Hysterosalpingogram and Sonohysterogram: Techniques to Evaluate Infertility

Hysterosalpingogram and sonohysterogram can be utilized to identify reproductive abnormalities. The information gathered through these techniques will aid in providing accurate diagnosis and treatment.

Hysterosalpingogram (HSG)

A normal female reproductive tract including cervix, cervical canal, uterine cavity, and Fallopian tubes is essential to normal fertility and reproduction.  Hysterosalpingogram (HSG) is an x-ray test and is useful in evaluating all of these areas and should be considered early in the investigation of the infertile female, especially for those with a history of previous abdominal or pelvic surgery, pelvic inflammatory disease, prior post-partum infection or C-section.  HSG provides immediate information about any abnormality such as tubal blockage or abnormalities of the uterine cavity caused by uterine fibroids, polyps, or intrauterine adhesions and scarring.  General anesthesia is not required for this procedure; however, some clinicians use a local anesthesia (Para cervical block) to decrease any potential discomfort during the procedure.  At times, a prostaglandin inhibitor (such as Ibuprofen) is given an hour or so before the procedure which may be beneficial in preventing or decreasing occasional pain or cramp during the procedure.  During HSG a speculum will be inserted into the vagina to access the cervix which then will be cleansed with antiseptic liquid (either Betadine or antiseptic soap).  A soft and flexible catheter will be introduced into the cervical canal and advanced into the endometrial cavity.  An x-ray contrast material will be injected through the catheter into the endometrial cavity and pictures will be taken as the media is filling the endometrial cavity and passing into the Fallopian tubes.  Upon completion of the procedure, the catheter will be removed.  During the procedure, the patient might experience some discomfort or cramping similar to menstrual cramps.  Following the procedure, there might be some mild spotting which usually should stop within a day or so.  Patients who are taking Metformin should stop this medication a few days prior to HSG.  In addition, if the patient has a history of Hydrosalpinx, prophylactic treatment with antibiotic may be considered. HSG is usually scheduled about six to ten days after the first day of menstrual cycle.

Sonohysterogram (SHG)

Sonohysterogram (SHG) is a technique which evaluates endometrial cavity and intrauterine pathologies such as endometrial polyps, fibroids, intrauterine adhesions, and congenital uterine anomalies.  This test utilizes ultrasound and unlike HSG (Hyserosalpingogram) no x-rays are involved.  During this test, a catheter is passed through the cervix and introduced into the endometrial cavity and sterile normal saline is instilled while transvaginal sonogram is carried out.  Instillation of normal saline would highlight uterine cavity anomalies such as septum, Fibroids, Polyp or adhesions. At times and by using special type of media, images of the Fallopian tubes may also be obtained.

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