Note: the information below is a general guide only. The arrangements, and the way tests are performed, may vary between different hospitals. Always follow the instructions given by your doctor or local hospital.

What is hysterosalpingography?

Hysterosalpingography is a specialised form of X-ray that produces images of a woman's uterus (womb) and Fallopian (uterine) tubes. It helps to assess the size and shape of the uterus. It can also assist in checking whether the Fallopian tubes are open.

What is hysterosalpingography used for?

Hysterosalpingography is commonly used in women who are having difficulty becoming pregnant. This test allows the doctor to evaluate the shape and structure of the uterus and any scarring in the region. The procedure may also be used to investigate repeated miscarriages as these may result from problems with the uterus.

Hysterosalpingography can also help to see whether there are other problems in the pelvis or uterus including:

• Polyps (small lumps of tissue).
• Fistula (an abnormal passage between two places that do not normally connect).
• Adhesions (areas where the walls of the uterus are sticking together).
• Uterine fibroids (noncancerous growths in the wall of the uterus).

Hysterosalpingography is also used to check the openness of the Fallopian tubes, and to monitor the effects of surgery on the Fallopian tubes, including:

• Blockage of the Fallopian tubes due to infection or scarring.
• Tubal ligation (also known as sterilisation or 'having your tubes tied').
• The closure of the Fallopian tubes in a sterilisation procedure and a sterilisation reversal.
• The re-opening of the Fallopian tubes following a sterilisation or disease-related blockage.

Anatomy and function of the female reproductive system

How does hysterosalpingography work?

Normally soft, hollow structures such as the uterus are difficult to see on X-ray images. In hysterosalpingography a contrast agent is inserted into the uterus and ovarian tubes. This helps to produce useful pictures. Contrast is a type of dye that blocks X-rays. By blocking the X-rays, contrast dye makes the structures being examined bright white in colour. This helps to show the important areas by making them stand out against the black background of the X-ray.

Hysterosalpingography also uses a special kind of X-ray technique called fluoroscopy. A fluoroscope is an X-ray unit attached to a television screen. The fluoroscope uses a continuous X-ray beam to make a sequence of images. These images are fed to a television-like monitor. This allows your doctor to watch as the contrast agent fills your uterus and Fallopian tubes and observe any problems or defects. In a normal hysterosalpingogram the contrast fills the uterus, enters the uterine tubes and spills out of the ends of these tubes into the body cavity. This helps doctors check that the uterine tubes are not blocked.

What happens during hysterosalpingography?

Procedures may vary slightly in different hospitals, so this explanation is written as a guide.
You may be given a sedative before the procedure takes place. This will not put you to sleep but may make you feel more relaxed.

An initial X-ray of your pelvis will be taken while you lie on the X-ray table. Then you may be asked to slide down to the end of the table, with your knees bent. Your perineal (pubic) area will be cleaned, and a speculum (the instrument used in a cervical screening test) will be inserted into your vagina. This allows the doctor to see your cervix. You may be given a local anaesthetic injection to your cervix. He/she will then insert a thin tube called a catheter through the cervix into the uterus. This may be uncomfortable but should not hurt.

Then the contrast agent will be gently syringed through the catheter, gradually filling your uterus and Fallopian tubes. You may feel some pressure, and possibly some crampy type pains. As the contrast enters the uterus the doctor will start taking the images using the fluoroscope. After the fluoroscopic images have been taken you may be asked to remain still for a final X-ray. Then the catheter and speculum will be removed. You may also be given a sanitary towel to absorb the contrast agent.

What should I do to prepare for hysterosalpingography?

Your local hospital should give you information about how to prepare before the test. Women who are pregnant should not have hysterosalpingography. This is because the X-rays may damage the unborn child. You should inform your doctor if you are, or think you may be pregnant. For this reason some hospitals may ask you to take a pregnancy test before the procedure. Or, the procedure may be done soon after a period to minimise the chance that you may be pregnant.

You may be asked to take a laxative the night before the procedure to help clear your bowels (guts) of stool (faeces). This can help to make the images clearer.

What can I expect after hysterosalpingography?

Contrast agent that remains in your uterus will gradually leak out through the vagina, due to gravity. Any contrast left in your pelvis will be absorbed safely by your body. Only a small amount of contrast is used during the examination, and it has no odour or colour. You may experience some cramping following the examination and some minor 'spotting' (light bleeding). Both should settle in a couple of days. You should use sanitary towels, rather than tampons, if the bleeding is a problem.

The radiation that you are exposed to during this examination, like the radiation produced during any other X-ray test, passes through you immediately. You are not 'radioactive' and it is not necessary to take any precautions following this procedure.

Are there any possible side-effects or complications?

Most women experience only minor side-effects. These may include: sticky vaginal discharge as some of the fluid drains out of the uterus; cramps; feeling dizzy, faint, or sick; slight vaginal bleeding.

Serious problems are rare. They may include an allergic reaction to the fluid, injury to the uterus, or pelvic infection. See your doctor if you are unwell after the procedure. In particular if have any of these symptoms: vomiting; fainting; severe abdominal pain or cramping; heavy vaginal bleeding; fever or chills.