Path To Fertility Blogger Lisa Rosenthal  

Lisa Rosenthal has over twenty-five years of experience in the fertility field, including her current roles as Coordinator of Professional and Patient Communications for RMACT and teacher and founder of Fertile Yoga, a class designed to support, comfort and enhance men and women's sense of self. Her experience also includes working with RESOLVE: The National Infertility Association and The American Fertility Association, where she was Educational Coordinator, Conference Director and Assistant Executive Director

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Infertility Testing On Medical Monday - Hysterosalpinogram Explained


Infertility Testing - What is a HSG?

Hysterosalpingogram HSG testMedical Monday. A look at infertility testing. What do you need to know if you are scheduled for a HSG?


First of all, what is a HSG?


HSG stands for Hysterosalpingogram. It’s a procedure that is used in almost every board certified reproductive endocrinologists’ program. A HSG or hysterosalpingogram establishes the viability of your fallopian tubes. Without knowing whether your fallopian tube or tubes can carry an egg from the ovary to the uterus, you would be doing fertility treatment without any real knowledge that it could work.


Kind of like wandering around in the dark. There’s a lot you can miss. The HSG is a basic test to make sure that any fertility treatment you undergo will be effective.


No need to wander around in the dark when there’s a light switch right next to your hand.


No need to undergo fertility treatment without knowing whether it can work either.


Below is the information that Reproductive Medicne Associates of Connecticut (RMACT) shares on our website. It explains HSG simply, yet comprehensively.


As always, please let me know if you have any questions. I’ll be glad to help you find the answers.

Hysterosalpingography (HSG) Explained

Hysterosalpingography, or HSG for short, is an X-ray procedure used to evaluate the status of a woman’s fallopian tubes, the two structures that carry eggs from the ovaries to the uterus. It is also used to make sure that the uterine cavity has a normal shape and size and to identify uterine malformations, adhesions, polyps or fibroids. These types of problems may cause painful menstrual periods or repeated miscarriages.


The HSG procedure, which lasts five to ten minutes, is performed in a radiology facility separate from the clinic. It is scheduled during Days 7 to 10 of a woman’s menstrual cycle (Day 1 is the first day of bleeding), in the window of time between the end of the period and ovulation. Because some menstrual-like cramping is to be expected from an HSG, patients are advised to take 600 mg of Advil an hour prior to the test to help relax the uterus.


At the time of your HSG, your cervix will be cleaned and a thin, soft catheter will be threaded through the vagina and into the uterine cavity. Contrast dye will be connected to the catheter. Using a machine placed over your abdomen, a radiologist will inject a dye into your uterine cavity and through your fallopian tubes.


The HSG is a very accurate test to document tubal patency. Occasionally the dye used during the procedure pushes through and opens a blocked tube. In other patients, dye does not spill through the fallopian tubes at all. If your tubes are blocked, or if you have a uterine polyp or fibroid, your RMACT physician will review your hysterosalpingogram findings and future treatment with you.


If you experience pain or fever after your HSG, please notify your nurse or physician. Contact us for more information about Hysterosalpingography (HSG).


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Infertility specialists answer most frequently asked questions


Fertility Specialists Answer Most Common Infertility Questions

Norwalk, CT (March 30, 2010) - The fertility doctors of Reproductive Medicine Associates of Connecticut (RMACT) - Fairfield county's largest fertility clinic - have compiled the most common questions they receive about fertility, as well as answers. 

"Infertility can be confusing, and people frequently ask questions because they want to know if they should seek help from a fertility specialist," says Dr. Mark Leondires, Medical Director.  "The questions and answers below are intended to give some basic knowledge.  Many couples put off seeing a fertility specialist when they are having trouble getting pregnant, but they are typically reassured after being diagnosed and starting a treatment plan."

What is infertility?

Infertility is a disease or condition of the reproductive system often diagnosed after a couple has had one year of unprotected, well-timed intercourse, or if the woman has been unable to carry a pregnancy that results in a live birth.

Is infertility a "women's problem"?

Infertility is a medical problem. Approximately 35% of infertility is due to a female factor and 35% is due to a male factor. In the balance of cases, infertility results from problems in both partners or the cause of the infertility cannot be explained.

How long should we try before we see a doctor?

In general, if you are less than 35 years old and have been trying for more than one year you should schedule an appointment with a fertility specialist. If you are greater than 35 years old we would like to see you after at least six months of timed, unprotected intercourse. However, if you have a reason to suspect you may have a problem getting pregnant such as a history of pelvic inflammatory disease, painful periods, miscarriage, irregular menstrual cycles, or if your partner has a low sperm count, you should seek help sooner. Many couples have a hard time admitting that there may be an infertility problem, but be reassured there are often many things we can do to help.

What is a Fertility Specialist?

A fertility specialist, or Reproductive Endocrinologist, is a medical doctor who has been specially trained in the complex issues that can contribute to infertility. In addition to being trained as an Obstetrician/Gynecologist which requires a four-year residency a fertility specialist must complete an additional two to three year fellowship in reproductive endocrinology.  This fellowship training is highly specialized to focus on the diagnosis and treatment of infertility and  female endocrinology.. A physician can become Board Certified in Reproductive Endocrinology by successfully completing the fellowship as well as written and oral examinations. 

Currently in the Unites States, there are only about 1,000 Board Certified Reproductive Endocrinologists. Specifically for infertility related to males, Urologists with a sub-specialty in Andrology are the most qualified experts as they have often completed two-year fellowships and passed exams to become Board Certified in Andrology.

At what time of the month is a woman fertile?

