9 Common Questions About Sonohysterogram
Understanding the sonohysterogram and its role in fertility
At Markham Fertility Centre (MFC) we offer many testing options, one of which is a sonohysterogram (SHG), also known as a saline infusion sonogram (SIS) or sono for short. The sonohysterogram is a test that we do as part of the initial workup for somebody who is looking to get pregnant. If somebody is thinking about freezing their eggs, or is looking at becoming an egg donor, we don’t typically order this test. But, in a situation where somebody is trying to get pregnant or wants to be pregnant, then it’s a commonly ordered test. Now let’s answer a few of the common questions about sonohysterograms:
- What is a sonohysterogram or sono?
- Is a sono painful?
- What do you look for in a sono?
- What are the risks of a sono?
- What to expect after a sono
- When to schedule a sono
- How long should you wait after a sono to have intercourse?
- How often is a sono done?
- How long after an ectopic can you do a sono?
What is a sonohysterogram or sono?
A sono is done on-site at MFC, at Care Imaging by one of the gynecologists, and the ultrasound department. We use a little catheter that is inserted in through the cervix with a speculum. A speculum is a medical instrument that goes in the vagina to allow us to see the cervix; it can be metal or plastic in composition. At MFC, we use metal, which is actually more comfortable and allows us to see the cervix when we put the little catheter through the cervix.
What Can a Sonohysterogram Find?
A sonohysterogram (also called a saline infusion sonogram or SIS) gives your fertility specialist a detailed view of the inside of your uterus. By gently filling the uterine cavity with sterile saline during a transvaginal ultrasound, the test can reveal abnormalities that may not be visible on a standard ultrasound.
Common findings include:
Endometrial Polyps
Polyps are small growths that develop in the lining of the uterus. Although many are non-cancerous, they can interfere with embryo implantation or contribute to abnormal uterine bleeding. If a polyp is identified, your fertility specialist may recommend removing it before fertility treatment.
Submucosal Fibroids
Fibroids are non-cancerous growths within the uterine muscle. When they grow into the uterine cavity, they may reduce implantation rates or increase the risk of miscarriage. A sonohysterogram helps determine whether a fibroid is affecting the cavity and whether treatment may improve fertility outcomes.
Uterine Adhesions (Asherman’s Syndrome)
Scar tissue inside the uterus can develop after surgery, infection, or certain pregnancy-related procedures. Adhesions may prevent normal implantation or cause changes to menstrual cycles. Identifying these adhesions allows your specialist to discuss treatment options that may restore the uterine cavity.
Congenital Uterine Abnormalities
Some women are born with differences in the shape of their uterus, such as a septate or bicornuate uterus. These structural variations can sometimes contribute to infertility or recurrent pregnancy loss. A sonohysterogram helps your fertility team evaluate whether additional testing or treatment is appropriate.
Endometrial Irregularities
The examination also provides a detailed assessment of the uterine lining. Areas of thickening, irregular tissue, or other abnormalities can be identified and investigated further if necessary.
Not every abnormal finding requires treatment. Your fertility specialist will interpret the results alongside your medical history, symptoms, and fertility goals to recommend the most appropriate next steps.
Sonohysterogram vs. Regular Ultrasound
Both a transvaginal ultrasound and a sonohysterogram are valuable fertility tests, but they serve different purposes.
| Feature | Regular Transvaginal Ultrasound | Sonohysterogram (SIS) |
|---|---|---|
| Uses sterile saline | No | Yes |
| Visualises the uterine cavity | Limited | Excellent |
| Detects uterine polyps | Moderate | High accuracy |
| Detects submucosal fibroids | Moderate | Improved visualisation |
| Evaluates uterine lining | Basic assessment | Detailed assessment |
| Commonly used before fertility treatment | Sometimes | Frequently |
A regular transvaginal ultrasound is excellent for evaluating the ovaries, uterus, and developing follicles. However, because the walls of the uterus remain collapsed, small abnormalities inside the cavity can sometimes be missed.
A sonohysterogram gently expands the uterine cavity with sterile saline, allowing your fertility specialist to obtain a much clearer view of the endometrium and identify conditions that could affect implantation or pregnancy.
What to Expect During a Sonohysterogram
Understanding each step of the procedure can help you feel more comfortable before your appointment.
Before Your Appointment
A sonohysterogram is usually scheduled after your menstrual period has ended but before ovulation. This timing provides the clearest view of the uterine cavity while avoiding disruption to an early pregnancy.
Your fertility specialist may recommend taking an over-the-counter pain reliever about an hour before the procedure to minimise mild cramping.
During the Procedure
You will lie comfortably on the examination table, similar to a routine pelvic examination.
A thin catheter is gently inserted through the cervix into the uterus. Sterile saline is then introduced to expand the uterine cavity while a transvaginal ultrasound captures detailed images.
Most procedures take approximately 10 to 20 minutes.
After the Procedure
Many patients experience mild cramping or light spotting for a day or two after the examination. These symptoms are generally temporary and resolve without treatment.
Most people return to their normal daily activities immediately following the procedure.
You should contact your fertility clinic if you experience severe pelvic pain, heavy bleeding, fever, or unusual discharge after your appointment.
When Is a Sonohysterogram Recommended?
Your fertility specialist may recommend a sonohysterogram if you are experiencing:
- Difficulty becoming pregnant
- Recurrent pregnancy loss
- Multiple unsuccessful IVF or embryo transfer cycles
- Abnormal uterine bleeding
- Suspected uterine polyps or fibroids
- A history of uterine surgery
- Findings on a routine ultrasound that require further investigation
The test provides valuable information that helps your care team develop a personalised fertility treatment plan.
Frequently Asked Questions
Does a sonohysterogram hurt?
Most patients describe the procedure as causing mild cramping similar to menstrual cramps. Any discomfort is usually brief, and most women return to normal activities immediately afterward.
How long does a sonohysterogram take?
The examination itself typically takes between 10 and 20 minutes, although your total appointment may be slightly longer to allow for preparation and discussion of the procedure.
Is a sonohysterogram more accurate than a regular ultrasound?
For evaluating the inside of the uterus, yes. The saline used during the procedure expands the uterine cavity, making polyps, fibroids, scar tissue, and other abnormalities easier to identify than with a standard transvaginal ultrasound alone.
Can I try to get pregnant after a sonohysterogram?
In most cases, yes. A sonohysterogram does not reduce fertility. Your specialist will review your results and advise when you can continue trying to conceive or begin fertility treatment based on your individual circumstances.
What happens if my sonohysterogram shows an abnormality?
If an abnormality is identified, your fertility specialist will explain the findings and discuss whether further testing or treatment is recommended. Depending on the condition, treatment may include monitoring, medication, or a minimally invasive procedure before proceeding with fertility treatment.