Exam Instructions

Before Your Exam

Eating and Drinking

There are no dietary restrictions. You may eat and drink normally before your exam.

What to Wear

Wear comfortable clothing.
You will change into a gown for the exam.

Pregnancy Precautions

For your safety:

Avoid unprotected intercourse from the first day of your menstrual period until your HSG is completed.
Take an at-home pregnancy test the evening before your appointment.

Medication to Reduce Cramping

Taking an over-the-counter pain reliever before your appointment may help reduce cramping.

Ibuprofen (Advil or Motrin)
Dose: 400 mg
When: 30–60 minutes before your appointment

If you cannot take ibuprofen:

Acetaminophen (Tylenol)
Dose: 500 mg
When: 30–60 minutes before your appointment
Acetaminophen is an alternative, although it may be less effective for uterine cramping.

Other medications: If you have been prescribed antibiotics or other medications, take them exactly as directed.

Pro-Nox: Comfort and Anxiety Relief

If you are concerned about discomfort or anxiety, Pro-Nox is available as an optional comfort measure. It is a patient-controlled nitrous oxide and oxygen system that allows you to remain awake and in control.

Helps reduce discomfort and anxiety
Works within seconds and wears off within minutes
You control when you use it
$75 (not covered by insurance)

After Your Exam

Light bleeding or spotting is normal. Please bring a pad or liner to use afterward.
Drink extra fluids. We recommend drinking at least 1 liter more than you normally would during the remainder of the day.
Mild cramping may occur. Over-the-counter pain medication can be used if needed.
You can return to normal activities right away.

Frequently Asked Questions

Please reach us at info@hsgexam.com if you cannot find the answer to your question.

Why do I need an HSG?

An HSG exam, also known as a hysterosalpingogram, is a diagnostic fertility test used to assess the anatomy and health of the fallopian tubes and uterine cavity.

Here are some reasons why you might need an HSG exam:

Infertility: HSG can help identify potential causes of infertility, such as blockages in the fallopian tubes or abnormalities in the shape of the uterus.
Recurrent miscarriage: If you have experienced recurrent miscarriages, an HSG can help identify any abnormalities in the shape or structure of the uterus that may be contributing to the problem.
Planning for fertility treatments: If you are planning to undergo fertility treatments such as in vitro fertilization (IVF), an HSG may be required to evaluate your uterus and fallopian tubes.

During ovulation, one of your ovaries releases an egg that travels down one of your fallopian tubes, where the sperm and egg will meet, and fertilization can occur. Once an egg is fertilized, an embryo will develop and continue through the fallopian tubes until it reaches the uterus, where it will implant into the uterine lining.
HSG is performed routinely for patients having difficulty conceiving because it is an excellent test that can not only confirm that a woman’s fallopian tubes are open but can also evaluate whether the uterus has a normal shape. Tubal factors cause 25–35% of female infertility.
During an HSG, liquid x-ray contrast is injected into the uterus and fallopian tubes to evaluate the flow of the contrast through the reproductive system. This can aid in locating any obstructions or anomalies that might be causing fertility problems.

How does the HSG work?

The hysterosalpingogram (HSG), also known as utero-tubal evaluation, is a medical imaging test used to evaluate the health of a woman's reproductive system, specifically the uterine cavity and fallopian tubes.

Here's how the HSG exam works:

Preparation: Before the HSG, the patient will need to discuss any medical conditions or allergies with their doctor. The exam is typically scheduled between days 6-12 of the menstrual cycle to avoid potential interference with early pregnancy.
Procedure: The patient will lie down on an examination table during the examination, and a speculum will be introduced into the vagina. A small tube (catheter) will then be inserted into the cervix, through which a special dye is injected into the uterus. The dye will fill the uterus and flow into the fallopian tubes. X-ray images are taken as the dye moves through the reproductive system.
Results: The HSG images show the shape of the uterus and whether the fallopian tubes are open. The findings are discussed with you immediately after the exam. Your referring physician will also receive the report and can discuss the results with you and recommend any additional evaluation or treatment, if needed.

When should I schedule my HSG?

When to Call: Ideally, call our office on Day 1 of your period, the first day of full menstrual bleeding, not spotting. Calling on Day 1 helps us schedule your HSG at the appropriate time in your cycle. If you are already past Day 1, please call us as soon as possible. We can often still schedule your HSG between Day 5 and Day 12 of your cycle.

The HSG is typically performed after your menstrual bleeding has ended and before ovulation. This timing helps minimize the possibility of performing the procedure during an early, unrecognized pregnancy.

Tell us if you have a history of pelvic infection, as this may affect how and when your HSG is performed.
Discuss the timing of your HSG with your doctor if you have irregular menstrual cycles or other circumstances that may affect the timing of ovulation.
Do not hesitate to call us with any questions. Our Manhattan office can be reached at (212) 246-2063.

