Sonohysterography and its role in fertility testing

By Constance McGraw, MPH

‍Sonohysterography procedure

Sonohysterography (SHG), also referred to as saline infusion sonography (SIS), is a safe and relatively painless ultrasound procedure used as an initial screening method to identify potential issues related to the uterus and ovaries. Lasting no longer 30 minutes, the SHG involves inserting a transducer wand into the vagina and cervix, delivering fluid into the uterus. Simultaneously, sound waves transmitted through gel create a real-time image of the uterus's interior. The saline solution enhances the ultrasound, offering clearer details of the uterus's structure compared to traditional ultrasounds. 

Saline infusion sonohysterography indication

Healthcare practitioners use sonohysterography to help diagnose a number of medical conditions related to infertility. If a patient experiences abnormal uterine bleeding, infertility, repeated miscarriages, or an abnormal pelvic exam, SHG is frequently recommended to determine if there may be additional contributing factors at play, including:

• Uterine fibroids
• Uterine polyps
• Scarring inside the uterus
• Abnormal shape of the uterus
• Uterine cancer

Sonohysterography vs. hysteroscopy

Sonohysterography is non-invasive and cost-effective and can be used as an initial screening tool for women with abnormal uterine bleeding. Conversely, while hysteroscopy is the go-to method for checking uterine lesions, it is considered invasive, costly, and has higher odds of complications like bleeding or perforation. Studies comparing hysteroscopy and SHG (SIS) indicate they both detect uterine and endometrial lesions with similar accuracy. However, hysteroscopy employs biopsies to distinguish between benign and malignant lesions more accurately.

Sonohysterography vs ultrasound   

Traditional transvaginal ultrasound (TVS) is commonly used to check the uterus, but it is limited in its ability to detect small uterine cavity lesions or accurately differentiate various endometrial issues. On the contrary, sonohysterography (SIS) provides a clearer view and accurately images different types of endometrial lesions, making it a more precise evaluation method than ultrasound.

Sonohysterography vs. HSG

In contrast with hysterosalpingography (HSG), which uses X-ray imaging to examine the uterus and fallopian tubes, sonohysterography focuses on uterine cavity conditions using ultrasound and saline solution. While HSG is standard for tubal infertility diagnosis, sonohysterography is more accurate in evaluating the uterine cavity.

Sonohysterography near me

A sonohysterography test can be done in a doctor's office, a hospital, or a clinic and is covered by most insurance. Consult your healthcare provider to decide the best test for your fertility concerns. Find fertility specialists near you.

References:

1. The American College of Obstetricians and Gynecologists (ACOG) 2021. Sonohysterography. Retrieved December 2023 from https://www.acog.org/womens-health/faqs/sonohysterography.
2. Cleveland Clinic 2022. Sonohysterogram. Retrieved December 2023 from https://my.clevelandclinic.org/health/diagnostics/22320-sonohysterogram.
3. Kumar K, Pajai S, Baidya GR, Majhi K. Utility of Saline Infusion Sonohysterography in Gynecology: A Review Article. Cureus. 2023 Feb 24;15(2):e35424. doi: 10.7759/cureus.35424. PMID: 36987479; PMCID: PMC10040238.
4. Aslam M, Ijaz L, Tariq S, Shafqat K, Meher-Un-Nisa, Ashraf R, Kazmi T. Comparison of transvaginal sonography and saline contrast sonohysterography in women with abnormal uterine bleeding: correlation with hysteroscopy and histopathology. Int J Health Sci (Qassim). 2007 Jan;1(1):17-24. PMID: 21475448; PMCID: PMC3068651.
5. Aas-Eng MK, Langebrekke A, Hudelist G. Complications in operative hysteroscopy - is prevention possible? Acta Obstet Gynecol Scand. 2017 Dec;96(12):1399-1403. doi: 10.1111/aogs.13209. Epub 2017 Sep 27. PMID: 28832907.
6. Schwärzler P, Concin H, Bösch H, Berlinger A, Wohlgenannt K, Collins WP, Bourne TH. An evaluation of sonohysterography and diagnostic hysteroscopy for the assessment of intrauterine pathology. Ultrasound Obstet Gynecol. 1998 May;11(5):337-42. doi: 10.1046/j.1469-0705.1998.11050337.x. PMID: 9644773.
7. Epstein E, Ramirez A, Skoog L, Valentin L. Transvaginal sonography, saline contrast sonohysterography and hysteroscopy for the investigation of women with postmenopausal bleeding and endometrium > 5 mm. Ultrasound Obstet Gynecol. 2001 Aug;18(2):157-62. doi: 10.1046/j.1469-0705.2001.00472.x. PMID: 11529998.