What is Sonohysterography?
Saline infusion sono-hysterography is a new technique developed to better image the uterine cavity and the lining of the womb.
Sterile saline is infused through a soft plastic catheter placed in the cervix. The solution distends the cavity of the womb allowing a much better view with transvaginal ultrasound.
This technique may be used to assess abnormalities of the uterus and endometrium (lining of the womb). If your doctor also wants us to test for tubal patency, a special occlusive catheter and special ultrasonic contrast agent are used.
Why is it performed?
This procedure is used when:
There is abnormal vaginal bleeding (before or after menopause):
Many women have unusual bleeding around the time of menopause. This is often due to hormonal changes. But sometimes it can be because of pathology like a polyp. If no obvious problems are seen within the uterus on sonohysterography there is no need for further investigation. Sometimes the ultrasound an point to a problem with the hormone replacement therapy. Sometimes the sonohysterogram can show why the periods are very heavy or why there is bleeding after intercourse.
A mass is suspected in the womb on ultrasound:
If a mass is found within the uterus, its type and size can be assessed prior to surgery. The most common findings are benign endometrial polyps, fibroids or a thickened uterine lining.
When should it be done?
If the bleeding is really irregular, the test can be done at any time. If you are having regular cycles and there is a chance of pregnancy, the procedure should be performed in the first 10 days of the menstrual cycle, before ovulation.
This avoids the chance of the sonohysterography interfering with the implantation of the embryo.
Investigating infertility & recurrent miscarriage
Sonohysterography can detect benign endometrial polyps or adhesions within the uterus which may prevent conception.
Recurrent miscarriage may be due to fibrous bands (septations) within the uterine cavity or to an abnormal uterine shape.
These can be difficult to see, using ultrasound alone but become clear on sonohysterography.
Assessing the uterine lining in patients on Tamoxifen therapy
A side effect of Tamoxifen therapy for breast cancer can by polyps, thickening, or even cancer of the uterine lining. Sonohysterography can distinguish true abnormalities from thickening that happens beneath the uterine lining that is a common finding of no significance.
Seeing if the Fallopian tubes are blocked (tubal patency)
Blocked tubes are a common cause of infertility.
Hysterosalpingo-contrast-sonography is a modification of the sonohysterography procedure that involves injecting a special solution that is easily identified on ultrasound into the uterus. The fluid can be seen as it passes along the Fallopian tubes and this will show if there is any blockage. This test can also be used to prove that the tubes are blocked after a tubal ligation or the Essure procedure.
Will it be painful?
Sonohysterography does not required hospitalisation, anaesthetic or analgesia. Some women have some period-like pain during or shortly after the procedure.
Tubal patency studies can cause a bit more cramping. We recommend you take a couple of Nurofen or Naprogesic beforehand.
After the procedure?
We recommend that you sit and rest for 10 minutes or so after the test. We will explain the results to you. The report will be forwarded to your doctor. Your doctor will plan whether or not you need further treatment.
Are there any risks?
Some women feel a bit faint after the procedure, but after a rest, they recover. There is a risk of introducing infection, though this is extremely rare. If there is a chance that you already have a pelvic infection the procedure should be avoided because of the risk of it being exacerbated. Please talk to the doctor about your history before the procedure.
Why is HyCoSy more expensive?
Sonohysterography showing a normal endometrial cavity
The tubal patency studies may need special ultrasonic contrast fluid called Levovist. It is a sterile solution which has to be made up specially for each individual patient, immediately before use. It is the most expensive part of the procedure.
Saline outlining two endometrial polyps in the cavity.
The other options available to test tubal patency are laparoscopy and dye, done under general anaesthetic, or hystero-salpingo-graphy done with x-ray visualisation. These other tests are more uncomfortable and more expensive. You may wish to discuss these options with your doctor.