Hysterosalpingogram (HSG) Lipiodol Flush HSG Fallopian Tube Recanalization

HSG is a radiology procedure to check the uterus and fallopian tubes, aiding in fertility assessment and treatment planning.

Request an appointment

Tel: (212) 246-2063

Hysterosalpingogram (HSG) Lipiodol Flush HSG Fallopian Tube Recanalization

HSG is a radiology procedure to check the uterus and fallopian tubes, aiding in fertility assessment and treatment planning.

Request an appointment

Tel: (212) 246-2063

HSG Instructions

Before Your HSG Exam:

You can eat and drink normally; there are no dietary restrictions.
About 30 to 60 minutes before your appointment, take a pain reliever like Tylenol or ibuprofen.

After Your HSG Exam:

You may want to bring a pad or liner, as light bleeding is possible after the exam.
Drink plenty of fluids to help flush out the contrast material.
If you experience cramping, feel free to take additional pain relief medication.

Our Services

Our radiology services include hysterosalpingograms (HSG), fallopian tube recanalizations (FTR) and Lipiodol flush HSG.

Frequently Asked Questions

Please reach us at info@hsgexam.com if you cannot find an answer to your question.

Why do I need an HSG?

An HSG exam, also known as a hysterosalpingogram, is a diagnostic fertility test used to assess the anatomy and health of the fallopian tubes and uterine cavity.

Here are some reasons why you might need an HSG exam:

Infertility: HSG can help identify potential causes of infertility, such as blockages in the fallopian tubes or abnormalities in the shape of the uterus.
Recurrent miscarriage: If you have experienced recurrent miscarriages, an HSG can help identify any abnormalities in the shape or structure of the uterus that may be contributing to the problem.
Planning for fertility treatments: If you are planning to undergo fertility treatments such as in vitro fertilization (IVF), an HSG may be required to evaluate your uterus and fallopian tubes.

During ovulation, one of your ovaries releases an egg that travels down one of your fallopian tubes, where the sperm and egg will meet, and fertilization can occur. Once an egg is fertilized, an embryo will develop and continue through the fallopian tubes until it reaches the uterus, where it will implant into the uterine lining.
HSG is performed routinely for patients having difficulty conceiving because it is an excellent test that can not only confirm that a woman’s fallopian tubes are open but can also evaluate whether the uterus has a normal shape. Moreover, it can check to see if there are any polyps, fibroids, or scar tissue inside the cavity. Tubal factors cause 25–35% of female infertility.
During an HSG, liquid x-ray contrast is injected into the uterus and fallopian tubes to evaluate the flow of the contrast through the reproductive system. This can aid in locating any obstructions or anomalies that might be causing fertility problems.

How does the HSG work?

The hysterosalpingogram (HSG), also known as utero-tubal evaluation, is a medical imaging test used to evaluate the health of a woman's reproductive system, specifically the uterus and fallopian tubes.

Here's how the HSG exam works:

Preparation: Before the HSG, the patient will need to discuss any medical conditions or allergies with their doctor. The exam is typically scheduled between days 6-12 of the menstrual cycle to avoid potential interference with early pregnancy.
Procedure: The patient will lie down on an examination table during the examination, and a speculum will be introduced into the vagina. A small tube (catheter) will then be inserted into the cervix, through which a special dye is injected into the uterus. The dye will fill the uterus and flow into the fallopian tubes. X-ray images are taken as the dye moves through the reproductive system.
Results: The images obtained from the HSG exam can help diagnose structural problems within the reproductive system, such as blockages or abnormalities in the uterus or fallopian tubes. The results of the exam are usually available immediately or shortly after the procedure, and the patient may need to follow up with their doctor to discuss any findings or necessary treatments.Add an answer to this item.

When should I schedule an HSG?

The best time to schedule a hysterosalpingogram (HSG) exam is usually between days 5 and 12 of your menstrual cycle.

This timing allows for the procedure to be done after the end of your menstrual bleeding, but before ovulation occurs. Scheduling the HSG within this timeframe helps to minimize the risk of interfering with a possible pregnancy, as well as ensure that the uterus and fallopian tubes are most receptive to the injection of contrast dye.
Avoid scheduling the exam during your period, as this can interfere with the accuracy of the results.
Inform your doctor if you have a history of pelvic infections. This information is crucial as it may influence the timing and approach to your exam to ensure it is performed safely.
It's recommended that you discuss the timing of the HSG exam with your doctor, as they may have specific recommendations based on your individual situation and medical history.
If you have any questions about the HSG, don't hesitate to call our Manhattan office at (212) 246-206

Will insurance cover HSG?

