HSG stands for hysterosalpingography. It is an X-ray procedure in which contrast dye is gently passed through the cervix into the uterus so doctors can check whether the fallopian tubes are open and whether the uterine cavity has a normal shape.

It is a key fertility test because sperm and egg must meet through open tubes for natural conception. In most Indian hospitals and fertility centres, the actual procedure takes about 15 to 30 minutes, though the visit may be a little longer.

HSG is mainly ordered to look for tubal blockage, which contributes to roughly a quarter of female infertility cases. Past pelvic infection, tuberculosis, endometriosis, previous surgery, or severe pelvic inflammation can all damage or block the tubes.

The test also gives useful information about the inside of the uterus, including a septum, polyp, adhesions, or an unusual cavity shape. That makes it helpful before planning IUI and sometimes before IVF, especially when the doctor wants a complete baseline workup.

HSG is usually scheduled between day 7 and day 12 of the menstrual cycle. That means after the period has ended but before ovulation, when the chance of an early pregnancy is lowest and the uterine lining is still thin enough to image clearly.

This timing matters because HSG should not be done during pregnancy. Many doctors confirm the date carefully from cycle history, and some clinics or radiology units in India may also ask for a urine pregnancy test before proceeding.

Your doctor may prescribe antibiotics, often doxycycline, starting one or two days before the test to reduce the risk of pelvic infection, especially if there is past PID or a higher-risk history. A common pain plan is ibuprofen 400 mg about 30 minutes before the appointment.

Empty your bladder before the procedure and carry a sanitary pad because light spotting or dye leakage can happen afterward. In India, generic ibuprofen may cost about Rs 50 to Rs 100 and doxycycline about Rs 50 to Rs 150, depending on brand and city.

You will lie on an examination table much like during a pelvic exam. A speculum is placed in the vagina, the cervix is cleaned, and some doctors use local numbing medicine before passing a thin catheter through the cervix into the uterus.

Contrast dye, either water-based or sometimes oil-based, is then injected slowly. Real-time fluoroscopy shows how the dye fills the uterus and whether it travels through the fallopian tubes and spills into the abdomen, with intermittent X-ray images taken during the process.

Most women describe HSG as causing moderate period-like cramps, mainly when the dye is injected. The stronger part usually lasts only five to ten minutes, and for many people it is uncomfortable but still tolerable, especially with pre-procedure ibuprofen.

Pain can feel sharper if a tube is blocked because the dye meets resistance and pressure builds behind the blockage. Anxiety also amplifies discomfort, so asking the team to explain each step slowly often helps the test feel more manageable.

If the tubes are open, the report usually says there is free spill of dye into the peritoneal cavity. In plain language, that means the dye moved through the tubes and out into the abdomen, which is the expected sign of tubal patency.

If the dye stops partway, the doctor may suspect blockage or severe spasm and explain which side is affected. The uterine cavity may also be reported as normal, septate, T-shaped, irregular, or suggestive of adhesions such as Asherman syndrome, and your OB-GYN will interpret what that means for treatment.

In government settings, HSG may be free or very low cost at centres such as AIIMS and many district hospitals, and Ayushman Bharat or state schemes may help cover parts of the diagnostic workup where applicable. Private pricing is commonly about Rs 3,000 to Rs 8,000 at hospital groups such as Apollo, Fortis, and Cloudnine.

At IVF chains such as Nova or Indira IVF, HSG often falls around Rs 5,000 to Rs 12,000 depending on city and package. If oil-based contrast is used, the bill may rise to roughly Rs 8,000 to Rs 15,000. Fertility specialist consultations often cost about Rs 800 to Rs 2,500.

Some women conceive in the months after HSG because of the so-called tubal flushing effect. The idea is that the dye may clear minor mucus plugs or very mild debris, slightly improving the chance that sperm and egg can meet.

Across studies, roughly 10 to 25 percent of women may conceive within three to six months after HSG, especially when at least one tube is open and there are no major male-factor or ovulation problems. Oil-based contrast has been linked with a somewhat stronger effect in some groups.

HSG is generally safe, but small risks include pelvic inflammatory disease, allergic reaction to iodine-based contrast, fainting, or unusually severe cramping. Infection risk is uncommon but important, often quoted around 1 to 3 percent, which is why some doctors follow ISAR- and FOGSI-aligned antibiotic precautions.

After HSG, light spotting and mild cramps for two to three days can be normal. Many doctors advise no tampons and no sex for 48 hours. Seek urgent care if you develop fever, foul discharge, severe worsening pain, heavy bleeding, or feel very unwell.