The most fertile time of a woman's cycle is just before or the of day ovulation. Ovulation usually occurs two weeks before a period starts, so it is necessary to count backwards from the anticipated start of the next period in order to find the most fertile time. Take the number of days in the usual cycle (from the beginning of one period to the beginning of the next) and subtract 14. For example, a woman with a 32-day period would likely ovulate around day 18 (32-14=18), while a woman with a 28-day cycle would ovulate around day 14 (28-14=14). We recommend every other day intercourse around the day of ovulation. That would mean days 12, 14 and 16 for women with 28 days cycles.

It is best to have intercourse before ovulation rather than afterwards, so a woman who ovulates on day 14 would have a good chance of conceiving if she has intercourse on either day 13 or 14. For women with irregular cycles you can extend the period of having sexual relations to every other day from day 11 to 18 ( 11-13-15-17).  In order to better understand what day you ovulate take your average menstrual cycle length (for example 32 days) and subtract 14 and that will give you that day you ovulate around (that would be about day 18).  Therefore you would have relations days 15-17&19 to cover all your bases.

Alternatively, women with irregular cycles may want to use an ovulation predictor kit, which can be purchased over the counter at most local pharmacies. This involves testing your urine around the time of ovulation using a detector stick, which give you a visual reading. Additionally, there are electronic monitors which detect ovulation by tracking two hormones (estrogen and luteinizing hormone) starting with urine testing on day one of your menstrual cycle. The methods that utilize urine predictor sticks or urine ovulation detector machines are usually highly sensitive, accurate, and reliable.

How can a woman tell if she ovulates?

The simple, inexpensive way of finding out the approximate time of your ovulation is to take your basal temperature (that is, your body temperature at rest) every morning and record it on a chart. You can buy a Basal Body Thermometer at your local drug store. Save all your charts so you can review them with your doctor. Three or four months of charting should be adequate. If your temperature goes up after the middle of your menstrual month you likely do ovulate. In general you ovulate about two days prior to the temperature rise.

How often should we have intercourse?

It is a good idea to have intercourse every other day around the time you ovulate. Remember, every woman is different, and may not ovulate exactly on "Day 14." And, just because you ovulated on "Day 14" this month, doesn't mean you will next month. It is preferable to have intercourse every other day rather than every day so that sufficient sperm will be available. To increase your chances of the egg becoming fertilized, do not douche or use lubricants immediately before having intercourse.

What fertility testing should our fertility doctor perform?

Your doctor will likely do the following:

  • Blood tests to check reproductive hormone levels in the woman; estradiol (E2), progesterone, follicle stimulating hormone (FSH), luteinizing hormone (LH), thyroid hormone, prolactin, and possibly male hormone levels.
  • Complete semen analysis on the male partner
  • Hysterosalpingogram (HSG), an x-ray exam to evaluate if the woman's fallopian tubes are open
  • Ultrasound to confirm the normal appearance of your uterus and ovaries in the woman

What about smoking and drinking alcohol and caffeine?

There is evidence linking reproductive impairment with exposure to alcohol, tobacco, and caffeine.

Alcohol and tobacco use have been demonstrated to affect the reproductive capacities of both men and women, and tobacco is an especially potent reproductive toxin that negatively effects female fertility by damaging eggs. In men there is a direct effect on sperm quantity, quality, and reproductive function. In general we ask that women consume less than 150 mg of caffeine per day which is equivalent to two small 8 oz cups per day. Remember sodas and tea also contain caffeine. In addition, it is wise to be in the best physical shape possible while you attempt to conceive and, of course, to ensure a healthy pregnancy and baby.

Are hot tubs really bad for a man?

Yes. High temperatures can damage sperm. That is why the scrotum is located outside the body - to act as a kind of "refrigerator" to keep the sperm cool. So, it is a good idea to avoid hot tubs, saunas, and steam rooms when men are trying to help in the pregnancy pathway.

What else can we do?

Learn as much as you can about infertility.

  • Get and read good, reliable information (not just from popular magazines) from your doctor, library, or trusted friends or family.
  • RESOLVE (http://www.resolve.org/) and the American Fertility Association (AFA - www.theafa.org) has over 60 fact sheets on different topics related to infertility, and support groups in many areas.
  • Also visit the ASRM (http://www.asrm.com/), SART (http://www.sart.org/), ACOG (www.acog.org) and CDC (http://www.cdc.gov/) web sites for more information.



Reproductive Medicine Associates of Connecticut (RMACT) specializes in the treatment of infertility.  With Connecticut fertility clinics and egg donation offices in Norwalk, Danbury and Greenwich, and affiliate New York fertility clinics serving Westchester, Putnam and Dutchess counties, our team of Board-Certified Reproductive Endocrinologists offer a wide range of infertility treatments from ovulation induction and intrauterine insemination (IUI) to the most advanced assisted reproductive technologies including in-vitro fertilization (IVF), egg donation and preimplantation genetic diagnosis (PGD). The RMACT team of fertility doctors includes Drs. Mark P. Leondires, Spencer S. Richlin, Joshua M. Hurwitz and Cynthia M. Murdock. All physicians are members of the American Society for Reproductive Medicine (ASRM), the Society for Assisted Reproductive Technology (SART) and the Fairfield County and Connecticut Medical Societies. RMACT's IVF laboratory is accredited by the College of American Pathologists (CAP), and CLIA; other accreditations include the Accreditation Association for Ambulatory Health Care (AAAHC) and the American Institute for Ultrasound in Medicine (AIUM). RMACT offers individualized infertility treatment plans in a patient-focused and supportive environment. Support services, such as, infertility treatment financing, psychological counseling, acupuncture and yoga are also available. For more information visit, http://http://www.rmact.com/.



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