Sonohysterogram

  • Sonohysterography uses sound waves to create images of a woman’s uterus and diagnose several conditions(1).
  • Sonohysterography is frequently used to examine uterine abnormalities in women with infertility or recurrent miscarriages(2).
  • Patients may cramp from the sonohysterogram saline infusion(3). Over-the-counter painkillers should ease operation discomfort. After surgery, some women may have vaginal bleeding.
  • Typically, a sonohysterogram costs between $500 and $700. The price will increase if the test is paired with other procedures(4). The test may or may not be covered by the insurance company. Coverage typically relies on the reason for the procedure.

What Is a Sonohysterogram?

Sonohysterography (also called saline-infusion sonohysterography) uses sound waves to generate images of the inside of a woman’s uterus and aids in diagnosing several conditions(5)

These medical conditions include unexplained vaginal bleeding, infertility, and recurrent miscarriages. 

The procedure is a simple and safe examination using sound waves and a computer to produce visuals. Methods that do not utilize radiation are used in sonohysterography(6).

Sonohysterography is also painless(7).

Differences Between Sonohysterogram and Hysterosalpingogram

Sonohysterogram ultrasound scans can help identify the reason for uterine bleeding or infertility(8).

Hysterosalpingography is the primary diagnostic test for the prognosis of tubal infertility and can provide valuable information about the uterine cavity(9). However, sonohysterography is more sensitive, specific, and accurate than hysterosalpingography for evaluating the uterine cavity(10)

Unlike a hysterosalpingogram, a sonohysterogram does not use X-rays or iodine dye and can be administered in a physician’s office, hospital, or clinic(11).

Uses of Sonohysterogram

As mentioned, sonohysterography is frequently used to examine uterine abnormalities in women with infertility or recurrent miscarriages(12).

Doppler ultrasound images can help the clinician see and evaluate(13):

  • Pelvic varicose veins and aneurysms
  • Obstructions to blood flow (such as clots)
  • Polyps, tumors, and blood flow in polyps

Sonohysterogram is a valuable method for examining unexplained vaginal bleeding, which may result from uterine abnormalities such as(14):

  • Polyps or uterine fibroids
  • Endometrial atrophy
  • Endometrial adhesions 
  • Malignant growths or lesions
  • Congenital disabilities 

In addition, sonohysterography assists in diagnosing an abnormal uterine shape or sheds light on an abnormal pelvic exam(15)

Meanwhile, sonohysterography offers many advantages over conventional uterine diagnostic procedures(16). Additional tests include:

  • Hysterosalpingography: This form of X-ray involves the utilization of radiation.
  • Magnetic resonance imaging, or MRI: It is an imaging test using a computer and big magnets. The MRI may not provide a clear image of the uterine lining.
  • Hysteroscopy: This surgical technique must be performed under anesthesia.

Benefits and Risks of Sonohysterogram

Ultrasound is non-ionizing, harmless, and provides a good image of the pelvic organs(17). Sonohysterography is minimally invasive, typically well tolerated, has a low risk of complications, and offers a great picture of the uterus and endometrial lining. 

With hysterosonography, several abnormalities that are difficult to detect with regular transvaginal ultrasound are evident(18). Having this information, women can avoid unnecessary surgery. 

​​ Meanwhile, some women experience discomfort during the operation. Since a small risk of pelvic infection is still possible, the healthcare practitioner will take preventative measures(19).

Women with active pelvic inflammatory disease (PID) should not undergo sonohysterography(20). A healthcare practitioner recommends a pregnancy test before the operation to avoid potential risks to a growing baby. 

This recommendation is to prevent any potential danger to a developing infant. Also, women who are pregnant should not have a saline sonohysterography exam.

Preparation

It is necessary to have the procedure within the week after the menstrual cycle ends(21). Doing so will help improve the accuracy of the test and lower the risk of infection.

Patients can eat and drink as normal on the day of their procedure(22). They may take some of their medicines as usual.

The healthcare provider can also advise the patients to take over-the-counter pain medicine(23). The pain relief medicine will help prevent the discomfort.

Suppose the patients are not allergic to ibuprofen. In that case, they can take 800 milligrams (four regular-strength Advil or Motrin tablets) one hour before the procedure(24).

Patients will be asked to empty their bladder so their uterus can be seen clearly(25).

Patients may also be given antibiotics before the test(26). The antibiotics will help prevent infection. In addition, they can use an absorbent pad in their underwear to help remove fluids from their uterus after the procedure.