Whether or not your insurance will cover the hysterosalpingogram exam (HSG) will depend on your specific insurance plan and fertility coverage.

Some insurance plans may cover the HSG exam as a diagnostic test to help evaluate fertility issues or check for certain medical conditions, while other plans may not cover it at all. Coverage can depend on many factors, including the specific insurance plan you have, your deductible and copay amounts, and the reason for the procedure.
To find out if your insurance plan covers the HSG exam, contact your insurance provider or review your plan documents. You may also want to speak with your healthcare provider, who can help you understand the specific reasons for the test and whether it is likely to be covered by your insurance plan.

CPT Codes For HSG:

58340 ($360)

74740 ($220)

Plans accepted at Interventional Radiology:

Aetna

Anthem

Blue Cross Blue Shield

Oxford (excluding Community Plan)

What are the CPT codes for HSG?

The CPT codes for a hysterosalpingogram (HSG) are as follows:

58340: This code is used for catheterization and the introduction of saline or contrast material during the hysterosalpingography procedure.
74740: This code is for the radiological supervision and interpretation of the hysterosalpingography.

Both codes are used together to cover the procedure and the imaging interpretation.

What if I am allergic to HSG contrast?

With individuals at elevated risk for iodinated contrast hypersensitivity, gadolinium hysterosalpingography offers a secure alternative to the iodinated contrast medium for HSG.

Allergic reactions to HSG contrast are rare but possible. The contrast used for HSG is the same as that used in intravenous CT (or CAT) scans. If you have a known allergy to the contrast material used in HSG, it is important to inform your healthcare provider immediately.
Symptoms of an allergic reaction can range from mild to severe and may include hives, itching, swelling, difficulty breathing, or anaphylaxis.
If you have a known allergy to contrast material, your healthcare provider may recommend alternative imaging tests or prescribe medications to help prevent an allergic reaction. If you develop symptoms of an allergic reaction during the procedure, your healthcare provider will have the necessary medications and equipment on hand to manage the reaction.
It is important to discuss any concerns or allergies you have with your healthcare provider before undergoing any medical procedure, including an HSG, to ensure that appropriate precautions are taken and that you receive the safest and most effective care possible.

Should I take antibiotics?

It is not routine to prescribe antibiotics for a hysterosalpingogram (HSG) exam.

An HSG is a diagnostic procedure that uses X-ray imaging to check for obstructions or anomalies in the fallopian tubes and uterus. Because there is a low chance of infection with this exam, antibiotics are not given as a preventative before this test.
However, if you have a history of pelvic infection or other conditions that increase your risk of infection, your healthcare provider may recommend taking antibiotics before the procedure to help prevent infection. Additionally, if you develop signs of infection after the HSG, such as fever, chills, or increased pain, it is important to contact your healthcare provider right away, as antibiotics may be necessary to treat the infection.

What should I bring with me to my appointment?

When going to your hysterosalpingogram (HSG) appointment, it is recommended to bring the following items:

Your insurance card and identification: Make sure to bring your insurance card and a valid photo identification with you to the appointment.
Referral and authorization forms: If your healthcare provider has given you a referral or authorization for the HSG, make sure to bring the necessary paperwork with you to the appointment.
Comfortable clothing: You may want to wear comfortable clothing that is easy to change in and out of, as you will be asked to change into a hospital gown for the procedure.
Sanitary pads: You may experience some light bleeding or spotting after the HSG, so it is recommended to bring some sanitary pads with you to the appointment. Wearing a pad for the rest of the day will help protect your clothing.
Pain relievers: You may experience some cramping or discomfort during or after the HSG, so it may be helpful to bring some over-the-counter pain relievers, such as ibuprofen or acetaminophen, with you to the appointment.

What will occur during the appointment?

Policy on Procedure Room Access During Hysterosalpingography

At our practice, your safety and well-being are our top priorities. To ensure the highest standards of care during your hysterosalpingography (HSG) procedure, we maintain a clean and carefully controlled environment. For this reason, only essential medical personnel are permitted in the fluoroscopy room during the procedure.

