Hysterosalpingography (HSG)—often searched as “HSG” or “infertility X-ray”—is a special X-ray test that looks at the inside shape of the uterus and whether the fallopian tubes are open. During the procedure, a clinician places a small catheter through the cervix and gently fills the uterus with a liquid contrast dye. A moving X-ray technique called fluoroscopy then tracks how the dye flows through the uterus and into the fallopian tubes.

This test mainly evaluates two things:

1) Uterine cavity shape: The images can show whether the uterine cavity looks normal or if there are changes that might affect implantation or pregnancy (for example, filling defects from polyps or fibroids, scarring, or a congenital uterine shape difference).

2) Tubal patency (tube openness): If the dye travels through the tubes and “spills” freely into the pelvic area, that typically suggests the tubes are open. If the dye stops or does not spill, it may suggest a fallopian tube blockage or spasm. Sometimes the test cannot fully distinguish a true blockage from temporary tubal spasm, so your clinician may recommend repeat imaging or additional testing when needed.

What results can mean in plain language:

• Normal/Patent tubes: Dye fills the uterus, runs through both tubes, and spills out—often a reassuring finding in an infertility evaluation.

• Possible blockage: Dye does not pass through part or all of a tube—this can be due to prior infection, endometriosis, scarring, previous surgery, or other causes.

• Abnormal uterine cavity: The cavity may look irregular or have areas where dye does not fill as expected—this can be consistent with polyps, fibroids that distort the cavity, adhesions (scar tissue), or certain uterine shape variations.

An HSG does not directly measure hormones or ovarian reserve. It is primarily an anatomic test used in infertility workups to help explain why pregnancy has not occurred or to guide the next steps in care.

HSG is most commonly ordered as part of an infertility evaluation to check for problems that may prevent sperm and egg from meeting or prevent an embryo from implanting normally.

Your clinician may recommend hysterosalpingography when:

• You have trouble getting pregnant: Often after 12 months of trying (or after 6 months if you are 35 or older), or sooner if there are risk factors.

• There is concern for fallopian tube blockage: For example, a history of pelvic inflammatory disease (PID), chlamydia or gonorrhea, prior pelvic infection, or known scarring.

• You have a history suggesting uterine scarring or structural issues: Such as prior uterine surgery (e.g., dilation and curettage/D&C), complicated delivery, or known adhesions.

• You have recurrent miscarriage or implantation failure: An HSG can help identify cavity abnormalities that may be contributing and guide whether additional evaluation (like sonohysterography or hysteroscopy) is appropriate.

• You are planning certain fertility treatments: Results can influence decisions about timed intercourse, IUI, IVF, or whether tubal surgery may be helpful.

In many clinics, an HSG is scheduled after menstrual bleeding ends but before ovulation (often days 6–10 of the cycle) to reduce the chance of performing the test during an early pregnancy and to get clear images. Your care team may also discuss infection prevention (especially if you have PID risk factors), pain control, and whether you need a pregnancy test beforehand.

• Fallopian tube blockage (tubal occlusion)
• Hydrosalpinx (fluid-filled, damaged fallopian tube)
• Pelvic inflammatory disease (PID) and post-infectious tubal scarring
• Endometriosis with adhesions affecting the tubes or pelvic anatomy
• Uterine fibroids (submucosal or cavity-distorting leiomyomas)
• Endometrial polyps
• Intrauterine adhesions (Asherman syndrome)
• Congenital uterine anomalies (e.g., septate uterus, bicornuate uterus)
• Chronic endometritis (sometimes suspected when cavity findings are abnormal; typically confirmed with other testing)

• Identifying causes of infertility (female-factor evaluation)
• Confirming whether fallopian tubes are open before attempting conception or IUI
• Assessing the uterine cavity for factors that may affect implantation or pregnancy outcomes
• Guiding next steps in fertility care (expectant management, IUI, IVF, or surgical correction)
• Evaluating the uterine cavity after miscarriage, uterine procedures, or suspected scarring
• Supporting preconception planning by clarifying anatomic barriers to pregnancy