5.3.7 Hysterosalpingogram (HSG) in Surrogacy: When and Why It May Be Required

1. What Is HSG?

An HSG, or hysterosalpingogram, is a type of X-ray that lets doctors take a closer look at the uterus and fallopian tubes. It’s used to check the shape of the uterus and see if there are any blockages, scar tissue, or other issues that could affect pregnancy.

This test is commonly used during fertility evaluations—and sometimes as part of the surrogacy medical screening process—to make sure the uterus is healthy and ready to carry a baby.

How it works: A small amount of contrast dye is gently inserted into the uterus through the cervix. Then, using a type of X-ray called fluoroscopy, the doctor watches how the dye moves through the uterus and fallopian tubes. The images can reveal if anything looks abnormal or if there’s anything that could get in the way of a healthy pregnancy.

🔗 Reference: American College of Obstetricians and Gynecologists (ACOG) on Hysterosalpingography

2. Why Is HSG Sometimes Required for Surrogate Medical Screening?

Not all surrogates need to have an HSG. But if the fertility doctor wants more information—maybe based on your medical history or a previous delivery—this test can provide helpful details.

Some of the reasons a clinic might request an HSG include:

• To check for fibroids, scar tissue, or polyps that might interfere with implantation
• To get a better idea of the shape and condition of the uterus
• To rule out any underlying infections or conditions that could affect the pregnancy
• To make sure the uterine environment is suitable for embryo transfer

Even though fallopian tubes aren’t used in IVF, blockages can still be a sign of other past complications, like pelvic infections or adhesions. That’s why doctors sometimes want to take a full look at your reproductive history.

In most cases, an HSG isn’t part of the initial screening. But if it’s recommended, it’s a helpful and relatively quick way to make sure everything looks good before moving forward.

🔗 Reference: Mayo Clinic - Hysterosalpingography

3. What Happens If an HSG Shows an Abnormality?

If your HSG shows something unusual, the next step depends on what the issue is. Sometimes it’s something small—like a tiny polyp or a bit of scar tissue—that can be removed with a minor procedure, like a hysteroscopy.

If the test shows more serious problems—like a significantly abnormal uterine shape or heavy scarring—the doctor may recommend further testing or decide it’s best not to move forward with surrogacy, in order to protect both you and the intended parents from potential complications.

Your doctor will explain everything clearly and help you understand what the results mean for your health and your ability to be a surrogate.

🔗 Reference: Society for Assisted Reproductive Technology (SART) - Uterine Health in Fertility