We understand that medical tests can be an emotional experience, and having the support of loved ones is important. While family members or friends are welcome to accompany you to the office, we kindly ask that they wait in our comfortable waiting area during the procedure. This policy is in place to protect your privacy, ensure the best clinical outcome, and minimize any potential risks related to unnecessary exposure.

What will occur during the HSG exam?

During the hysterosalpingogram (HSG) exam, you will be asked to lie on an exam table and place your feet in stirrups. The following steps will generally happen during the exam:

Preparation: You will be asked to change into a gown and lie on the examination table.
Speculum: A speculum is placed into the vagina to hold the vaginal walls apart.
Position catheter: A thin catheter will be inserted through the cervix and into the uterus.
Injection of contrast: Liquid contrast is then injected slowly and flows into the uterine cavity and out through the fallopian tubes into the pelvis. The flow of the dye is monitored via fluoroscopy (x-ray) images.
Monitoring: You may be asked to move into different positions during the procedure to help the dye flow into your fallopian tubes.
Completion: Once the X-rays have been taken, the catheter and speculum will be removed.

The HSG usually takes less than five minutes once the catheter is positioned. You should be able to return to your normal activities immediately afterward. You may experience some cramping, spotting, or light bleeding for a few days following the procedure, but these symptoms usually subside quickly. Your healthcare provider will discuss the results of the HSG with you after the exam.

How painful is the HSG?

Undergoing a hysterosalpingogram (HSG) or fallopian tube recanalization (FTR) is an important step in your fertility journey. While these procedures are typically quick and well-tolerated, we understand that some patients may feel anxious about potential discomfort. To help make your experience as comfortable as possible, we offer Pro-Nox, a patient-controlled nitrous oxide system, along with additional pain relief options such as ibuprofen and acetaminophen.

Although some women may experience discomfort or pain during an HSG, it is typically well tolerated. The level of discomfort varies from person to person and may be influenced by individual pain thresholds or underlying medical conditions.

During the exam, you may feel cramping or discomfort when the catheter and contrast dye are inserted into your uterus and fallopian tubes. This sensation can resemble menstrual cramps and may be sharp or dull. Some women experience a brief, intense cramp as the dye is injected.

What to Expect After the HSG:

Some women experience new cramping approximately 3–4 hours after the procedure.
Mild spotting or bleeding can occur for a day or two.
Over-the-counter pain relievers such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) can help manage discomfort both before and after the exam.

If you are concerned about pain or discomfort, discussing your concerns with your healthcare provider beforehand can be helpful. They can provide additional information about the procedure and suggest strategies to minimize discomfort.

Pain Management Options for HSG and FTR

To help minimize discomfort, we provide several pain relief options:

Pro-Nox (Nitrous Oxide & Oxygen): A safe, fast-acting inhaled gas that lets you control your own pain and anxiety relief. The effects are felt within seconds and wear off quickly, so you can return to normal activities immediately.
Ibuprofen or Acetaminophen: Taking an over-the-counter pain reliever about 30–60 minutes before your procedure can help reduce cramping. It is also recommended for post-procedure discomfort.
Relaxation Techniques: Deep breathing and calming exercises can further ease any tension during the procedure.

Why Choose Pro-Nox for HSG and FTR?

Hysterosalpingography (HSG) and fallopian tube recanalization (FTR) are essential diagnostic and therapeutic procedures, but some patients may experience cramping or mild discomfort. Pro-Nox can help by

✅ Providing immediate relief – Effects are felt almost instantly.
✅ Allowing you to stay in control – You decide when and how much to use.
✅ Reducing anxiety – Helps you stay relaxed throughout the procedure.
✅ Wearing off quickly – No lingering drowsiness, so you can resume daily activities right away.

What to Expect During Your Procedure with Pro-Nox

If you choose Pro-Nox, you will have a small mouthpiece to inhale the gas as needed. You will remain awake and alert while experiencing relief from discomfort. Once the procedure is complete, the effects dissipate within minutes, allowing you to continue your day as usual.

Is Pro-Nox or Additional Pain Relief Right for You?

Most patients are good candidates for Pro-Nox and can also benefit from taking ibuprofen or acetaminophen beforehand. If you have concerns about discomfort, let us know—we’re happy to discuss the best pain management approach for you.