Typically, the exam takes less than 30 minutes to complete(27).

Tests and Procedures

The test is administered at a doctor’s office or hospital. The operation may be performed by a technician or an AART-certified radiologist(28). A radiologist is a physician who specializes in diagnosing and treating illnesses using imaging techniques.

A speculum, the same device used for a Pap smear, will be placed into the vagina. The device is helpful for the healthcare professional to see the cervix (the opening to the uterus)(29)

A soft plastic tube will be introduced into the uterus through the cervix. The speculum will then be withdrawn, and a small quantity of salt water will be injected into the uterus via the tube.

Individuals may have moderate cramping while receiving the sterile saline injection(30). The uterus will be seen using an ultrasound wand on an ultrasound monitor.

Most ultrasound examinations are painless, quick, and well tolerated(31).

Physicians often employ transvaginal ultrasonography when searching for the origin of pelvic discomfort(32). However, the ultrasound itself should not be uncomfortable or cause individuals substantial distress. 

Generally speaking, vaginal ultrasonography is more comfortable than a manual gynecologic checkup.

As a result of the infusion of saline during the sonohysterogram, patients may experience cramping on occasion(33). The pain connected with the surgery should be alleviated with over-the-counter medicines. After the operation, patients can have vaginal bleeding for a few days.

Suppose the physician does a Doppler ultrasound examination. In that case, patients may hear pulse-like noises that vary in pitch while they monitor and assess blood flow.

Patients should be able to immediately resume normal activities after an ultrasound examination(34).

Expected Results

The physician or technician doing the sonohysterogram may or may not be able to provide the patients with the results(35)

Following the exam, patients will likely arrange a follow-up appointment with a doctor specializing in gynecology (gynecologists).

If the test result is typical, the physician can create a fertility treatment plan based on the results of the full fertility assessment(36).

If a sonohysterogram reveals abnormalities, the next step will rely partly on what the doctor discovered and the testing objectives. 

Suppose abnormal growths inside the uterus, such as polyps or fibroids, are discovered. In that case, the physician will discuss the advantages and drawbacks of removing them. Hysteroscopy may be used to remove polyps surgically.

Small fibroids may also be removed with surgical hysteroscopy(37). However, large tumors may require laparoscopy or abdominal myomectomy. 

Laparoscopy is a type of surgical treatment that enables the surgeon to examine the inside of the abdomen and pelvis without making extensive skin incisions(38). This method is sometimes referred to as keyhole surgery or minimally invasive surgery.

Meanwhile, an abdominal myomectomy, sometimes known as an “open” myomectomy, entails creating a skin incision on the lower abdomen and removing fibroids from the uterine wall(39). The uterine muscle is then reattached with many layers of sutures (stitches). Patients will be unconscious during the process.

Limitations

Due to the size and form of the fallopian tubes, sonohysterography has limitations in determining the patency or openness of the tubes(40). When the physician detects an abnormality of the fallopian tubes, hysterosalpingography may be recommended for additional assessment.

Stenosis or constriction of the cervix inhibits effective catheter implantation(41). Scarring of the endometrial cavity also hinders sufficient filling, diminishing the study’s value.

Recovery Guide

Patients may have mild vaginal bleeding after the surgery, which should subside and cease within one to two days(42)

In addition, the iodine used to clean the cervix may cause a brown vaginal discharge, so women should wear a pad for the remainder of the day.

Patients must confirm that they have done all suggested tests before the treatment and then plan a follow-up appointment with their doctor to discuss the findings.

Cost

Typically, a sonohysterogram costs between $500 and $700. The price will increase if the test is paired with other procedures(43). The test may or may not be covered by the insurance company. Coverage typically relies on the reason for the test.

For instance, abnormal menstrual bleeding is more likely to be covered by insurance. If performed in preparation for IVF therapy, coverage may be denied. Before the test, patients must consult their financial counselor and insurance provider.

FAQs

1. What is the purpose of a sonohysterogram test?

Sonohysterography uses sound waves to produce images of the inside of the uterus and help diagnose various disorders(44). This condition is described by unexplained vaginal bleeding, infertility, and recurrent miscarriages.

2. How long does a sonohysterogram take?

Typically, the exam lasts less than 30 minutes(45).

