Getting Pregnant

Sonohysterogram for Fertility – Procedure, Benefits, and Risks

A sonohysterogram is a specialized ultrasound of the uterus and fallopian tubes to determine the suspected intrauterine abnormalities. Suppose your doctor has asked you to undergo saline sonohysterogram test. In that case, it may be to determine the actual cause of the uterine problems such as abnormal menstrual bleeding, cramping, infertility, or pelvic pain. Your doctor may also perform the exam before the IVF treatment to possibly rule out difficulties that could arise during the embryo implantation.


What is a Sonohysterogram?

Saline infusion sonohysterography (SHG) is a non-invasive transvaginal ultrasound that introduces saline water inside the uterine cavity. The exam does not use radiation and is a painless procedure. It uses sound waves that create real-time images of the inside of your uterus on a computer.

During the sonohysterogram exam, a skinny tube, called a catheter, is gently inserted inside the cervical opening. Then a saline solution is slowly introduced into the uterine cavity through the catheter. The saline solution gently stretches the uterus, making the uterine walls move away from each other. This stretching of the uterus causes the transvaginal ultrasound wand to evaluate the condition of the uterus precisely. Also, the fluid pathway through the sonohysterogram fallopian tubes provides the details of its defects on ultrasound.


Then a long and slender wand (transducer) is inserted into the vagina. The wand, in turn, emits sound waves that bounce back echoes. The transducer records these echoes and sends them to the computer screen, where a real-time image of the uterus’s inside is developed.

Your doctor can perform SHG without using the saline solution as it is done during pregnancy. However, the results with saline solution are precise and beneficial.


Why Would You Need Sonohysterography?

SHG exam evaluates uterine abnormalities, such as uterine adhesion or scarring. It also considers endometrium problems and many other disorders such as abnormal pelvic pain or pressure, irregular shape or size of the uterus, and repeated miscarriages.


Your doctor may also perform SHG during fertility testing. It gives a close glimpse of the endometrial cavity. It enables the doctor to evaluate the thickness of the endometrial lining and any irregularities that could interfere with pregnancy. Here are the benefits of Sonohysterogram:


  1. It is a very easy, non-invasive procedure for detecting Uterine fibroids, Uterine polyps, or cancer
  2. It causes no or only mild discomfort (varies from woman to woman)
  3. It does not carry any risk or scarce risk of infection or complications
  4. It doesn’t use radiations but only sound ways to get the real-time images
  5. It is less expensive compared to other tests
  6. It provides an excellent and real-time image of the inside of the uterus

Risks of Sonohysterography

Sonohysterography is a very safe procedure with rare chances of complications and risks. Some women may feel minor discomfort during the process that vanishes quickly after the test. There is a low risk of infection (in very rare cases) that needs doctor consultation.


However, SHG may sometimes cause mild pain, spotting, or vaginal bleeding in some women, but that gets cured in day or two. Due to this, a sonohysterogram during the period is not recommended. However, you don’t need to contact a doctor or be anxious about these mild problems. However, pregnant women and women with active pelvic or vaginal infections should not undergo this procedure.


Cost of Sonohysterography

An SHG exam may cost between $500 and $700. And, if your doctor has prescribed a combination of tests, the cost will be more. Although insurance covers this test, it may not be covered if it is advised for IVF treatment. So, make sure to confirm with your insurance provider and the financial advisor at the fertility clinic to find out if your medical insurance covers it.

Other Fertility Tests During Sonohysterogram

Many other tests are used to evaluate the abnormalities of the uterine cavity, endometrium, and fallopian tubes. Other tests are:


1. Hysterosalpingography (HSG)

HSG is an age-old method that uses X-rays for evaluating tubal health. It places an iodinated contrast through the cervix and takes X-rays to assess the shape of the uterus and fallopian tubes.

2. Transvaginal Ultrasonography

This ultrasound is done without using the saline solution to assess the uterus and the ovaries. The test doesn’t check the fallopian tubes because of the lack of contrast fluid.


3. Laparoscopy

Laparoscopy is an operative procedure and needs the use of anesthesia. In this test, the doctor makes one, two, or three tiny cuts in the abdomen through which they insert a laparoscope and other specialized surgical instruments. It would be best to have hospitalization in this test for a day and at least 15 days’ rest at home.

Your doctor may ask for an SHG test or any of the above tests or even a combination of an SHG and an HSG, depending upon your conditions. A combination of tests is generally performed to detect some complex uterine fertility problems.


Will the Sonohysterography Test Hurt?

Well, this is the question that comes to every woman’s mind when her doctor advises an SHG. Although a sonohysterogram exam doesn’t hurt, you may feel –

  • Certain discomfort
  • Little or no pain
  • Anxiety
  • Slight cramping

All these side effects of a sonohysterogram may vary from woman to woman and fade away either right after the test, in a few hours, or a day or two. If you find it difficult to bear with the pain and discomfort, talk to your doctor, who may prescribe you an over-the-counter medicine.


Certain factors can make SHG more uncomfortable, including:

  • If you are anxious or stressed about the test, it is more likely that you will experience certain discomfort.
  • If your cervix is narrow or the uterus is abnormally placed, it may cause difficulty in catheter placement and, in turn, result in pain.
  • If there are any blocked fallopian tubes due to which the fluid may not spill out as it should be, it might cause pain.
  • If you feel pain even during regular gynecological examinations, the procedure may be painful for you.

Discuss with your doctor the potential risks, pains, and discomfort before undergoing the SHG test. It will help in relaxing your mind at the time of the test.

Is Sonohysterography Better Than Hysterosalpingogram?