At Interventional Radiology, P.C., we are committed to providing expert, compassionate care while ensuring your experience is as smooth and comfortable as possible. Please contact our office if you have any questions or would like to schedule an appointment.

Should I fast before my HSG?

No, you do not need to fast before the hysterosalpingogram (HSG) exam.

It is important to follow any specific instructions provided by your healthcare provider. This may include avoiding certain medications or supplements before the exam.
If you have any questions about how to prepare for your HSG exam, don't hesitate to call our office at (212) 246-2063 or send a text via our Klara communication app.

What to anticipate following the test

Immediately after your HSG exam, you can resume normal activities.
Bring a pad with you. A small amount of spotting is normal after an HSG test, and there can also be leakage of the contrast dye. Wearing a pad for the rest of the day will help protect your clothing. You may need to wear a pad for a few days as the dye is slowly expelled from the uterus.
You may experience new cramping approximately 3-4 hours after the HSG. Don’t hesitate to take over-the-counter pain medications and drink lots of liquids after the exam.
Immediately following the examination, the doctor will discuss the HSG results and provide you with a written report for your records. We will also fax your HSG report to your referring physician.
After the exam, we will send you a text message confirming you are doing well after the procedure and have an opportunity to ask any additional questions.
Heavy bleeding, severe pain, and fever are not normal side-effects and should be investigated immediately.
Many patients ask if they should refrain from intercourse after having an HSG. No, you should not. Pregnancy after an HSG may be more likely, depending on the cause of your infertility.

Can HSG improve my chances of getting pregnant?

Although the HSG is generally used for diagnostic purposes, it has been found that women with unexplained infertility have a higher rate of spontaneous pregnancies following HSG examinations. The pregnancy rate after an HSG test is believed to be around 2–3 times higher than that of infertile women who have not undergone this test before.
The test itself is not a treatment for infertility; it is done to understand the reasons for infertility. However, it is a fact that a lot of infertile women get pregnant after the test; the exact reasons are unknown, though. Getting pregnant after the HSG, therefore, may be a coincidence, or due to some unknown reason in the procedure of carrying out the test.
While HSG tests are not a treatment for infertility, women with unexplained infertility may have a greater chance of getting pregnant after conducting this test.

Can HSG evaluate my ovaries?

No, hysterosalpingography is designed to evaluate the uterine cavity and fallopian tubes; HSG cannot be used to evaluate the ovaries or to diagnose endometriosis or fibroids.

Can HSG unblock my fallopian tubes?

A hysterosalpingogram (HSG) is a radiologic procedure used to evaluate the shape of the uterine cavity and the patency of the fallopian tubes. During this procedure, a clear liquid is injected through the cervix into the uterine cavity and fallopian tubes, and X-ray images are taken to visualize the flow of the contrast.
In some cases, the pressure of the contrast injected during the HSG can help to clear blockages in the fallopian tubes. These blockages might be due to mucus plugs, debris, or minor adhesions, and the procedure can sometimes help to dislodge them, thereby improving tubal patency and potentially enhancing fertility. This therapeutic effect of the HSG is sometimes referred to as "tubal flushing."
It's crucial to remember that the HSG is not a guarantee for clearing blocked fallopian tubes, and the success rate varies according to the severity and origin of the obstruction. In order to completely eliminate some obstructions and increase fertility, additional procedures, such as fallopian tube recanalization or laparoscopic surgery, may be necessary.
Fallopian tube recanalization (FTR), also referred to as selective salpingography, is a minimally invasive, non-surgical procedure used to reopen blockages in one or both of the fallopian tubes. This low-risk procedure is recommended as the first intervention for patients with blockage of the proximal fallopian tube, where the uterus meets the fallopian tube.

Lipiodol HSG

A Lipiodol HSG, also known as Lipiodol Flush, is a type of diagnostic test that is used to evaluate the fallopian tubes and uterus of a woman's reproductive system. It involves the use of a special type of oil-based contrast dye called Lipiodol, which isinjected through the cervix and into the uterus.

