Imaging Services: Sonohysterography
Sonohysterography is a clinically valuable procedure performed to examine the uterine cavity
and lining. It is also the easiest way to examine the fallopian tubes.
Relax - this is the best and gentlest way to get the information your doctor needs to best help you.
True North Imaging (TNI) has been performing sonohysterograms since 1994 when Dr. Alex Hartman first pioneered the procedure in Ontario. Since then, we have done this procedure almost 200,000 times. You are being sent to TNI because we are the world's largest providers of this technique and at the forefront of SHG research.
What is sonohysterography (SHG)?
A SHG is an ultrasound of the uterus done after fluid (sterile saline) is instilled into the cavity. The procedure is done to detect abnormalities of the uterus and endometrial (uterine) cavity. There are no dyes, radiation, or anesthetics required.
Why do we do a SHG?
The procedure gives us valuable information about the uterus and the cavity. The three commonest reasons for performing a sonohysterogram are
- Abnormal uterine bleeding
- Infertility (any type)
- Abnormal result on a regular ultrasound
It is also the best and easiest method to evaluate possible polyps, fibroids, scarring, endometrial thickening and congenital uterine malformations. The list of indications has grown to include cavity assessment pre-IUCD insertion, pre-ablation and pelvic pain among other uses.
Do's / Don'ts
Patients are typically asked to take an anti-inflammatory, such as ibuprofen (Advil) prior to the test. The anti-inflammatory helps to open up the fallopian tubes and aid in patient comfort. Don't take the anti-inflammatory if you have an allergy to it, or have a bleeding disorder. In that case, take acetaminophen (Tylenol). Some referring doctors pre-treat with antibiotics as well, especially if you have a history of pelvic inflammatory disease (PID), or fibroid embolization.
You can have the test if you are bleeding. Many patients are referred for the procedure because they can not stop bleeding.
Don't have the procedure if you are pregnant, or have acute PID.
While we recommend having the test between days 5-12 of your menstual cycle, we do not insist upon it. We realize that cycles vary and our experienced physicians are comfortable interpreting a test done at any stage. We ask that during that cycle you refrain from unprotected intercourse prior to the test. Postmenopausal patients can have the test done at any time.
How is a sonohysterogram performed?
The procedure can be easy, when performed by an experienced physician. Having performed more than 200,000 sonohysterography procedures, our patients report experiencing little to no discomfort. The procedure takes 1-2 minutes to perform.
Sonohysterography is an ultrasound procedure that starts with a small speculum placed in the vagina. A tiny plastic tube (catheter) is then placed in the cervix and about a teaspoon of salt water is instilled. We visualize the fluid, uterus and cavity with a transvaginal ultrasound probe.
Why U/S tubal patency assessment
There are two methods for assessing tubal patency, i.e whether the fallopian tubes are open. The traditional method involves the use of radiation and x-ray dye. This method has been used since 1910 and is known to cause great discomfort. Current clinical best practice, however, as adopted by The Canadian Fertility and Andrology Society (CFAS) and the American Society for Reproductive Medicine (ASRM) , promotes the use of ultrasound for tubal patency.
This method, used exclusively by TNI has proven to be both safe and effective in evaluating tubal patency. Of course, like sonohysterography, expertise with this procedure requires a great deal of practice.
TNI is also one of the only providers in North America of Echovist, a sugar solution to evaluate ultrasound tubal patency. This improves the sensitivity of the test and makes evaluation of the fallopian tubes easier.
Tubal blockage is a factor in 25-40 % of couples with infertility. By using ultrasound and Echovist our clinical staff can see if one or both tubes are open. We are especially concerned if you have a history of endometriosis, pelvic inflammatory disease (PID), or an ectopic pregnancy. We will also assess for nonfunctioning fluid-filled tubes and hydrosalpinges, which can decrease your chance of pregnancy, unless they are dealt with.
Is it uncomfortable?
Patients often tell us that the procedure was much easier than they expected. While some patients do not feel anything, most get some cramping, like a menstrual cramp. It may last for a few minutes. There may be spotting/bleeding afterwards. That's why we ask you to bring a sanitary pad with you.
Risks and complications
This is a very safe procedure. Cramping and spotting are the main complications. The cramping usually only last for a few minutes. Bleeding, if it occurs, usually is just a few hours of spotting. If it persists, call your doctor. Rarely, people may feel soreness after the test.
The most serious complication is pelvic infection, occurring in approximately 0.2 % of patients. If you experience severe pain, or fever within days of the procedure, call your doctor, or go to hospital for treatment.
More than 150 gynecologists and 2,500 family doctors trust TNI to provide their patients with the best sonohysterogram procedures available. This procedure has changed the standards for investigation of gynecological conditions and infertility.