What to Expect: HSG Test (Hysterosalpingogram)
Hands down, one of the most commonly asked questions in my fertility support group goes something like this:
“I’m getting my HSG test done on Monday and I’ve heard horror stories! Is it really as bad as they say? What can I expect?”
Well, friend, this is one of those questions that doesn’t have a black and white, yes or no answer. Some women have a really easy time with their HSG, and other women, like me, really do have horror stories to tell. In my opinion, your experience really comes down to two things:
Pain Tolerance
If you don’t have a high threshold for pain, chances are, this will not be fun.Your Radiologist
More on why this is a factor in my experience below.
What is a HSG and how is it done?
HSG is short for Hysterosalpingogram (hiss-ter-oh-sal-ping-o-gram) and is one of the assessment tests done before fertility treatments begin. HSGs determine if your fallopian tubes are open or closed (partially blocked, or blocked) and can also determine whether your uterus is a normal shape and size. HSG tests must be done during the first half of a menses.
The HSG test is performed by a radiologist (x-ray department). The procedure is as follows:
You lay on your back, like you would for a pap smear.
The radiologist inserts a speculum to open the vagina and view your cervix.
They then thread a thin catheter through your cervix and into the uterus.
The speculum is removed.
Dye gets pumped into the uterus and the radiologist looks for what is called “free spillage” out of the fallopian tubes. “Free spillage” indicates whether or not your tubes are open. No spillage indicates that your tubes are either partially blocked, or blocked.
What you can expect and what I personally recommend you to do, based off my experience.
Timing
As mentioned, HSG tests have to be done in the first half of your cycle, but not while you’re on your period. So, you’ll likely be doing the test from days 5 (depending on the length of your menses) to 14. So that you can have this done ASAP (I’m sure you’re like me and want the answers yesterday), you’ll want to ensure you’re beginning to work with a fertility clinic and have a consultation for next steps at least one week before your menses.Schedule Your Appointment w/ A Seasoned Radiologist
Your RE/fertility team is likely going to refer you to another doctor for your test. And, chances are, they’ll send you to someone they always work with. But, I challenge you to make sure of this. When they are referring you, ask questions like, “Is this who a majority of your patients see?” or “How often do you refer patients to this doctor/clinic?” (I’ll explain why in my story below).Figure Out Where Your Cervix Opening Is
You’re probably thinking this is so random. And yes, it kind of is. It will all come into focus later, but I recommend asking your RE or OB/GYN if your cervix opening tilts a certain way. This information can come in handy and save you from major pain and discomfort like I had to experience.Take A Pain Killer, One (1) Hour Before Your Procedure
Even with the painkillers, you’ll still feel discomfort and maybe a little pain. In general, though, pain killers can make all the difference between a good and bad experience. When I went, I took a 600mg Ibuprofen, because that’s the dosage that works best for me. With that said, I don’t recommend ibuprofen (it’s not recommended for women trying to conceive or who are pregnant). Instead, opt for acetaminophen (Tylenol).Plan For It To Take 10-15 Minutes
Generally speaking, the procedure is short and simple, so you can expect to be in the x-ray room for 10-15 minutes. But again, this is why asking for a seasoned radiologist in HSG testing is key. (More on this in my story below.)The Drive Home
My husband brought me to my HSG test so that he could drive me home afterward. You can drive yourself, but if you are able to have someone drive you instead, whether it’s your spouse, friend, mom, etc., I do recommend it. I still experienced some cramping afterward and I’m glad I didn’t have to drive for 30 minutes before I could lay down. I would say, if your pain threshold is on the lower side, then you may want to contemplate having someone drive you even more.
My HSG Horror Story, in a nutshell.
I think it’d be best for me to start with, I live in Hawaiʻi and if you know your geography at all, that means there are eight (8) main Hawaiian Islands. Of which, the island of Oʻahu is known as the “city.” It has everything, fertility clinics, corporate offices, all the big wig doctors, nightclubs, blah blah. I, however, live on the island of Kauaʻi which is considered rural. We literally have zero options for fertility help here. This means my doctor’s office is in Oʻahu and I have the fun task of hopping on a 20-30 minute flight for all of my appointments. (Fun, but not.)
