@cowgirlace: Hey! Good to see some medical students representing 🙂
Much of what you say is correct (in terms of risk factors for increasing the likelihood of a tubal factor) but I do want to clarify a few things.
HSG is actually part of the standard w/u for infertility because tubal problems account for about 20-25% of infertility.
from what I’ve heard/read/been taught, the risk of radiation is thought to be present yet generally not clinically significant.
tubal blockages can and do certainly occur in women without any *known* h/o PID; sometimes the infection can be undetected by the woman. Alternatively, endometriosis can lead to adhesions and tubal issues.
an alternative to HSG is SHG which uses a similar mechanism, but uses saline instead of contrast medium (dye).
another thing, the test is a breeze for many women but can be extremely painful for others.
so, i certainly wouldn’t jump to have the HSG after, say, 3 months of TTC unless you’re near the end of your reproductive years and time is of the essence, or unless there is a strong suspicion for tubal issues.
but after 1 year of TTC (or often even less), most REs that I know of will almost always perform HSG, the thought being that it is irresponsible not to rule out such a common issue particularly if further fertility treatments are going to be performed, which in the presence of blocked fallopian tubes would have zero chance of being effective.
now taking off my doctor hat and putting on my patient hat. . .i had one done, and it hurt. . .but I got through it. like I said above, I wouldn’t do it just for kicks, but if time is ticking and your doctor is recommending it, then I personally would feel more comfortable having it done and being able to rule out/identify tubal issues.