Tubal Patency Test (HSG): Checking Your Fallopian Tubes

Key takeaways

• Blocked or damaged tubes cause a significant share of female infertility.
• HSG, sonosalpingography (HyCoSy/SSG) and laparoscopy with dye test are the main tubal tests.
• The test is done after the period ends and before ovulation, to avoid an early pregnancy.
• Open tubes are needed for natural conception and IUI; blocked tubes usually point towards surgery or IVF.
• Antibiotics may be given to lower the small risk of infection.

What is a tubal patency test?

A tubal patency test shows whether the fallopian tubes are open (patent) and whether the uterine cavity has a normal shape.

The fallopian tubes are where sperm meets the egg and where the early embryo begins its journey to the uterus. Previous pelvic infection, endometriosis, ectopic pregnancy or abdominal surgery can scar or block the tubes. A blocked tube swollen with fluid (hydrosalpinx) can also lower IVF success.

Who needs tubal testing?

• Women who have not conceived after 12 months of trying (6 months if 35 or older).
• Before starting IUI or ovulation induction.
• Women with a history of pelvic infection, sexually transmitted infection, appendicitis with rupture, ectopic pregnancy or pelvic surgery.
• Women with suspected endometriosis.
• After reversal of tubal ligation, to check the tubes are open.
• Sometimes after recurrent miscarriage, to assess the shape of the uterus.

What are the types of tubal patency test?

Laparoscopy is the most detailed but is a surgical procedure, so it is usually reserved for women with other symptoms or abnormal results. Find out more on our laparoscopy and hysteroscopy pages.

What to expect during an HSG: step by step

1. Scheduling. The test is booked for days 6–11 of your cycle, after bleeding stops and before ovulation. Avoid unprotected intercourse from your period until the test.
2. Preparation. A pain reliever such as ibuprofen or paracetamol 30–60 minutes before; an antibiotic may be prescribed. Tell the team about any allergy to iodine or contrast.
3. Positioning. You lie on the X-ray table and a speculum is placed, as in a Pap smear.
4. Dye injection. A thin catheter is passed into the cervix and dye is gently introduced.
5. X-ray images. A few images show the dye filling the uterus and spilling from the ends of the tubes. The test takes about 15 minutes.
6. Results. Preliminary findings are often available the same day and are discussed at your follow-up visit.

What do the results mean?

Both tubes open: natural conception or IUI can be considered, depending on other tests. Some studies suggest a slight increase in pregnancy rates in the months after an oil-based HSG.

One tube blocked: conception is still possible through the open tube, often with ovulation induction or IUI.

Both tubes blocked: HSG sometimes shows a false blockage due to spasm, so the result may be confirmed by laparoscopy. Depending on the site, options include laparoscopic or hysteroscopic treatment, or IVF, which bypasses the tubes. A hydrosalpinx is usually treated before IVF.

What are the risks and side effects?

• Period-like cramps during and shortly after the test.
• Light spotting and a sticky discharge for a day or two.
• Pelvic infection, which is uncommon (around 1%); report fever or worsening pain.
• Allergic reaction to contrast, which is rare.
• Fainting or dizziness during the procedure, which passes quickly.
• A very small radiation dose from HSG; HyCoSy avoids radiation altogether.

Recovery and aftercare

Most women return to normal activities the same day. Use sanitary pads rather than tampons for a day or two, take simple pain relief if needed, and finish any antibiotics. Intercourse can usually resume once spotting stops. Laparoscopy needs one to two weeks of gradual recovery.

What does a tubal patency test cost?

The cost depends on the type of test (HSG, HyCoSy or laparoscopy), whether a radiologist’s fee and contrast are included, any antibiotics or pain relief, and, for laparoscopy, anaesthesia and day-care charges. Your estimate is discussed before the test is booked.

When to see a doctor

See a gynaecologist if you have been trying to conceive without success, or if you have a history of pelvic infection, ectopic pregnancy or painful periods. After a tubal test, seek prompt care for fever, foul-smelling discharge, heavy bleeding or pain that is getting worse.

Why choose Dr. Divya Venugopalan

Dr. Divya Venugopalan is a gynaecologist and fertility specialist in Bengaluru with more than 14 years of experience. She holds an MBBS from KIMS, a DNB in Obstetrics & Gynaecology, a Fellowship in Reproductive Medicine (FRM) and a Fellowship in Minimal Access Surgery (FMAS), and is a member of IAGE, IFS and ISAR.

She chooses the right test for your history and, when keyhole surgery is needed, can assess and treat the tubes in the same procedure. Book a consultation at Thanisandra, Sahakar Nagar or HRBR Layout.