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Sonohysterosalpingogram (SonoHSG)

Sonohysterography is one of a few tests that can be used to evaluate the fallopian tubes, uterine cavity, and endometrium. This test is best performed between days 6-11 of the menstrual cycle, when the lining is thin, for better visualization of structural defects within the uterine cavity. It also ensures that there is not an early pregnancy growing. Initially a gynecological ultrasound is done vaginally in a routine fashion, and measurements are taken of the uterus and ovaries. The ovarian antral follicular count (AFC) can also be recorded if it has not been done earlier in the cycle. Thereafter a Sonohysterogram catheter is placed through the cervical canal and the bulb is inflated allowing a seal to be formed, that prevents back flow of saline through the cervix and into the vagina. The Sonohysterogram is then performed while the infusion is started to identify any uterine defects such as various uterine polyps, scar tissue and fibroids. Thereafter, the injection of shaken saline (causing bubble formation in the saline) allows further views within the uterine cavity to visualize the fallopian tubes. The bubbles are followed through the tubal openings through the tubes and ultimately into the abdomen. If the saline bubbles are seen in the peritoneal cavity or abdomen, then tubal patency is confirmed. If bubbles/saline accumulate in a dilated tube, then a blocked distal tube or hydrosalpinx is diagnosed. If the bubbles/saline do not enter the tubal openings, then a proximal tubal obstruction is diagnosed.

WHEN TO HAVE A SONOHYSTEROGRAM:

A Sonohysterogram is used to examine the uterine cavity and lining for abnormalities related to a variety of signs and symptoms. This test might be recommended for the following reasons:

• Infertility before Embryo transfer, or to confirm tubal patency
• History of miscarriages
• Endometriosis / exam scar tissue
• Unexplained vaginal bleeding
• Identify abnormalities (uterine fibroids/polyps)
• Identify irregularities in the uterine lining
• Visualize shape of uterine cavity

WHAT TO EXPECT: During

The process of having a Sonohysterogram takes around 30 minutes or less. It’s typically performed after your menses and prior to ovulation (cycle day 8, 9, 10). For this test you will be undressed from the waist down, lying on an exam table, and can expect the following:

• Pelvic exam: to check for any abnormalities prior to starting the test.
• Ultrasound: a probe will be inserted into the vagina to capture images of the uterine cavity. After this, the probe will be removed.
• Speculum: a speculum will then be inserted into the vagina to open the cavity for visualization and access to your cervix. After this, a swab is used to wipe and clean your cervix.
• Catheter: next, a thin catheter will be inserted into the opening of your cervix, which may cause a slight cramping once the catheter is fully inside. After this, the speculum will then be fully removed, while the catheter remains in place.
• Ultrasound: the probe will then be re-inserted into the vagina, while saline is injected in the catheter, through the cervix, and into the uterus. Once the uterus is filled with fluid, images will be captured to determine any signs of irregularities within the cavity.
• If the test is also to examine for Tubal Patency (SHSG), a solution of agitated saline with air bubbles will now be instilled. This determines if there is a blockage in either tube, and where it might be located. After this, the probe will be removed.
• Remove catheter: the catheter will then be removed from the cervix and vagina which will cause saline fluid to leak out—you can expect this for a few hours following the test.

WHAT TO EXPECT: After

It is common for saline water to leak from the vagina after the test, using a pad will help with this (to avoid infection, do not use a tampon for the next 24hrs). Most women immediately resume normal activity and return to work or home. However, there are some side effects that you might experience including:

• Cramping and mild discomfort
• Light spotting
• Watery discharge
• Fever
• Pain
• Foul smelling discharge
  In rare cases, you may develop an infection which should be addressed immediately. Please inform us if you experience any of the above side effects.

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