Before you begin fertility treatment, your doctor needs to uncover any potential roadblocks. One of the ways they do this is by performing a diagnostic cycle, which includes a short test called a saline sonogram (also known as a sonohysterogram, or SHG).
In this article:
- What is a saline sonohysterogram (SHG)?
- What to Expect at Your SHG Test
- What happens before an SHG?
- What happens during an SHG?
- What happens after an SHG?
- What are the risks of a sonohysterogram?
- Saline Sonogram vs HSG
- Will I have to repeat my SHG or HSG?
- Saline Sonohysterogram FAQs
- Is a sonohysterogram (SHG) painful?
A saline sonogram (also referred to as a sonohysterogram, saline ultrasound, saline infusion sonohysterogram, SIS, or SHG) is an important fertility test performed during the diagnostic process to help ensure there are no physical barriers to successful conception.
Between days 5 to 9 of your menstrual cycle, your doctor will perform an SHG to carefully evaluate the shape of the uterine cavity and look for any fibroids, polyps, scar tissue, or other abnormalities that should be resolved prior to beginning fertility treatment.
Completing diagnostic tests like an SHG will give you the best chance of a healthy pregnancy.
As a medical assistant at Illume Fertility, my role includes helping our doctors perform procedures and diagnostic tests - such as sonohysterograms. In this guide, we will discuss what you can expect from an SHG test and answer common questions about the procedure to help you feel more at ease.
During the diagnostic testing process, you will be given detailed instructions at each step, and will always be able to ask your nurse any questions you may have along the way.
However, we know it can feel overwhelming trying to keep track of what's next. With that in mind, let's walk through what to expect before, during, and after your sonohysterogram (SHG) to help you feel more prepared.
Your nurse or doctor will discuss the timing of your sonohysterogram with you to ensure it is performed at the proper time during your cycle. However, you should always contact your Care Team if you are still having a full flow (bleeding, not spotting) before your SHG.
During your sonohysterogram, you can expect to have a provider (typically, this will be your primary doctor) and a medical assistant in the room. If there happens to be a medical student or resident shadowing our team on the day of your SHG, you might be asked if you are comfortable having them in the room as well - which is completely up to you.
Reminder: If you are feeling anxious or uncomfortable at any point, always let your doctor know. They will do everything they can to help you feel more relaxed.
After your SHG has been completed, a sanitary pad will be provided to capture any residual saline as it leaves the uterus. Fluid leakage is expected, so don't be alarmed if you see this.
Unless instructed otherwise, you will be able to continue on with your normal daily activities.
If you have any questions while you are still at the office, don't hesitate to ask your doctor or medical assistant. If any concerns arise after leaving the office, always feel free to contact your Care Team.
A sonohysterogram is low-risk and has very few, mild side effects. There’s a very slight chance of infection, but your provider will take steps to prevent this.
You may feel uncomfortable at points during the procedure, but taking over-the-counter pain medication (such as Tylenol or ibuprofen) one hour prior to your test can help.
If you notice any of these symptoms, let your Care Team know right away:
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Another test performed during the diagnostic process is called a hysterosalpingogram (HSG). The two procedures have similar names and common goals, but both are usually necessary for a complete fertility evaluation.
With that in mind, you may be wondering: how does an SHG differ from an HSG?
While the saline sonogram (SHG) is performed via transvaginal ultrasound, using sterile saline water to view the inside of the uterus, a hysterosalpingogram (HSG) involves the use of an X-ray to evaluate the anatomy of both the uterus and the fallopian tubes.
An HSG also uses a firmer catheter with a balloon tip in order to introduce iodine-based dye into the uterus, which can make the procedure more uncomfortable than an SHG.
An hysterosalpingogram (HSG) is typically performed only once and is unlikely to be repeated.
A saline sonogram (SHG) must be repeated every six months, since polyps, fibroids, and other uterine abnormalities can develop. Both procedures are a part of our initial fertility evaluation here at Illume Fertility, as they help to determine the best next steps for each patient.
If you have any lingering concerns before your appointment, keep reading to review some commonly asked questions about the saline sonohysterogram (SHG) test.
The length of each sonohysterogram varies slightly, but you can expect the test itself to last between 15-20 minutes on average.
The optimal time for a sonohysterogram is after your period has ended, but before you ovulate (usually around days 5 to 9 of your cycle). Why? This is when the lining of your uterus is at its thinnest, allowing your doctor to visualize the uterine cavity most clearly.
You may feel some cramping or mild discomfort at times during your SHG, but for the most part, you should expect a quick, fairly painless experience.
While a hysteroscopy and a sonohysterogram both allow your doctor to see inside your uterus, a sonohysterogram is less expensive, less invasive and faster than a hysteroscopy. The only downside to sonohysterography is it can only be used for diagnosis. Hysteroscopy allows your provider to remove any polyps, fibroids or scar tissue at the same time if needed.
As the sterile saline is gently pushed through the catheter and into your uterus, the ultrasound wand sends sound waves through the gel and into your body. The echoes from those sound waves create a moving image of the inside of your uterus that your doctor then evaluates in real time.
Saline solution expands the uterus and outlines the uterine cavity, which allows for a more detailed evaluation than a conventional ultrasound. Your doctor is then able to assess the uterus to ensure it is a healthy environment ready for an embryo to implant and develop in.
A sonohysterogram can be a helpful tool for those who aren't trying to conceive as well. By evaluating the shape and structure of your uterus, your doctor may be able to pinpoint what is causing symptoms like pelvic pain and unexplained bleeding.
Your provider may recommend a sonohysterogram if:
Getting a more comprehensive view of your uterine cavity helps your doctor establish an accurate diagnosis, keep tabs on any abnormal growths or possible issues, and assess whether surgical interventions will be necessary to resolve them.
While it can feel daunting to face a calendar full of appointments and learn about the many different tests involved in preparing for fertility treatment, remember the reason why you are choosing to put in all this effort: to give yourself the best possible chance at success.
If you have any questions not answered in this SHG guide, don't hesitate to reach out and ask your Care Team - they will always be happy to provide answers and reassurance.
We wish you all the best on your journey!