What if I am allergic to HSG contrast?

Use of gadolinium MRI contrast offers a safe alternative to iodinated contrast for HSG.

Allergic reactions to HSG contrast are rare but possible. The contrast used for HSG is the same as that used in intravenous CT (or CAT) scans. If you have a known allergy to the contrast material used in HSG, it is essential to inform your healthcare provider immediately.
Symptoms of an allergic reaction can range from mild to severe and may include hives, itching, swelling, or difficulty breathing.
If you have a known contrast allergy, your healthcare provider may recommend alternative imaging tests or prescribe medications to help reduce the risk of an allergic reaction.
It is essential to discuss any concerns or allergies you have with your healthcare provider before undergoing any medical procedure, including an HSG, to ensure that appropriate precautions are taken and that you receive the safest and most effective care possible.

Should I take antibiotics?

Antibiotics are not routinely prescribed for the HSG exam.

HSG is a diagnostic procedure that uses X-ray imaging to check for obstructions or anomalies in the fallopian tubes and uterus. Because there is a low chance of infection with this exam, antibiotics are not given as a preventative before this test.
However, if you have a history of pelvic infection or other conditions that increase your risk of infection, your healthcare provider may recommend taking antibiotics before the procedure to help prevent infection. Additionally, if you develop signs of infection after the HSG, such as fever, chills, or increased pain, it is important to contact your healthcare provider right away, as antibiotics may be necessary to treat the infection.

What should I bring with me to my appointment?

When going to your HSG exam appointment, it is recommended to bring the following items:

Your insurance card and identification: Make sure to bring your insurance card and a valid photo identification with you to the appointment.
Referral and authorization forms: If your healthcare provider has given you a referral or authorization for the HSG, make sure to bring the necessary paperwork with you to the appointment.
Comfortable clothing: You may want to wear comfortable clothing that is easy to change in and out of, as you will be asked to change into a hospital gown for the procedure.
Sanitary pads: You may experience some light bleeding or spotting after the HSG, so it is recommended to bring sanitary pads with you to the appointment. Wearing a pad for the rest of the day will help protect your clothing.
Pain relievers: You may experience cramping or discomfort during or after the HSG, so it may be helpful to bring over-the-counter pain relievers, such as ibuprofen or acetaminophen, with you to the appointment.

What will occur during the appointment?

Policy on Procedure Room Access During Hysterosalpingography

At our practice, your safety and well-being are our top priorities. To ensure the highest standards of care during your hysterosalpingography (HSG) procedure, we maintain a clean and carefully controlled environment. For this reason, only essential medical personnel are permitted in the fluoroscopy room during the procedure.

We understand that medical tests can be an emotional experience, and having the support of loved ones is important. While family members or friends are welcome to accompany you to the office, we kindly ask that they wait in our comfortable waiting area during the procedure. This policy is in place to protect your privacy, ensure the best clinical outcome, and minimize any potential risks related to unnecessary exposure.

What will occur during the HSG exam?

During the hysterosalpingogram (HSG) exam, you will be asked to lie on an exam table and place your feet in stirrups. The following steps will generally happen during the exam:

Preparation: You will be asked to change into a gown and lie on the examination table.
Speculum: A speculum is placed into the vagina to hold the vaginal walls apart.
Position catheter: A thin catheter will be inserted through the cervix and into the uterus.
Injection of contrast: Liquid contrast is then injected slowly and flows into the uterine cavity and out through the fallopian tubes into the pelvis. The flow of the dye is monitored via fluoroscopy (x-ray) images.
Monitoring: You may be asked to move into different positions during the procedure to help the dye flow into your fallopian tubes.
Completion: Once the X-rays have been taken, the catheter and speculum will be removed.

The HSG usually takes less than five minutes once the catheter is positioned. You should be able to return to your normal activities immediately afterward. You may experience some cramping, spotting, or light bleeding for a few days following the procedure, but these symptoms usually subside quickly. Your healthcare provider will discuss the results of the HSG with you after the exam.

How painful is the HSG?

Most patients experience some cramping or discomfort during an HSG, similar to menstrual cramps. The intensity varies from person to person. Some patients have only mild cramping, while others may experience a brief, more intense cramp when contrast is injected.

The procedure is typically very brief, and any discomfort usually subsides quickly after the exam. Mild cramping or spotting may occur afterward. Ibuprofen or acetaminophen can be used before or after the exam to help with discomfort.

For patients who are concerned about pain or anxiety, Pro-Nox (nitrous oxide and oxygen) is available as an additional option. Pro-Nox is patient-controlled, works quickly, and wears off within minutes.

What should I anticipate following the exam?

