fertility X ray explained

Overview

A fertility X-ray, also called a hysterosalpingogram or HSG, is a test that uses X-rays and a safe dye to look at your womb (uterus) and fallopian tubes. It helps doctors check whether your tubes are open or blocked, and whether your womb has a shape that could make it harder to get pregnant.

Yes. It is a standard test for women who have been trying to get pregnant for a year or more without success, or who have had repeated miscarriages.

It affects women and anyone with a womb who is having fertility investigations. It is mainly offered when there are no obvious reasons for difficulty conceiving.

Symptoms

Common symptoms

• Having trouble getting pregnant after a year of regular unprotected sex
• Experiencing repeated miscarriages
• Having a history of pelvic infection, endometriosis, or previous abdominal surgery

Symptoms in children

• This test is not used in children. If a child has pelvic pain or other problems, doctors will use other methods.

Symptoms in older adults

• This test is not typically performed in older adults. Fertility testing is usually for people of reproductive age.

Causes

Main causes

• Blocked fallopian tubes, often due to previous infection or endometriosis
• Abnormalities in the shape of the womb, such as fibroids or a uterine septum

Risk factors

• Previous pelvic inflammatory disease or sexually transmitted infection
• Previous surgery to the pelvic area, including caesarean section
• Endometriosis
• History of ectopic pregnancy

When to see a doctor

See a doctor urgently if:

• If you are trying to conceive and have pelvic pain, painful periods, or unusual bleeding, speak to your doctor to see whether a fertility X-ray might help.

Book a routine appointment if:

• If you have been trying to conceive for a year or more (or six months if you are over 35), ask for a fertility assessment.

Diagnosis

A fertility X-ray is usually done by a radiologist or a specially trained doctor. You lie on a table, a thin tube is gently placed through the cervix, and a small amount of dye is released. X-ray pictures are taken as the dye travels through your womb and tubes. If the dye spills out of the tubes, they are open. If it stops, there may be a blockage.

Tests that may be done

• Hysterosalpingography (HSG) – the standard X-ray test
• Hysterosalpingo-contrast sonography (HyCoSy) – a similar ultrasound test using dye
• Laparoscopy with dye – a keyhole surgery test that can also look for other pelvic problems

What to expect at your appointment

You may feel mild cramping similar to period pain. You can usually go home straight after. A tiny amount of water-based dye may leak afterwards. You should not have the test if you think you might be pregnant or if you have an active pelvic infection.

Treatment

If the X-ray shows a problem, your doctor will talk through the best options. These may include helping to unblock tubes, surgery, or assisted conception such as IVF. If the tubes are open and the womb is normal, the test itself may have given your fertility a helpful boost.

Self-care at home

• Take gentle exercise and stay well hydrated around the time of the test
• Use a heating pad or warm bath if you get mild cramping afterwards
• Rest for the rest of the day if you need to

Medical treatments

Depending on what the X-ray shows, you may be offered techniques to open blocked tubes, keyhole surgery to remove fibroids or scar tissue, or assisted reproduction such as IVF. Your fertility team will explain the options and what each involves. They will never rush you into a decision.

When is surgery considered?

Surgery is only considered if a clear problem is found, such as a blocked tube, adhesions, or fibroids. Keyhole surgery (laparoscopy) is often used because it is less invasive and you recover more quickly.

Living with this condition

After the test, you can usually return to your normal routine the next day. You may have a little spotting or cramping, which is normal. If you are waiting for results, try to keep busy and be kind to yourself.

Lifestyle tips

• Manage stress with activities like walking, reading, or talking to a friend
• Avoid sexual intercourse for two or three days after the test, or as advised by your doctor
• If you are trying to conceive, try to live a generally healthy lifestyle, but do not be too hard on yourself

Diet and exercise

Eat a balanced diet with plenty of fruits, vegetables, whole grains, and protein. Aim for moderate exercise most days. Being a healthy weight helps fertility, but even small changes can make a difference.

Mental health and emotional wellbeing

Fertility tests can feel emotional. You might feel anxious, vulnerable, or worried about the future. These feelings are completely normal. It may help to talk to your partner, a close friend, or a counsellor who understands fertility.

Prevention

Some causes of blocked tubes cannot be prevented, but you can lower your risk of pelvic infection by practising safer sex and treating any infections early. Limiting your number of sexual partners and using condoms can also reduce the risk of sexually transmitted infections that can damage the tubes.

Vaccines

Ask your healthcare team about the HPV vaccine, which can reduce the risk of cervical changes that sometimes need treatment. The vaccine does not directly prevent blocked tubes, but it prevents infections that can lead to pelvic problems.

Screening programmes

If you have a history of pelvic pain or irregular periods, an early fertility assessment can help you make choices before attempting to conceive.

Complications

If left untreated

• If a blocked tube is left untreated, it will not get better on its own and may reduce your chance of natural conception.
• Some conditions that cause blockages, like endometriosis, can slowly progress, so it is worth getting a clear diagnosis.

Long-term outlook

The news from a fertility X-ray can feel overwhelming, but many fertility problems are now treatable. Even if your tubes are blocked, IVF offers a real chance of pregnancy. And if your X-ray is normal, that is positive information you can use going forward. Your healthcare team will be with you at every step.

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