Hysterosalpingogram (HSG) is an X-Ray of the abdomen that helps the doctor find out the condition of the fallopian tubes. The doctor may suggest this test to check whether tubes are open or blocked. The doctor performs the test to investigate the reasons for miscarriages, such as tumors, adhesions, or uterine fibroids. However, the test has a few disadvantages, such as:

  • The procedure uses radiopaque contrast that contains iodine, which may cause a reaction.
  • The procedure uses X-rays that may carry some risks of radiation.

In contrast, SHG doesn’t use any iodine contrast; also, there is no radiation risk. The procedure is comparatively safe and painless. It is cost-effective, quick to perform, and delivers precise results.


How to Prepare for the Sonohysterography Test?

Doctors do not recommend sonohysterography during periods. They suggest the test in the mid-cycle of menstruation (from day 6 to 10 of a regular 28-day cycle). This duration is best suited as it helps in visualizing the thin endometrium with maximum clarity. Also, the risks of disturbing an early pregnancy or infections are less.

Although you don’t need special preparation before the exam, but-

  • Your doctor may advise you to take an over-the-counter painkiller, like ibuprofen, 30 to 60 minutes before the procedure to alleviate any potential discomfort.
  • You must come dressed in a comfortable outfit that is easy to remove and put on. Or, the health adviser may give you a gown to change.
  • The doctor may ask you to have an oral antibiotic to prevent any infection during this procedure.
  • Your doctor may prescribe a urine pregnancy test as sonohysterography is not suitable for pregnant women.
  • You need to visit the restroom just before going to the exam.

How Does the Sonohysterogram Procedure Work?

The sonohysterogram procedure utilizes sound waves to get clear pictures of the inside of a woman’s uterus. These pictures help the doctor diagnose unexplained vaginal bleeding and many other uterus anomalies. This test uses a saline solution and is also known as saline infusion sonography (SIS).

The SHG test is performed very much like a regular gynecologic exam. Still, it involves the insertion of the transducer (a long and slender wand) and saline solution into the woman’s vagina on an empty bladder. The doctor inserts a small tube (catheter) into the vagina and injects a small sterile saline solution into the uterus cavity. Then, the doctor inserts an ultrasound transducer into the vagina. High-frequency sound waves travel from the transducer into the body, and it recollects the waves that bounce back. A computer uses these sound waves to create a real-time image of the inside of the uterus. It is a non-invasive medical test and helps doctors diagnose and treat a woman’s uterus-related medical conditions.


During the Sonohysterography

The sonohysterography test is performed by a radiologist or technician at a healthcare provider’s office or a hospital. You can expect the following during the test:

  1. Before the procedure begins, you have to empty your bladder. Then, you need to undress from the waist down and lie on an examination table. You may experience mild cramping during or after the procedure.
  2. Your healthcare provider will perform a pelvic exam to check for any pain or infection.
  3. They will cover the transducer with a thin covering and a special gel and insert it into your vagina.
  4. They will move the wand slightly to capture different images of your uterus, just like a standard vaginal ultrasound.
  5. After this, they will remove the transducer and insert a speculum into your vagina to see and reach your cervix.
  6. They will insert a swab to wipe clean your cervix.
  7. Next, they will insert a thin catheter into the cervix and remove the speculum from your vagina.
  8. Then they will put the wand back into your vagina and send a saline solution through the catheter into the uterus.
  9. After sending enough saline fluid into your uterus, they will take images of the inside of your uterus.
  10. After that, the healthcare provider will remove the wand and catheter. And, the saline solution will drain out of your uterus by itself over the next few hours.

After the Sonohysterography

In most cases, you can resume your normal activities right after the procedure. But, for a few minutes or hours after the procedure, you may experience a few symptoms like:

  1. Cramping
  2. Light brown spotting
  3. Fluid leakage from your vagina

All the after-effects mentioned above are usual and nothing to be worried about. However, most women do not feel any pain after the procedure; you can take over-the-counter painkillers if you think so.

When to Contact Doctor?

If you experience symptoms that are not normal, like-


  • Severe pain that doesn’t go away after taking ibuprofen or another painkiller
  • High fever in the next few days
  • Change in the amount or type of vaginal discharge

These might be indications of a rare pelvic infection associated with sonohysterography. These symptoms are alarming, and you need to see your doctor. Your doctor may examine your conditions and accordingly either prescribe some medication or other diagnostic tests.

A sonohysterogram is a transvaginal ultrasound that puts saline fluid into the uterus cavity to judge the condition of the uterine cavity. The primary purpose of performing this test is to make sure your uterus and fallopian tubes are healthy and fit for a pregnancy to grow. It is a cost-effective, safe, and low-risk diagnostic test and doesn’t need any special sonohysterogram preparation.


The SHG offers a simultaneous view of the uterine cavity, endometrium, and fallopian tubes. It is the preferred choice of doctors as a first-line diagnostic procedure for finding the cause of abnormal uterine bleeding, abnormalities, and infertility.


1. How Much Time Does the Test Take?

The sonohysterography exam takes about 45 minutes. While the preliminary pelvic scan may take approx. 20 minutes, the saline sonohysterography procedure will take around 15 minutes, making the total time to be approx. 45 minutes.


2. Who Interprets the Results and How to Get Them?

A doctor trained in supervising and interpreting radiology exams, called a radiologist, will analyze the images produced in the sonohysterography test. The radiologist will create a signed report and send it to the doctor who asked for the examination. The doctor will go through the reports and share the results with you. In some cases (if you insist), the radiologist may also discuss the test results with you after the exam.

After checking your test reports, your doctor may ask for some follow-up exams and explain your reasons and needs. The follow-up exams are performed to find out other potential causes or effects of the abnormality.


Also Read:

Feng Shui Methods for Fertility
Importance of Trigger Shots for Fertility
Effective Fertility Supplements That Helps to Conceive

This post was last modified on July 21, 2021 7:04 pm

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