An HSG (hysterosalpingogram) before IVF is often recommended to evaluate the health of your fallopian tubes and uterus to ensure the best chances of success.

Understanding what to expect and how to manage any discomfort can help make the process smoother.

In this article, we’ll explore why an HSG is commonly performed before IVF, how painful it may be and what you can do to prepare for the procedure.

If your HSG results suggest potential challenges with fertility that would make IVF difficult or ineffective, there are other options. Contact us today to learn more about how surrogacy can help you achieve your dreams of parenthood.

Is HSG Necessary Before IVF?

An HSG before IVF is often recommended or sometimes required, especially if fallopian tube issues are a concern.

The test is particularly useful for identifying blockages or abnormalities in the fallopian tubes, which can prevent sperm from reaching the egg or affect embryo transport.  

If you have conditions like blocked tubes or uterine abnormalities, proceeding with IVF without identifying and addressing them could waste valuable time and resources and, more importantly, put your embryos at unnecessary risk.

If you experience multiple failed IVF attempts, it may be time to consider surrogacy. Read more about surrogacy after failed IVF.

Whether an HSG before IVF is necessary depends on your clinic or fertility specialist’s evaluation. There are other diagnostic tests available, and your doctor may suggest an alternative if HSG is not the best fit for your case.

Is a Hysterosalpingogram Painful?

Women who have had a hysterosalpingogram (HSG) before IVF report feeling extreme pain to mild discomfort, to barley feeling anything at all.

The pain associated with HSG comes from the dye-release process. To release the dye, a thin catheter is passed through the cervix.

To do this, physicians make use of a tenaculum, a common gynecological tool. Most women who recall a painful HSG experience attribute their pain to the catheter, the tenaculum, or the release of the dye.

If you know you have a sensitive cervix, HSG may be more painful for you than for others. Talk to your physician about the pain management strategies listed further down in this article.

What to Expect During an HSG Before IVF

An HSG is a straightforward procedure, though it can feel uncomfortable. Here’s what you can expect:

• Before the procedure: You’ll be asked to lie on an exam table, similar to a pelvic exam. A speculum is inserted to open the cervix, and a catheter is passed through the cervix into the uterus.
• During the procedure: A contrast dye is gently injected through the catheter, which helps highlight your uterus and fallopian tubes on an X-ray. This part typically lasts about 5-10 minutes. You may feel cramping or pressure as the dye is injected.
• After the procedure: Once the X-rays are taken, the catheter is removed, and the procedure is complete. Some mild cramping, spotting or light bleeding may occur, but it usually subsides within a few hours.

Though it’s quick, the discomfort varies by individual. Some patients report mild to moderate pain, but there are many who describe their pain as intense. While this isn’t ideal, this test is in the best interest of future family.

Saline Sonogram vs. HSG Before IVF: What’s the Difference?

A saline infusion sonogram (SIS) may be recommended instead of or in addition to your HSG. B

• HSG: This test uses a special dye and x-ray to check for issues like blocked fallopian tubes or uterine abnormalities.
• Saline sonogram: Instead of dye, this test uses sterile saline and ultrasound to take pictures of your uterus.

While an HSG before IVF is typically less painful than a saline sonogram, it is ideal for checking fallopian tubes for blockages.

Both procedures are important for fertility, but your doctor will be able to determine which test or if both tests are right for you.

Does Painful HSG Mean Blocked Tubes?

A painful HSG before IVF doesn’t necessarily mean your fallopian tubes are blocked.

Anyone can experience pain during HSG. Any number of natural factors can cause HSG to be more painful than would be typically expected, from a sensitive cervix to a narrow uterus. Pain during HGS doesn’t necessarily mean anything is abnormal.

However, many women with blocked tubes experience much more significant pain during HSG. So although a painful procedure doesn’t mean a blocked tube, an exceptionally painful experience may be indicative of an obstruction.

How to Make HSG Test Less Painful

No one wants you to be in unnecessary pain. Talk with your doctor about these strategies for HSG pain management and mitigation.

Can I Take Valium for HSG?

Typically yes. Valium, a muscle relaxant, is a popular pain management technique for an HSG before IVF. Many doctors are willing to administer a dose at your request before HSG.

Keep in mind that Valium is a drug that can cause disorientation and drowsiness. If you request Valium for your HSG, make sure you have someone with you to help you get home.

Can I Take Ibuprofen Before HSG Test​?

Typically yes, but check in with your doctor first. To ensure best results, take ibuprofen several hours before the procedure.

Can I Take Tylenol before HSG Test?

Yes. Acetaminophen, the active ingredient in Tylenol, is typically allowed and recommended before an HSG. Be sure to check with your doctor.

Is it Normal to Have Pain after HSG Test?

Yes, it’s completely normal to experience some discomfort after an HSG.  Some women may experience subdued lingering pain for up to a day after HSG.

HSG can also induce cramping during and immediately after the procedure. Depending on how significant these cramps are for you specifically, you could experience uncomfortably tightened and sore muscles for up to a week afterwards.

Other common side effects include:

• Light spotting
• Dizziness and nausea
• Bloating
• Mild cramping
• Light bleeding

These side effects are usual and typically not a cause for concern. They can last up to 24 hours.

How Long Does HSG Pain Last?​

Prolonged pain could be an indication of an infection. If any of these last for more than 24 hours, or if you experience any of the side effects from the following list, please contact your physician as soon as possible:

• Severe abdominal pain
• A fever over 100F
• Unusual discharge
• Heavy bleeding
• Fainting
• Vomiting
• Any symptoms of anaphylaxis (hives, difficulty breathing, swelling throat, etc.)

Keep in mind; no one knows your body as well as you do. If you feel like something isn’t right, don’t hesitate to contact your doctor, regardless of your symptoms.

Pain a Week after HSG

If your pain persists a week after your HSG, it is very important that you contact your doctor. This could be an indication of a serious but treatable condition, like an infection.

Next Steps After Receiving Your HSG Test Results

An HSG before IVF can diagnose many different conditions. Unfortunately, many of these conditions make pregnancy, even with IVF, either impossible or an exceedingly high risk.

At this point, you’ll want to talk about your options with the diagnosing doctor.

If you decide surrogacy is right for you after receiving your HSG results, we’ll help match you with the right surrogate quickly. Take the first step toward growing your family. Contact us today.