This week I finally worked up my nerve and had an HSG done, since after 14 months of trying my husband and I have not yet been able to conceive. The hysterosalpingogram or HSG is often ordered as part of an infertility workup to show the shape and condition of the uterus and fallopian tubes. If there are blockages in the tubes sperm can't find their way to the egg. If there are abnormalities in the shape of the uterus it may be difficult or impossible to carry a baby to term. Your doctor may order an HSG to help rule out physical abnormalities as the cause of infertility.

An HSG is an xray of your uterus and fallopian tubes done with a “contrast” dye so that the shape of these organs will show on the xray (normally soft tissues such as muscle and skin don't show on an xray). The HSG must be done on days 7-10 of your cycle to rule out any chance that you might be pregnant.

About half the women I talk to say it is no big deal, the other half said it was very painful. I took two ibuprofen and two acetaminophen two hours before the test to be on the safe side.

I was very upset to learn that at this hospital they don't allow spouses to accompany women through the procedure. I could have rescheduled for a different hospital since many do allow spouses to come along for moral support, but I decided I just wanted this done. The technicians were super nice and explained everything they were going to do.

As with most gynecological procedures, I was on my back with my feet in stirrups. The radiologist used a larger than usual speculum so he could get a good view of what he was doing. He then threaded a small catheter with a tiny flat balloon on the end into my cervix. This wasn't as bad as I expected but there was some cramping. He then inflated the balloon slightly and began injecting the dye.

The catheter slid right out. This time my cervix had moved and he had a lot of trouble getting it back in. Worse, now I was cramping as bad as my worst periods and the muscle contractions didn't help him in getting the catheter back in place. He started apologizing for the intense pain he was causing, but the catheter just wouldn't go in. He turned the speculum a few times to get a better view. THAT was even better. He did eventually get the catheter in and said “This is one of the worst I have ever done! I do twelve of these a day and this was really difficult.” Trust me to be the one with the extra long cervix!

He explained that my cervix was more than twice as long as normal, likely from all those years of not having periods (I have polycystic ovarian syndrome). Once he had it in place and began inserting dye, it got even more painful as my cramps got worse when the dye pushed in. The good news is that most women don't go through this much. The even better news is that my tubes both showed clear and my uterus is normal. This was a huge relief after so many years of worrying about it.

Having an HSG can often clear any debris or mucus blocking the tubes, so many women actually do get pregnant after an HSG. For most women it is not a terribly painful procedure, I just got lucky again. Both the radiologist and the technician complimented me on my pain tolerance and apologized for how unusually difficult my procedure was. I asked them if this was supposed to change my mind about wanting to go through labor. The laughed and said, “No, this is supposed to make labor look easy!”

If the test shows that you tubes are blocked, it is important to understand that this can be a false reading if your tubes are spasming they may appear blocked but not actually be blocked. It is also possible for mucus to block the openings. If your tubes appear blocked your doctor can often open themby inserting a small catheter into the opening of the tube.