Saline Sonogram

The Sonohysterography Procedure: A Guide to Saline Sonograms

Infertility affects men and women equally. Approximately one-third of infertility is attributed to the female partner, another third to the male partner, and the final third to both partners or is unexplained. One in seven couples (14%) has trouble conceiving or sustaining a pregnancy.

A diagnosis of infertility does not mean that your dreams of building a family are over; it just means that you'll need a little help from a reproductive endocrinologist or fertility specialist.

Before starting fertility treatment, a fertility specialist utilizes several screening tools to rule out any medical conditions. Below we outline what to expect when your physician orders a saline ultrasound, commonly known as a saline sonogram or sonohysterogram.

The Sonohysterography Procedure

How a Saline Procedure Works

A sonohysterography procedure starts with a transvaginal ultrasound to establish a baseline look at the uterus and ovaries, before instillation of any saline. Then, the vaginal ultrasound probe is removed and a sterile speculum is inserted into the vagina (just like in a Pap smear exam). The outside of the cervix is cleansed with cleaning solution, and a small, flexible tube (catheter) is passed through the cervix and into the uterus. This can sometimes be the trickiest part of the procedure, as everyone’s cervix is shaped differently. Depending on how narrow or curved the cervix is, it can take a little bit of manipulation to pass the catheter through the cervix. Most patients do not experience any issues and have minimal discomfort during this portion of the procedure.

Once the catheter is placed in the uterus, the saline solution is slowly injected while a transvaginal ultrasound is performed.

This creates a real-time image of the uterine cavity on a monitor, allowing the doctor to examine the shape and contour of the uterine cavity, and identify any abnormalities or issues that may affect fertility or cause other medical problems.

This test usually takes around 10 minutes to complete and can be done in an OBGYN office, hospital, or clinic.

How to Prepare for a Saline Sonogram

Individuals who are or may be pregnant or individuals who have an active pelvic infection or pelvic inflammatory disease (PID) should not undergo a sonohysterogram.

This test is best performed during the first half to menstrual cycle, after bleeding has stopped. Typically, the test is done between cycle days 5-10.

Additional notes:

• The doctor may recommend taking one or more over-the-counter pain relievers or NSAIDs, such as ibuprofen (Motrin or Advil), before the procedure to prevent discomfort.
• Some individuals may be asked to take an antibiotic beforehand to prevent infection.
• Some individuals may be asked to take a medication called misoprostol that helps dilate the cervix and allows for easier insertion of the catheter. This medication is taken the night before the procedure.
• Before the procedure, the clinical staff will ask the patient to empty their bladder.
• Wearing an absorbent pad is recommended to catch any leakage or vaginal discharge that may occur after the procedure.

The purpose of sonohysterography: Pros and cons of a saline ultrasound

A saline ultrasound produces a sonographic image of the interior of the uterine cavity. This image helps specialists identify and diagnose any abnormalities inside the uterus.

Advantages of sonohysterography include:

• clear imaging of the uterine cavity
• minimal pain or discomfort

Disadvantages of sonohysterography include:

• a rare possibility of pelvic infection
• inability to assess fallopian tubes

The purpose of HSG: Pros and cons of hysterosalpingography

HSG is an alternative uterine imaging method that uses a contrast dye and an X-ray machine. HSG is often used to see whether or not there are blockages in the fallopian tubes.

Advantages of HSG include:

• ability to determine whether or not blockages in the tubes are present
• screen for large filling defects in the uterine cavity

Disadvantages of HSG include:

• exposure to radiation
• potential allergic reaction to the contrast dye
• a rare possibility of pelvic infection
• potentially more painful than a saline ultrasound
• can miss small defects in the uterine cavity