One of the main reasons for an HSG is to identify if there are any tubal issues. If your tube shows as clear, then you should be good to go. The main fallacy with HSG and tubal issues is that sometimes your tube spasms during the test and the tube appears blocked, when in fact it isn't.

Yes OP it is possible that an HSG will not show all scar tissue. I'm seeing an RE about that issue right now who explained that to me. Another doctor performed my HSG and said everything was fine. However, I have reason to believe it's not. My RE has explained that he has to study the pics of my HSG to see how the spillage looks at the end. Apparently if sits altogether it's a sign of scar tissue, but if it spills it's a sign that there is none. He also explained that these tests may not always pick up scar tissue so if after a year of trying I want to perform laprascopic surgery to rule it out, that is the only real way to make sure there is no scarring. I had a ruptured appendix and that is why we believe I might have scarring.

Thanks for the replies. To clarify, I'm wondering specifically about how accurate an HSG can be at showing "clear" tubes. In other words, my HSG showed one removed tube (from an ectopic) plus one "clear" tube... but given my history, is it possible you wouldn't be able to see blockages in the remaining tube?

I'm not sure exactly what you are asking but I'll share my experience. I had surgery on my uterus for fibroids that led to some scarring/adhesions outside of the uterus and around the tubes. This showed up on an HSG because the fluid didn't spill out like it should..it stayed stuck in a little pocket.

My RE looked at the results, said my tubes probably weren't going to work (because they need to be flexible and able to move around in there) and recommended IVF. We ended up doing one IUI because we'd already pretty much started the cycle and had nothing to lose. Turns out, BFP.

I can't speak to adhesions inside the uterus at all, but between an HSG and a saline sonogram, they should be able to see inside there pretty decently I'd think.

Were you adhesions your OB mentioned in your uterus or outside? Adhesions are very common outside of the uterus after c-section. The HSG is only looking inside of the uterus and should pick up any scarring there, though it may not always. Scarring in the uterus is called Asherman's syndrome and is most commonly the result of a d&c. Hysteroscopy is the best procedure for examining the uterus for scarring.

I don't know the medical answer to your question, but from personal experience I can say that the HSG picked up a tiny, tiny bit of scarring in my uterus. It wasn't even big enough to be a problem for pregnancy, though it was removed on the "abundance of caution" theory.

Have you talked to your doctor about other causes? If you're working with only one tube, it would probably take longer too.

How does scar tissue show on an HSG?

I had an ectopic after a C-section. My Ob noted I had a ton of adheasions, some of which he was able to remove. Although the HSG showed one tube remaining and clear, I wonder if there are adheasions there that an HSG wouldnt pick up? Ive been trying to conceive a while...