If you've been trying to get pregnant for a while and it hasn't happened, you'll probably hit a stretch where you start wondering what to do next – whether it's time to see a doctor, and what they’d even look for.

If you book a consultation with a fertility clinic, one of the first things they'll want to do is a fertility workup. That’s a set of tests to understand your baseline and figure out what might be preventing you from getting pregnant. An HSG (hysterosalpingogram) is one of the earliest diagnostic tests doctors recommend trying. It’s a short imaging test that lets your doctor look inside your uterus and fallopian tubes to make sure everything is open, shaped normally, and clear of debris or mucus plugs.

Here's what happens during the appointment, what it feels like, and what to expect afterward.

How it works

During the procedure, your provider will place a thin catheter through the opening of your cervix, inject a small amount of contrast dye, and take a series of X-ray images. As the dye moves through the uterus and into the fallopian tubes, the images show what's happening structurally in real time. If the tubes are open, the dye flows through and out the ends. If something is blocking the flow (common reasons are a tube blockage, an unusual uterine shape, a fibroid, a polyp, or scar tissue), the images show it.

When it's scheduled

An HSG is typically scheduled between day 7 and day 10 of your menstrual cycle, after your period ends and before ovulation. The timing serves two purposes: it makes sure you're not pregnant, and it works within your natural cycle.

What happens in the room

The appointment usually takes 30 to 60 minutes total, with the imaging portion closer to 15 minutes. You'll lie on an exam table, similar to a pelvic exam. A speculum is placed, the cervix is cleaned, and the catheter is inserted. The dye is injected slowly while the images are captured, and you may even be able to see them on a monitor.

When the images are complete, the catheter comes out. That's the end of the procedure.

Does it hurt?

Some patients experience mild cramping, similar to a period cramp. Others feel stronger cramps, especially if a tube is blocked and the dye can't pass easily.

What the research consistently finds: discomfort tends to peak at the moment of dye injection, stays elevated for about five minutes, and then drops off quickly. By 30 minutes, most patients describe what's left more as a mild discomfort than pain.

You can (and should!) ask about pain management in advance. Options can include an over-the-counter pain reliever taken an hour before the procedure, a cervical numbing gel or injection, or in some cases, a stronger medication. Not every clinic offers every option, but every clinic should be willing to discuss them.

What to expect after a hysterosalpingogram

Most people go back to normal activity the same day, and a common symptom is light cramping. You might also have sticky or lightly bloody discharge for a day or two. That's normal; it's the contrast dye draining out. 

You’ll typically get your results within a few days, although your doctor might also be able to share what they saw after completing the procedure. 

What we’ve learned about oil-based vs water-based contrast

There are two types of contrast dye used in HSG: oil-based and water-based. Most clinics use water-based by default, but recent studies have shown that in some cases, using oil-based contrast dye can improve odds of pregnancy within the first year after tubal flushing. In some cases, clearing debris or mucus plugs from the fallopian tubes can make a huge difference.

A large Dutch trial known as H2Oil measured results from oil-based contrast dye compared to water-based, particularly in cases of unexplained infertility. The reason it’s effective isn't fully understood, and the impact is still being evaluated. If it's something you're curious about, ask your doctor which type of contrast they use and whether either option is available in your case. 

Why having coverage in place ahead of time matters here

Diagnostic tests like HSG can help identify what's actionable well before it becomes a crisis. Having FLORA in place before the workup starts means that if a doctor recommends moving forward with treatment, you’ve already got the coverage side handled. You can apply at heyflora.com.

Wrapping up

If you’ve been trying to get pregnant for a while and it hasn’t happened yet, an HSG can help you and your doctor make a plan. It’s short, uncomfortable at its worst, and often more useful than any other single fertility test at showing what's happening structurally. To set yourself up for success, talk to your doctor ahead of time about pain management, the type of contrast dye they’ll use, and what they expect to learn from the results.