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.
What is a saline ultrasound?
A saline ultrasound, also known as a sonohysterogram (SHG), or a saline infusion sonogram (SIS), is a medical procedure in which a doctor or fertility specialist uses ultrasound technology to examine the inside of the uterus. The uterus is filled with saline solution during this procedure. The saline helps achieve a clearer ultrasound picture by gently causing the uterine walls to expand, allowing a good assessment of the inside contour of the uterine cavity.
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.
Common uses of a Sonohysterogram
Sonohysterography is a safe and minimally invasive diagnostic procedure that can help a doctor discover the underlying cause of infertility, abnormal uterine bleeding, and repeated miscarriages.
A sonohysterogram can detect:
- abnormal growths inside the uterus (e.g., polyps, fibroids, etc.)
- abnormal uterine shape
- scar tissue inside the uterus
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.
- 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.
Potential Side Effects of Saline Ultrasound
Although sonohysterography is a very safe procedure, some potential side effects include mild discomfort or cramping, light vaginal bleeding. In rare cases, there is a small risk of pelvic infection.
Individuals who experience pelvic pain or develop a fever should contact a healthcare professional immediately.
How Long After Saline Ultrasound Can You Start IVF?
Patients who receive a saline ultrasound typically do so in the family-planning phase or before starting fertility treatments to ensure there are no underlying issues or potential barriers to conception.
Couples curious about getting pregnant via assisted reproductive technology following a saline ultrasound should speak with a healthcare professional to see if in vitro fertilization (IVF) is viable. It's important to note that a saline ultrasound is just one piece of the puzzle when evaluating fertility. Other factors, such as sperm count, ovulation timing, and age, should also be considered.
Saline Ultrasound vs. HSG: What’s the difference?
Although hysterosalpingography (HSG) is another imaging test used to evaluate the uterus and fallopian tubes, there are some differences between a saline ultrasound and an HSG.
One key difference is that an HSG uses x-ray technology instead of sound waves, which may concern patients who are sensitive to radiation or have had previous radiation exposure. Additionally, an HSG is a better test to evaluate the fallopian tubes — blockages in the tubes do not always appear on a saline ultrasound.
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
Ultrasound, IVF, and Fertility Solutions for Your Family
If you're looking for fertility support and compassionate care, entrust your family planning needs to the RMA Network. RMA Fertility Clinics offer 22 locations throughout four states, serving California, New Jersey, Pennsylvania, Florida, Washington, and Texas.
Where you can get a saline-infused ultrasound may depend on your location and insurance coverage. However, many patients can get a saline ultrasound at their fertility clinic, doctor's office, or local hospital.
RMA fertility clinics offer saline ultrasounds to patients in California, New Jersey, Pennsylvania, Texas, and Florida.
Ultimately, the answer to this question is up to the individual, as pain is subjective. Many patients report minimal pain or discomfort during a saline sonogram.
If you're worried about feeling pain, you may take a pain reliever such as acetaminophen or ibuprofen before the procedure.
Prices for a saline ultrasound vary widely and depend on whether you’re paying out-of-pocket or with insurance. If your insurance happens to cover a saline ultrasound, you may be able to have part or all of the cost covered. Talk to your doctor or one of our financial coordinators for more information on cost.
It’s best to schedule a saline sonogram early in your menstrual cycle. Ideally, this will be shortly after your period ends but before ovulation.
RMA Provides Ultrasound, IVF, and Fertility Solutions for Your Family
If you're looking for fertility support and compassionate care, entrust your family planning needs to the RMA Network. RMA Fertility Clinics offer 22 locations throughout six states, serving California, New Jersey, Pennsylvania, Florida, Texas, and Seattle.
Our fertility specialists and financial coordinators will work with you to create a personalized treatment plan that fits your unique needs and budget. Contact us today to schedule a consultation and take the first step towards starting or growing your family.