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Sonohysterography: A safer alternative to hysterography


Sonohysterography ("SHG") is an ultrasound-monitored procedure similar to a hysterosalpingogram ("HSG"), and is used to detect abnormalities of the uterus and fallopian tubes or tubal blockage. The indications for its use overlap with those for an HSG. Under these circumstances, it no doubt offers a safer alternative to the conventional HSG.


Conventional hysterosalpingography is generally performed in a radiology department. It usually involves:

  • The placement of a speculum into the vagina through which a catheter is positioned in the uterus;
  • Radiographic contrast material ("dye") is injected into the uterine cavity, and
  • Several X-rays of the pelvis are taken.


There is exposure to radiation and the contrast material contains iodine.

Sonohysterography can be performed as an office procedure. It usually involves:

  • The placement of a speculum into the vagina through which a catheter is positioned in the uterus;
  • A saline solution is injected into the uterine cavity, and
  • At the same time, a transvaginal ultrasound is being performed


There is no radiation and no iodinated contrast material involved.

Either procedure can be associated with discomfort. In general, the SHG is more comfortable than the HSG because saline may be less irritating than radiographic contrast material.

Sonohysterography can be used to evaluate the endometrium and Fallopian tubes. For endometrial evaluation, SHG plays a role in an infertility workup.


The injection of saline into the endometrial canal (uterine cavity) acts to separate the two sides of the endometrium and improve the visualization of masses, such as polyps. In addition, the saline acts as a contrast material which can make abnormal intraluminal structures, such as synechiae (adhesions), visible. Submucous myomas (fibroids which displace the endometrium) may be better evaluated when an SHG is performed.


An SHG can also be employed to evaluate the Fallopian tubes, especially for patency.In my experience, color Doppler imaging improves the ability to detect tubal patency. When the saline is injected, some of it may be seen flowing from the tubes into the pelvis, a finding that confirms patency.


Sonohysterography, in my opinion, is an excellent procedure for evaluation of the endometrium and tubal patency. It has the added advantages of no radiation exposure, no iodinated contrast injection (which can be associated with increased discomfort and allergic reactions), the potential for fewer complications. And SHG offers the advantage that ultrasound of the uterus, ovaries and pelvis can be performed at the same time. Thus, uterine masses and other abnormalities may be discovered which would have been missed during a conventional HSG.


However, to evaluate the Fallopian tubes for more than just patency the HSG gives better information. How frequently this type of evaluation is necessary depends on the way a physician practices and how you as his/her patient presents. It can also be argued that HSG is better than SHG for determining patency; however, it should be noted that it can also be argued that SHG is better than HSG. Each procedure has its proponents and opponents. Many, if not most, infertility physicians are unfamiliar with the performance and interpretation of this study.


Some infertility physicians may choose not to refer a patient to another location and lose the income generated from performing and/or interpreting a test which they cannot or do not perform.

Many, if not most infertility physicians, rely on ultrasound techs to perform and essentially interpret the ultrasounds (realistically speaking). These physicians (possibly the techs, too) may be unwilling to assume the perceived risks of performing an SHG.


Some infertility physicians may not have the equipment necessary to perform color Doppler imaging which is very helpful, though not completely necessary.

If your doctor suggests an HSG, it may be to your advantage to ask about SHG. She/he should be more than willing to discuss the options with you.


Dr. Michael Applebaum is a Board Certified Radiologist whose practice is limited to Diagnostic Ultrasound. He is an internationally recognized authority in Infertility Ultrasound. He can be reached at (312) 337-0732. His Website is located at