Hysterosalpingography (HSG) Tubal Patency Assessment

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] HSG tubal filling and spill
   HSG tubal filling and contrast spill? (HSG injects contrast through the cervix under fluoroscopy to assess tubal patency + cavity shape (infertility). Timing: follicular phase (after menses, before ovulation). Contraindications: active PID, pregnancy, active bleeding, contrast allergy; antibiotic prophylaxis for hydrosalpinx/PID risk.)
   • Both tubes fill + free fimbrial spill → Bilateral patent
   • Proximal/cornual non-filling (may be spasm) → Proximal obstruction · exclude spasm
   • Distal filling without spill, tube dilated with fluid → Distal obstruction · hydrosalpinx
2. [End] Bilateral patent
   Both tubes fill with free fimbrial spill into the peritoneum = bilateral patent; with a normal cavity, continue other infertility workup (ovulation/semen/ovarian reserve).
3. [End] Proximal obstruction · exclude spasm
   Proximal/cornual obstruction (tube non-filling): first exclude tubal spasm false positive (antispasmodic/repeat later, or hysteroscopic cannulation, laparoscopic methylene blue chromopertubation to confirm); true proximal obstruction → interventional recanalization or move to IVF.
4. [End] Distal obstruction · hydrosalpinx
   Distal obstruction (tube fills without spill) + dilation = hydrosalpinx: lowers IVF success, raises ectopic risk, usually treat the hydrosalpinx (proximal ligation/salpingectomy) before IVF; assess pelvic adhesions/endometriosis.

Source guidelines & references

• Hysterosalpingography for tubal patency assessment (infertility)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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