Immediately after your HSG exam, you can resume normal activities.
Bring a pad with you. A small amount of spotting is normal after an HSG test, and there can also be leakage of the contrast liquid. Wearing a pad for the rest of the day will help protect your clothing. You may need to wear a pad for a few days as the dye is slowly expelled from the uterus.
You may experience new cramping approximately 3-4 hours after the HSG. Don’t hesitate to take over-the-counter pain medications and drink lots of liquids after the exam.
Immediately following the examination, the doctor will discuss the HSG results and provide you with a written report for your records. We will also fax your HSG report to your referring physician.
After the exam, we will send you a text message confirming you are doing well after the procedure and have an opportunity to ask any additional questions.
Heavy bleeding, severe pain, and fever are not normal side-effects and should be investigated immediately.
Many patients ask if they should refrain from intercourse after having an HSG. No, you should not. Pregnancy after an HSG may be more likely, depending on the cause of your infertility.

Can HSG improve my chances of getting pregnant?

Although the HSG is generally used for diagnostic purposes, it has been found that women with unexplained infertility have a higher rate of spontaneous pregnancies following HSG examinations. The pregnancy rate after an HSG test is believed to be around 2–3 times higher than that of infertile women who have not undergone this test before.
The test itself is not a treatment for infertility; it is done to understand the reasons for infertility. However, it is a fact that a lot of infertile women get pregnant after the test; the exact reasons are unknown, though. Getting pregnant after the HSG, therefore, may be a coincidence, or due to some unknown reason in the procedure of carrying out the test.
While HSG tests are not a treatment for infertility, women with unexplained infertility may have a greater chance of getting pregnant after conducting this test.

Can HSG unblock my fallopian tubes?

Sometimes. The pressure of the contrast injected during an HSG can occasionally clear a minor blockage or mucus plug. However, an HSG is primarily a diagnostic test and is not designed to treat a significant tubal blockage.

If an HSG shows a blockage near the uterus, fallopian tube recanalization (FTR) may be an option. FTR is a minimally invasive procedure that uses a small catheter and guidewire to attempt to reopen the blocked fallopian tube.

Can HSG evaluate my ovaries?

No, hysterosalpingography is designed to evaluate the uterine cavity and fallopian tubes; HSG cannot be used to evaluate the ovaries or to diagnose endometriosis or fibroids.

How is radiation exposure minimized during HSG?

Radiation exposure during the HSG is minimized by using the lowest possible amount of radiation needed to produce high-quality images. Additionally, the duration of the X-ray exposure is kept as short as possible to reduce radiation exposure.
To reduce radiation exposure during HSG exams, our office uses state-of-the-art fluoroscopy with digital imaging and a high-resolution flat panel detector. This advanced technology allows us to obtain clear images using the lowest possible dose of radiation.
Dr. Silberzweig has performed over 40,000 HSG exams and has also completed research with multiple publications on minimizing radiation exposure and improving patient comfort, ensuring that your treatments will be safe and effective with minimal discomfort.

Are there alternatives to HSG?

Other procedures that can give your doctor some of the same information as HSG:

Laparoscopy —This surgical procedure requires general anesthesia.
Hysteroscopy —This procedure can give a detailed view of the inside of the uterus. However, it cannot show whether the fallopian tubes are blocked.
Sonohysterography —This technique uses ultrasound to show the inside of the uterus. Like hysteroscopy, it does not give complete information about the fallopian tubes.

The choice of a particular test will depend on several factors, including the reason for the evaluation, the healthcare provider's preference, and the patient's medical history. Your fertility specialist can help determine which test is right for you.

Will insurance cover my HSG?

Insurance coverage for an HSG depends on your individual insurance plan and benefits. Even if we participate with your insurance plan, your HSG may be subject to a deductible, copay, or coinsurance.

How We Bill Your HSG

For a routine fertility evaluation, we generally bill:

CPT 58340 – Introduction of contrast material into the uterus and fallopian tubes
CPT 74740 – Radiological supervision and interpretation of the HSG
ICD-10 Z31.41 – Encounter for fertility testing

Z31.41 indicates that the HSG is being performed as part of an evaluation of the uterus and fallopian tubes. It does not mean that you have been diagnosed with infertility.

We use diagnosis and procedure codes that accurately reflect the reason for your examination. Codes cannot be changed to obtain insurance coverage.

How to Check Your Coverage

The most reliable way to determine your benefits is to contact the Member Services number on the back of your insurance card.

Provide your insurance representative with these codes:

CPT 58340
CPT 74740
ICD-10 Z31.41

Ask whether the procedure is covered under your plan and whether you will have a deductible, copay, or coinsurance.

Our office can assist with insurance verification, but your insurance company makes the final determination of coverage and your financial responsibility.