Sonohysterogram for Fertility- Procedure, Benefits, and Risks

A variety of factors, including the environment, have a negative effect on women's reproductive health. Because of this, the number of people having difficulties conceiving a child is increasing each day. A woman's reproductive health can be assessed via a variety of diagnostic procedures. In this article, we learn more about the sonohysterogram, a subtype of ultrasound used to assess the uterine cavity. This test may be performed as part of a fertility evaluation, right before in vitro fertilization (IVF), or if you've been experiencing any symptoms that might indicate a problem with your uterus. 

What is a sonohysterogram?

A sonohysterogram is an imaging procedure that permits the healthcare provider to view the interior of the uterus. Symptoms like pelvic pain, heavy menstrual bleeding, and infertility can often be traced back to issues in the uterus and its lining (the endometrium), which can be detected and evaluated with this type of ultrasound. Saline infusion sonohysterography (SIS) is another name for this procedure.

What is the goal of sonohysterogyaphy?

Sonohysterography's main purpose is to provide clearer images of the endometrial cavity and endometrial lining than those provided by standard transvaginal ultrasonography. Sonohysterography can also be used to assess tubal patency, which identifies whether the fallopian tubes are open and disease-free.

Sonohysterography may be used to evaluate:

• Abnormal uterine bleeding.
• Liomyomata and polyps in the uterine cavity.
• Abnormalities detected on transvaginal ultrasonography. These include endometrial or intracavitary abnormalities.
• Infertility; recurrent pregnancy loss; uterine abnormalities at birth.

How is sonohysterography carried out?

Sonohysterography involves inserting a catheter (an extremely thin tube) through the cervical opening. Through the thin tube, a saline solution (a sterile salt water solution) is slowly introduced. The uterus is gently dilated by the saline solution, causing the uterine walls to move apart slightly. Imagine that your uterus is a balloon that has been deflated. The balloon's walls would pull apart from each other if you injected a tiny amount of water or air into it. During sonohysterography, this is the function that the saline solution serves. During the time that the saline solution is being injected into the uterus, the transvaginal ultrasound wand is used to examine the uterine cavity, uterine walls, and, in some cases, fallopian tubes. Thus, the procedure aids in diagnosing and treating conditions related to the uterus non-invasively.

What is the procedure for sonohysterography?

Before the procedure begins, the woman will be asked to empty her bladder. She must then undress from the waist down and lie on an examination table. It is quite normal for her to feel mild cramps during or after the procedure. Sonohysterography is conducted by a radiologist or radiology technician in a doctor's clinic or hospital. The procedure is performed with the patient awake and laying on her back with her knees bent. An ultrasound transducer looks like a thin wand and is inserted vaginally. 

The procedure progresses as follows:

1. The physician will initially perform a physical exam of the pelvis to check for symptoms like pain or infection.
2. Before inserting the transducer into the vagina, they will give it a thin coating with a special gel.
3. To get different views of your uterus, the radiologist will move the wand around like they would during a regular vaginal ultrasound.
4. The radiologist will then remove the transducer and insert a speculum into the vagina in order to visualize and assess the cervix.
5. After that, the cervix will be wiped clean using a cotton swab.
6. The radiologist then inserts a catheter into the vagina and injects a small amount of sterile saline solution into the uterine cavity.
7. Then, the wand will be reinserted into the vagina. 
8. They will take images of the uterus after injecting a sufficient amount of saline fluid there.
9. The transducer sends high-frequency sound waves into the body and collects the reflected waves. These sound waves are fed into a computer, which then generates a live picture of the uterine cavity.
10. After obtaining images, the technician removes the wand and catheter. As time passes, the saline solution will naturally drain from your uterus.

What are the benefits of a sonohysterogram?

A sonohysterogram can provide insight into the uterine anatomy that can be used to identify potential fertility-limiting factors such as:

• Fallopian Tube Obstructions
• Polyps
• Uterus with an unusual shape, such as bicornuate, for example.
• Endometriosis
• Fibroids
• Endometrial cancer

When is the best time to get a sonohysterogram?

An ideal time for a sonohysterogram is between the end of your period and before you ovulate. If count from the first day of bleeding, that's somewhere between days 6 and 11 of the menstrual cycle. The uterine lining will be at its thinnest and most easily visible at this time.

How long does a sonohysterogram take?

Sonohysterography examinations typically last 45 minutes. The initial pelvic scan could take up to 20 minutes, while saline sonohysterography itself should take about 15 to 20 minutes. 

Who should get a sonohysterogram?

The doctor  may ask the woman to get a sonohysterogram if:

• She is facing fertility issues.
• Her period is heavier or lasts longer than usual.
• She is experiencing intermenstrual bleeding.
• She is experiencing persistent pelvic pain.
• She's had at least two miscarriages in a row.

Who shouldn’t get a sonohysterogram?

A sonohysterogram should not be performed on a woman who is pregnant or who has the pelvic inflammatory disease (PID).

What are the risks of a sonohysterogram?

A sonohysterogram is a safe procedure with minimal risk and discomfort. Taking pain medication prior to the procedure can alleviate any discomfort the patient may experience during the procedure. After a sonohysterogram, a woman can typically return home and resume her normal routine. 

The harmless consequences of  sonohysterogram include:

• In the hours following your procedure, you may experience a watery discharge. This is nothing but the saline that is induced into the uterus, leaving your body.
• Mild pain or cramping may occur, which is completely normal. Women feel better after taking an anti-inflammatory drug like ibuprofen or acetaminophen.
• After a sonohysterogram, some women experience spotting in the days that follow. This is normal and occurs if the procedure causes irritation to the tissues.

There is still some risk of infection, though it is low. Keep an eye out for these possible signs of infection:

• Fever.
• Excruciating pain.
• Changes in vaginal discharge.

If you experience any of these symptoms, please inform your doctor immediately.

FAQs

What sets a sonohysterogram apart from a hysteroscopy?

Hysteroscopy and sonohysterogram are two methods your doctor can use to examine your uterus. When compared to hysteroscopy, the cost of a sonohysterogram is significantly lower and less invasive, and the procedure takes significantly less time to complete. However, sonohysterograms can only be used for making a diagnosis. A hysteroscopic procedure, on the other hand, allows your doctor to see the uterine lining and remove any abnormal tissue at the same time.

What distinguishes a sonohysterogram from hysterosalpingography (HSG)?

Hysterosalpingography (HSG) is a noninvasive imaging technique that uses radiation instead of sound waves to create an image of the uterine cavity on a screen. The HSG will show if any of your fallopian tubes are obstructed. A sonohysterogram, which uses sound waves to generate an image, may not always detect these obstructions.