Benefits of a Lipiodol Flush:

There are several benefits to using Lipiodol for a hysterosalpingogram compared to other types of contrast dyes. Lipiodol is an oil-based dye that is thicker and more viscous than other types of contrast dyes, which allows it to adhere better to the walls of the fallopian tubes and uterus.
Lipiodol is also believed to have potential therapeutic benefits, as it may help to clear blockages in the fallopian tubes and improve fertility. Studies have shown that Lipiodol hysterosalpingograms may be associated with higher rates of pregnancy and live births compared to other types of contrast dyes. Although HSG is not a new procedure, recent research has shown significant benefits for fertility linked with the use of Lipiodol, an oil-based contrast, compared to water-based HSG contrast. A recent landmark study published in the New England Journal of Medicine confirms significant fertility benefits from Lipiodol.
Overall, Lipiodol hysterosalpingograms can be a valuable tool for diagnosing and treating fertility issues in women. However, as with any medical procedure, there are potential risks and side effects, and it is important to discuss these with a healthcare provider before undergoing the procedure.
We begin the HSG exam with water-soluble contrast to confirm that your fallopian tubes are open and are of normal size. If your fallopian tubes are normal, the exam can be followed by the injection of the oil-soluble contrast.
Please note that insurance carriers in the United States do not cover Lipiodol contrast. Lipiodol cost = $1,700 (one 10-mL vial of Guerbet Lipiodol).

Questions:

If you think using the oil-soluble contrast could be beneficial for you, talk to your doctor about it. If you have any questions about the Lipiodol HSG, don't hesitate to call our office at (212) 246-2063 or send a text via our Klara communication app.

How is radiation exposure minimized during HSG?

Radiation exposure during the HSG is minimized by using the lowest possible amount of radiation needed to produce high-quality images. Additionally, the duration of the X-ray exposure is kept as short as possible to further reduce radiation exposure.
Dr. Silberzweig has performed over 40,000 HSG exams and has also completed research with multiple publications on minimizing radiation exposure and improving patient comfort, ensuring that your treatments will be safe and effective with minimal discomfort.

Are there alternatives to HSG?

Other procedures that can give your doctor some of the same information as HSG:

Laparoscopy —This surgical procedure requires general anesthesia.
Hysteroscopy —This procedure can give a detailed view of the inside of the uterus. However, it cannot show whether the fallopian tubes are blocked.
Sonohysterography —This technique uses ultrasound to show the inside of the uterus. Like hysteroscopy, it does not give complete information about the fallopian tubes.

The choice of a particular test will depend on several factors, including the reason for the evaluation, the healthcare provider's preference, and the patient's medical history. Your fertility specialist can help determine which test or procedure is right for you.

Fallopian tube recanalization

Fallopian tube recanalization (FTR) is performed to open or clear a blockage in the fallopian tubes. This procedure is typically done to help improve the chances of pregnancy for women who are having difficulty conceiving due to blocked fallopian tubes.

During the procedure, a small catheter is inserted into the cervix and guided through the uterus and into the fallopian tubes. Contrast is then injected through the catheter, which allows the doctor to see the inside of the fallopian tubes on an X-ray machine. If a blockage is found, the doctor may use a small wire to open the blockage and restore normal flow through the tube. Some women may experience mild cramping or discomfort during the procedure, but this usually goes away quickly.

It is important to note that not all blocked fallopian tubes can be successfully recanalized, and the success rate of the procedure depends on the location and severity of the blockage. Additionally, even if the tubes are successfully recanalized, there is still a risk of scarring or re-blocking in the future. Women who undergo fallopian tube recanalization may also need to use assisted reproductive technologies, such as in vitro fertilization (IVF), to improve their chances of becoming pregnant.

Scientific Publications

Hysterosalpingography versus sonohysterography for intrauterine abnormalities. Acholonu UC, Silberzweig J, Stein DE, Keltz M. JSLS. 2011;15:471-4.
Hysterosalpingography with selective salpingography. Vardhana PA, Silberzweig JE, Guarnaccia M, Sauer MV. J Reprod Med. 2009;54:126-32.
Hysterosalpingography with use of mobile C-arm fluoroscopy. Phillips J, Cochavi S, Silberzweig JE. Fertil Steril. 2010;93:2065-8.
Cesarean section scar diverticulum: appearance on hysterosalpingography. Surapaneni K, Silberzweig JE. AJR Am J Roentgenol. 2008;190:870-4.
Gadolinium for hysterosalpingography. Silberzweig JE, Khorsandi AS, Caldon M, Alam S. J Reprod Med. 2008;53:15-o this item.