How does a sonohysterogram help in assessing female fertility?

The Sonohysterogram:

A sonohysterogram is an important part of a female infertility assessment and is an extension of a pelvic ultrasound that allows the patient to have uterine, uterine cavitary and tubal patency evaluation all within in the same test. When it is combined with a gynecological ultrasound it can also image the ovaries for abnormalities and the antral follicular counts.

 How is the test performed ?

 

The test is performed between days 6-11 of the menstrual cycle, when the lining is thin for better visualization of structural defects within the lining. 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 can 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 allow for a seal that prevents back flow of the saline through the cervix and into the vagina. Ultrasound is then performed while the infusion is started to note uterine defects such as various different uterine anomalies, polyps and fibroids. Thereafter, the injection of  shaken saline (causing bubble formation in the saline) allows  views of 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.

Summary of the conditions that can be discovered with the gynecological ultrasound and sonohysterogram

1. Uterine fibroids and their locations (subserosal, submucosal-types 0,1 and 2 and intramural).
2. Ovarian size and architecture- ie- PCOS or diminished ovarian reserve.
3. Antral follicle count from the ovaries.
4. Additional cavitary defects such as scarring and polyps.
5. Uterine malformations- Arcuate uterus, septate uterus, unicornuate uterus, bicornuate uterus etc.

Ultrasound image of a uterine fibroid:

 

 

 

 

 

 

 

 

Additional information:

1. Patients usually have minimal to mild pain and are asked to take ibuprofen 400-800 mg one hour before the procedure. The cramping is usually over within a few hour after the procedure.
2. Vaginal spotting or bleeding may continue for a few days after the procedure.
3. Pelvic infections can occur, but this is rare.

 

This information written by Dr. Manny Singh

 

About Manny Singh