When women struggle to conceive, one of the most essential steps in a fertility work-up is evaluating the uterus and fallopian tubes. While ultrasound can assess parts of the uterus and cervix, only hysterosalpingography (HSG) allows us to see the fallopian tubes and confirm whether they are open.
In this article, we’ll explain how HSG works, what terms like “tubal patency” and “contrast spillage” mean, and why this test matters in understanding female fertility.
I’m Dr. Bahare Mobasheri, a radiologist with subspecialty training in women’s and reproductive imaging. In this article, I’ll help you understand what an HSG test shows about your fallopian tubes, uterus, and fertility health.
Real-Life Scenario: A Patient’s Story
Sara had been trying to get pregnant for over a year. Her ultrasound showed a normal uterus and ovaries, but she was told her fallopian tubes couldn’t be evaluated on ultrasound. Her doctor recommended an HSG to check if her tubes were open.
She had questions: How does it work? Is it painful? What if something’s blocked?
Let’s walk through what happens during an HSG and what the results really mean. Understanding this procedure can bring a sense of relief and empowerment, helping you navigate your fertility journey with confidence.
What Does Hysterosalpingography (HSG) Evaluate?
The Uterine Cavity and Cervix
- These parts can also be seen with ultrasound.
- HSG helps confirm the shape of the uterine cavity and whether there are polyps, fibroids, or congenital anomalies.
- The cervical canal is also visualized as contrast flows through it.
The Fallopian Tubes
- Ultrasound cannot visualize fallopian tubes unless they are abnormally dilated.
- HSG is the only imaging test that allows for the visualization of the entire length of the fallopian tubes in real-time.
- The goal is to determine tubal patency—whether the tubes are open or blocked.
What Happens During an HSG?
Step-by-Step Procedure
- The patient lies on the exam table, sometimes under light sedation but often without it.
- A small catheter is inserted through the cervix.
- A contrast dye is injected, which fills the uterine cavity, travels through the fallopian tubes and ideally spills into the pelvic cavity.
What Is Spillage (Spill or Spill-Out)?
- Spillage refers to the free flow of contrast dye from the ends of the fallopian tubes into the pelvis.
- Normal result: Bilateral tubal patency with free spillage.
- Abnormal: No spillage or partial blockage suggests tubal obstruction.
What Can Cause Tubal Damage or Blockage?
- Pelvic Inflammatory Disease (PID): Infections can cause scarring, narrowing, or blockage of the tubes.
- Ectopic Pregnancy: Prior ectopic pregnancies can damage tubal structure.
- Endometriosis: Pelvic adhesions may distort or block the tubes.
- Surgery or Prior Infections: This can lead to irregular narrowing, strictures, or complete tubal occlusion.
Blocked or damaged tubes may lead to infertility or increase the risk of ectopic pregnancy. Identifying these problems early can help guide treatment, such as assisted reproductive techniques (ART) or IVF.
What Do the HSG Findings Mean for My Fertility?
- Normal tubes with free spillage: Good chance of natural conception.
- One tube blocked: Fertility may still be possible, depending on other factors.
- Both tubes blocked or damaged: Higher risk of infertility or ectopic pregnancy; may require IVF.
The HSG helps fertility specialists decide on the next best steps for your reproductive care.
Why Getting a Second Opinion on Your HSG Is Smart
HSG interpretation requires experience in women’s imaging. Reports may include phrases such as “distal blockage,” “no spillage,” or “tubal irregularity,” which can be confusing.
A second opinion can help clarify:
- Whether the blockage is complete or partial
- If further tests or surgery are needed
- Whether IVF is the best option
Need to Help Understand Your HSG or Fertility Report?
If you’ve had an HSG or any scan related to fertility and feel unsure about the findings, our expert radiology team can help.
✅ Upload your report for a second opinion:
https://ai-pacs.com/online-report/