When we started planning out all my pre-treatment testing (HSG, salpingogram, etc.), my RE gave me the option of doing my HSG test in Kauaʻi, where I live. I figured it would be easier, and cheaper, to do it here so they referred me to our local hospital. My husband was a bit wary (I am originally from a different island); I guess the hospital my test was scheduled at didn’t have rave reviews. I figured, eh, it’s just a quick test, can’t be that bad. WRONG.
Everything before my test went smoothly. And when I say everything, I mean me changing into a surgical gown and waiting… Here’s how it went down:
I had to lay on their x-ray machine table and was asked to spread my legs on my own, without the help of stirrups. (You know, those things you rest your feet on when you’re getting a pap smear done.) That, in itself, was very uncomfortable.
Probably because I’m petite, they had to put a block of some sort under my back. The block was not comfortable… it was actually pretty hard, but not rock hard so I guess that was a win.
The radiologist inserted the speculum and started to try and thread the catheter through. THIS WAS THE WORST F*CKING PART. Pardon my language, but it really was where the nightmare began. She couldn’t find the opening to my cervix, because apparently, mine is tilted to the right. So she was literally in my vagina poking around for the cervix (can you imagine the pain and discomfort) to no avail. The radiologist even started asking if they had smaller catheters, and was talking to herself. I could honestly, hear the panic in her voice. Not a good sign.
After 30 minutes, yes 30 minutes, she finally threaded the catheter through. Because she’d had such a hard time getting in, she told me she wasn’t going to remove the speculum for fear of dislodging the catheter… WUT. Imagine this now, I am being forced to hold my legs open with a speculum opening my vagina, and a catheter threaded through my cervix and uterus! It was so uncomfortable and so painful.
They pushed me back to position me under the x-ray and began pumping dye, which is usually what causes cramping. Luckily, for me, this did not cause cramping.
I didn’t know what was happening at the time, but as she pumped the dye in, she started talking to herself again… and you guessed it… with panic! This resulted in her asking me to lay on my left side, with my legs open, with the speculum and catheter in. It was so awkward. The nurses had to help push me onto my side.
For the next 15 minutes, she had me essentially rock back and forth in an attempt to get the dye to flow into my left tube. She didn’t have any luck. And, for the record, this hurt like hell (even with pain killers coursing through my blood).
She stood and stared at the x-ray screen and literally said, “What do I do? What do I do?” Her conclusion? I was to lay there for 20 minutes and then they would take an x-ray. She hoped that within those 20 minutes some of the dye would flow from my right tube to my left tube.
She removed the speculum and catheter, then had me lay in a huge room that had zero points of interest. It was not fun. In fact, I started to cry a little because I felt so alone and disappointed by what had just happened.
After 20 minutes went by, I was free to go! (Thank God.) By that time, a 10-minute procedure (I asked the nurse at the start how long it would take and she said 10 minutes) had turned into 1.5 hours. My husband was so worried he had to checkin with the receptionist!
In the end, guess what happened? They found that there was free spillage in my right tube, meaning I have at least one open fallopian tube (which is all you need to get preggos). While there was dye in my left tube, no free spillage was observed. Because so much of the dye flooded my right tube there wasn’t enough dye to enter my left tube. The conclusion? I don’t even know if I only have one open tube, or two.
Circling back to some of the things I mentioned above:
Scheduling Your Appointment With A Seasoned Radiologist
This is why it’s so important to make sure the person who’s doing your HSG test knows what they’re doing. My radiologist had very little experience working with female anatomy. I know this because no OB/GYN doctor or nurse practitioner has ever had issues inserting a catheter. Always, it took other doctors a minute or less. Definitely NOT 20-30 minutes. If I could do it all over again, I’d definitely make the flight to Oʻahu to work with someone they always refer to instead.Figure Out Where Your Cervix Opening Is
Tying back to my last point, if I had been armed with the knowledge of where my cervix opening is (tilted to the right), I could have told the radiologist while she was poking around for it. This would have saved so much time and again, pain and discomfort.
Please, don’t be scared or scarred by my story.
It’s just one in a million! And like I said, some women have an easy go of it while other women like myself, don’t. Now that you have the tools to prepare yourself and know how to avoid what I had to go through, you’ll be more than fine!
