A couple undergoing infertility evaluation is scheduled for hysterosalpingography (HSG). In which phase of the menstrual cycle should the procedure ideally be performed?

• A During menstruation, days 2 to 4
• B Periovulatory phase, days 13 to 15
• C Proliferative phase, after bleeding stops and before ovulation ✓
• D Secretory phase, days 20 to 24

Explanation

HSG is done in the early proliferative phase, roughly days 6 to 12, once bleeding has ceased. This avoids flushing a fertilised ovum into the tube if conception occurred in that cycle, and the thin proliferative endometrium does not occlude cornual ostia or obscure filling defects. Performing HSG in the secretory phase risks disrupting an early pregnancy, and during menses it causes pain and backflow.

Reference: Williams Gynecology, 4th ed.

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Written and medically reviewed by the StethoPrep medical team.