What’s an HSG test, you ask? If you’re dealing with infertility, you don’t have to ask. If you’re just testing the waters, an HSG test is a common infertility test with a name so long I don’t try to pronounce it (hysterosalpingogram), and a reputation that precedes it. The HSG test is used to see if your fallopian tubes are open and to look for any uterine abnormalities, and it is one of the first diagnostic tests that you will undergo as your doctor tries to determine the cause of your infertility. Click here to learn more about the test.
While I don’t intend this blog to be a day-by-day rehashing of my infertility tests, I do feel the need to add to the ever-growing Internet literature on the HSG test, if only to save another soul from the anxiety I faced leading up to this test.
I like to think of myself as having a high tolerance for pain, but a low tolerance for the anticipation of pain. Translation: I spent an entire week dreading both the physical and emotional pain that I was sure this test would cause me. This included extensive internet searches of “HSG and pain,” which brought up fun little stories like this one from a woman who said the HSG test was more painful than giving birth to twins. Awesome.
I have a family history of iodine allergy, which meant that on top of the fear of pain and blocked tubes, I was slightly worried that I would go into anaphylactic shock. I was pre-medicated with corticosteroids and Benadryl, in addition to 800mg of ibuprofen before the test, which probably helped manage my pain and control any type of allergic reaction.
So I’m here to set the record straight, or at least calm some nerves. The HSG test was no big deal for me. It was maybe a 3/10 on the pain scale, and ranks a bit more uncomfortable than a PAP smear. I was blessed to have an awesome nurse and radiologist who calmed my nerves and walked me through everything they were doing. I was in and out of the hospital in less than an hour, and the actual test took less than five minutes. I felt a great sense of relief afterwards, and felt a bit silly for getting so worked up about it.
I know some women experience intense pain during this test and I certainly don’t mean to discount their experiences, but I do think they are in the minority, as my radiologist said he performs the HSG test very frequently and only a small fraction of women experience intense pain.
If you want to know exactly what to expect, read on:
My husband and I arrived at the hospital and waited to be called back to the radiology department for the test. The nurse took us to the room, where she explained the procedure and answered any questions that we had. My husband then had to leave the room and wait for me in the waiting room.
I was asked to undress from the waist down and then laid down on a table with stirrups, similar to when you have a PAP smear at the gynecologist. The radiologist then came into the room, introduced himself, and went over the steps of the test. My feet went into the stirrups and he inserted a speculum, again similar to a PAP smear with minimal pain. Then the table (and you) are moved underneath the machine that allows the doctor to take x-rays during the test. It only covered my abdomen.
From here it got slightly more painful. The radiologist inserted a small catheter through my cervix and into my uterus. He said this is more painful for women who have never given birth – which I would assume is the majority of women who get this test. It was less of a cramping pain and more like intense pressure with a little bit of a scratching feeling. Again, nothing that I couldn’t bear and it subsided quickly.
The next step involved the radiologist inflating a tiny balloon at the end of the catheter that helps to hold it in place while the dye is injected. He then began to inject the dye and asked me to move my hips from side to side to help the dye travel from the uterus into the fallopian tubes. There was a screen beside me where I could see the dye filling my uterus, traveling through my tubes, and eventually spilling out the other ends. X-rays are taken every few seconds during the test to check for any uterine abnormalities, such as adhesions or issues with shape, as well as blocked tubes. I didn’t feel any pain when the dye was injected or circulating in my system.
When women report intense pain with the test, it is typically during the time when the dye is injected. It is my understanding that if your tubes are blocked and the dye has nowhere to go, it can cause your uterus to spasm and bring on intense cramping.
After the dye made it through my tubes, the doctor deflated the balloon and slowly removed the catheter. He then removed the speculum and the test was over. The entire test took less than five minutes. I was very fortunate to see the dye spill out of both of my fallopian tubes into my uterus, showing that my tubes are open. The radiologist did mention that my uterus is tilted forward, but that it common and nothing to worry about.
The nurse provided a pad, which was a lifesaver because the dye continues to spill out after the test for a few hours. It’s probably a good idea to pack one in case they don’t provide it. I was asked to wait around for 20 minutes to make sure that I didn’t have a delayed reaction to the iodine. Before I left the nurse gave me a CD of the images that I can share with my RE at my next appointment. I had slight spotting throughout the rest of the day and very light cramping which was less intense that my usual menstrual cramps.