HSG Test for Blocked Fallopian Tubes: Procedure, Pain and Results

Dr. Anshika Lekhi, MBBS, MS (Obstetrics & Gynecology), The Fertilife, Gurgaon

Almost everyone booked for an HSG arrives having read that it is painful. That reputation is not baseless, and it is also not the whole story, so here is what actually happens and what you can do about the part that worries you.

What the Test Is For

The question it answers

A hysterosalpingogram checks whether your fallopian tubes are open and looks at the shape of the uterine cavity. Contrast dye is introduced through the cervix and X-ray images follow it as it travels.

If the dye passes through and spills out of the tube ends, that tube is patent. If it stops, there is a blockage, and where it stops tells your doctor something about what kind.

Why it matters so much

Fertilisation happens inside the tube. If both tubes are blocked, sperm and egg cannot meet, which means IUI cannot work and IVF becomes the route, since IVF bypasses the tubes entirely.

That single finding redirects the whole treatment plan, which is why it comes early in fertility testing.

When It Is Done

Between day six and day eleven of your cycle, after bleeding has stopped and before ovulation. That window exists for two reasons: a thinner lining gives clearer images, and there is no risk of disturbing an early pregnancy.

You will be asked to confirm you are not pregnant. Some units prescribe antibiotics or an anti-inflammatory beforehand.

What Happens on the Day

The procedure itself

You lie on an X-ray table. A speculum is placed, the cervix is cleaned, and a thin catheter is passed through it. The dye goes in slowly while images are taken, and the whole thing usually takes around ten to fifteen minutes.

No anaesthetic is normally needed and you go home the same day.

What you will feel

Cramping, similar to strong period pain, mostly in the moments the dye is flowing. It builds and then eases fairly quickly once the injection stops.

Patients with open tubes often report less discomfort than those with a blockage, because the dye meeting resistance is part of what hurts.

About the Pain, Honestly

It is manageable, and anxiety makes it worse

Fear raises the experience of pain, and that relationship is well enough recognised that a 2025 randomised trial tested whether reducing anxiety during hysterosalpingography reduced reported pain.

What actually helps

Take the pain relief you are offered, timed properly rather than after you arrive. Tell the person doing the test that you are nervous, because a slower injection is genuinely more comfortable. Breathe out rather than holding your breath during the cramping. Arrange for someone to take you home.

Afterwards, expect mild cramping for a few hours and some spotting for a day or two. Normal painkillers are usually enough.

Reading the Result

What the images show

Both tubes filling and spilling is a normal result. One tube blocked still leaves a route to natural conception and to IUI. Both tubes blocked points to IVF.

The test also reveals cavity problems, including a septum, polyps, fibroids distorting the cavity or adhesions, any of which may need addressing before a transfer.

Where it can mislead

A tube can appear blocked on HSG because of spasm rather than true obstruction, particularly at the point where it meets the uterus. A result showing a single blocked tube sometimes warrants confirmation by another method rather than immediate action.

So read the result with your doctor rather than from the report. Female fertility assessment puts it alongside your reserve testing and your partner's results, which is where it means something.

What HSG Does Not Tell You

It is a test of patency, not function. A tube can be open and still not work, because the cilia lining it move the egg along and those can be damaged by past infection or endometriosis while the channel stays clear. Open is good news rather than a guarantee.

It also says nothing about egg quality, ovarian reserve or sperm, which is why it is one test in a panel rather than the test.

Other Ways to Check the Tubes

HSG is the usual first choice because it is quick, widely available and gives clear images of the cavity as well.

Sonohysterosalpingography uses ultrasound with saline or foam instead of X-ray, so no radiation. Laparoscopy with dye is the most definitive, since the surgeon watches the dye emerge and can treat endometriosis or adhesions in the same sitting, but it is surgery under general anaesthesia and not a first-line test.

When to Call Afterwards

Fever, heavy bleeding, severe pain that painkillers do not touch, or foul-smelling discharge all warrant a call the same day. Infection after HSG is uncommon and is treatable when caught early.

The NHS overview of fertility investigation covers where tubal testing sits among the other tests. To arrange yours, call +91 73037 08364.

Educational information only. Imaging findings should always be interpreted by your own gynaecologist alongside the rest of your results.