Evaluation, to check whether the Fallopian Tubes are open. 

Fallopian tubes (commonly called “the tubes”) are the structures that are connected to both sides of the uterus. Inside the tube, the sperms and the egg meet (“fertilization”) to form the embryo.

HSG is a type of X Ray, done by inserting a special liquid ("Contrast") into the Uterus through the Vagina. 

When HSG is done?

If you have been trying for pregnancy for one year, but could not conceive, HSG should be done. But in some cases, it should be done earlier (if you fail to conceive within 6 months). This includes advanced age (more than 35 years), previous operation in tubes/ ovaries, previous history of Ectopic Pregnancy (Pregnancy outside the uterus), Endometriosis (the lining of the uterus lying outside the uterus), Previous PID (Pelvic Inflammatory Disease- a form of sexually transmitted infection of the tubes/ ovaries) or severe pain during menstruation or pain during intercourse

What to do if both the tubes are found to be blocked in HSG?

You still can consider SSG (Sono Salpingo Graphy- doing ultrasound by putting saline inside the uterus) as a second test to check tubal patency. If SSG shows tubes are open, you do not need any special treatment. However, if SSG also shows the “block”, then there are simply two options. You can consider laparoscopy or go for IVF straightforward. 

When Laparoscopy is advised? 

If you are at a younger age, other fertility factors (Sperms and the ovaries) are normal and the infertility is of shorter duration, laparoscopy may be a suitable approach for you. If laparoscopy confirms the patency of the tube(s), you can try for pregnancy naturally. Sometimes, an attempt can be made to remove the block by laparoscopy. However, if laparoscopy shows the tubal block and the tubes cannot be opened, you need IVF after Laparoscopy. 

When to go for IVF?

If the conditions of the ovaries or the sperms are not satisfactory, your age is on the higher side, or infertility is of long duration, directly going for IVF would be the better option for you. Again, if you fail to conceive within 6-12 months’ time after laparoscopy, even when the tubes were found open, you may need to consider IVF.

What to do if one tube is blocked in HSG and the other tube is open?

In that case, you DO NOT need any special treatment like IVF or Laparoscopy, provided there is no Hydrosalpinx (Tubes are swollen) and the sperms and the ovaries are healthy. 

How HSG improves the chance of pregnancy?

During HSG the liquid is pushed forcefully into the tubes through the uterus. Thus, HSG can overcome "mild block" present in the tubes, if any. This, it can increase the chance if pregnancy.

This couple had been trying for pregnancy for last one and half year. The reports of sperms and the ovaries were normal. The woman tried medicines for few months. We advised HSG. The next month she conceived without need of any medicine.