3. Is a sonohysterogram painful?

Most ultrasound examinations are painless, quick, and well tolerated(46)

However, due to saline infusion during the sonohysterogram, patients may occasionally experience cramping(47). Over-the-counter medicines should help alleviate the pain. After the operation, patients can have vaginal bleeding for a few days.

The healthcare provider usually advises patients to take over-the-counter pain medicine before operation time(48). The pain relief medicine will help prevent the discomfort.

4. Does a patient need a full bladder for a sonohysterogram?

When undergoing this procedure, there is no need to have a full bladder(49). A scan of the abdomen is conducted first, after which the patients will be instructed to empty their bladder.

5. What are the side effects of the procedure?

Vaginal leaking is typical. Before the operation, the cervix is washed with saline and iodine soap. Some women may experience cramping during the test, which subsides afterward.


  1. Sonohysterography
    https://www.radiologyinfo.org/en/info/hysterosono
  2. Sonohysterography
    https://www.radiologyinfo.org/en/info/hysterosono#1d8cc495b74244789813b0ca8e1ad26e
  3. Ibid.
  4. Reasons for a Sonohysterogram
    https://www.verywellfamily.com/sonohysterography-procedure-and-fertility-4048711
  5. Sonohysterography
    https://www.radiologyinfo.org/en/info/hysterosono
  6. What is sonohysterography?
    https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/sonohysterography
  7. Ibid.
  8. Sonohysterogram
    https://www.peacehealth.org/medical-topics/id/abo3658
  9. Hysterosalpingography Versus Sonohysterography for Intrauterine Abnormalities
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3340954/
  10. Ibid.
  11. Sonohysterogram
    https://www.peacehealth.org/medical-topics/id/abo3658
  12. Sonohysterography
    https://www.radiologyinfo.org/en/info/hysterosono#1d8cc495b74244789813b0ca8e1ad26e
  13. Ibid.
  14. Ibid.
  15. Sonohysterography
    https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/sonohysterography#
  16. Ibid.
  17. What is sonohysterography?
    https://www.semc.org/services-directory/imaging-radiology/interventional-radiology/sonohysterography
  18. Ibid.
  19. Sonohysterography
    https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/sonohysterography#
  20. Ibid.
  21. Ibid.
  22. Ibid.
  23. Ibid.
  24. Sonohysterogram
    https://med.emory.edu/departments/gynecology-obstetrics/patient-care/patient-education/sonohysterogram/index.html
  25. Ibid.
  26. Sonohysterography
    https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/sonohysterography#
  27. Sonohysterography
    https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/sonohysterography
  28. Ibid.
  29. Sonohysterogram
    https://med.emory.edu/departments/gynecology-obstetrics/patient-care/patient-education/sonohysterogram/index.html
  30. Ibid.
  31. Sonohysterography
    https://www.radiologyinfo.org/en/info/hysterosono#1d8cc495b74244789813b0ca8e1ad26e
  32. Ibid.
  33. Ibid.
  34. Ibid.
  35. Reasons for a Sonohysterogram
    https://www.verywellfamily.com/sonohysterography-procedure-and-fertility-4048711
  36. Ibid.
  37. Reasons for a Sonohysterogram
    https://www.verywellfamily.com/sonohysterography-procedure-and-fertility-4048711
  38. Laparoscopy (keyhole surgery)
    https://www.nhs.uk/conditions/laparoscopy/
  39. Myomectomy
    https://www.ucsfhealth.org/treatments/myomectomy#
  40. Sonohysterography
    https://www.radiologyinfo.org/en/info/hysterosono
  41. What is sonohysterography?
    https://www.semc.org/services-directory/imaging-radiology/interventional-radiology/sonohysterography
  42. What to Expect From a Sonohysterogram
    https://fertilitycenterlv.com/diagnosing-infertility/what-to-expect-from-a-sonohysterogram/
  43. Reasons for a Sonohysterogram
    https://www.verywellfamily.com/sonohysterography-procedure-and-fertility-4048711
  44. Sonohysterography
    https://www.radiologyinfo.org/en/info/hysterosono
  45. Sonohysterography
    https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/sonohysterography
  46. Sonohysterography
    https://www.radiologyinfo.org/en/info/hysterosono#1d8cc495b74244789813b0ca8e1ad26e
  47. Ibid.
  48. Sonohysterography
    https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/sonohysterography
  49. Saline Sonohysterography
    https://womensimaging.net.au/what-we-do/gynaecology/saline-sonohysterography/

 

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