Saline Sonograms: How They Work and What You Can Expect

| Reviewed By Kimberly Langdon, M.D.

There are multiple examinations and assessments offered by an OB-GYN in order to detect any possible problems or abnormalities in your reproductive system.

Saline sonograms are one option that doctors use frequently to help diagnose and treat women struggling with fertility or other uterine medical conditions. 

A saline sonogram is a medical procedure that helps doctors see the inside of the uterus and detect any abnormalities that could be causing medical conditions. It involves inserting a saline solution into the uterus and using transvaginal ultrasound technology to get a clear and accurate picture. 

In the following, we’ll take a close look at saline sonograms including what they are, why they are performed, and what you can expect if one is in your future. 

Saline Sonogram – What To Know

Whether you’re preparing for a saline sonogram or you think you might need one, it’s important to know what it is and what you can expect during the sonogram. 

Sonohysterogram Procedure

This procedure is performed much like a gynecologic exam.

Step 1: 

First, the provider will perform a transvaginal ultrasound to get a baseline reading of the uterus. To do so, you will lie down with your knees bent. A small wand, called an ultrasound transducer, is then placed into your vagina. The wand is covered with a disposable covering and a special gel that will make the insertion painless. 

Step 2:

The provider will then remove the ultrasound transducer and use a speculum to open the vagina as they do during a pap smear. Then, a skinny and flexible catheter is placed into the cervix. Once the catheter is in place, the speculum is removed. 

Step 3: 

Sterile saline, or salt water, is injected into the uterus through the catheter. The ultrasound transducer is then inserted once again into the vagina.  As the solution fills the uterus, it outlines the uterine walls and cavity that can be seen using the transvaginal ultrasound transducer. The provider will study the images and look for any abnormalities inside the uterus. 

Saline Sonogram Purpose

The purpose of a saline sonogram is to detect any issues or abnormalities inside of the uterus. This procedure is usually done to investigate conditions such as: 

  • Abnormal uterine bleeding
  • Infertility
  • Recurrent miscarriage

Through a saline sonogram, OB-GYNs can detect unusual conditions or abnormalities of the uterus including: 

  • Congenital abnormalities of the uterus
  • Fibroids
  • Abnormal shape of the uterus
  • Polyps 
  • Suspected scar tissue in the uterus
  • Uterine cancer

Is a Saline Sonogram Painful?

A saline sonogram may be mildly painful, similar to a pap smear or gynecologic exam. 

What To Expect

This type of sonogram is minimally invasive, and you can expect a little bit of discomfort. You may experience moderate pain and discomfort when the provider opens up the vagina and inserts the catheter, similar to when you get a pap smear or go through cervical checks while pregnant. 

Saline Sonogram Side Effects

This is a very safe procedure with minimal risks. It is possible to experience slight cramping or light spotting after the procedure, but it should only last a few hours. 

Signs of Infection After Sonohysterogram

While it is extremely rare, infections can happen after a sonohysterogram. Symptoms of pelvic tissue infection can include fever, pain, and unusual vaginal discharge. You should call your OB-GYN if you experience any of these symptoms after a sonohysterogram. 

Saline Sonogram vs. HSG

An HSG is an x-ray procedure performed to look at the uterus and fallopian tubes. It is often used in place of a saline sonogram if your doctor is concerned that there is an abnormality in the fallopian tubes, but it can pick up uterine abnormalities too. 

During an HSG, radiographic dye is injected into the uterus rather than a saline solution. The dye runs through the uterus and should flow through the fallopian tubes into the abdominal cavity.

Using x-ray technology, your provider is able to see if there is a blockage in the fallopian tubes by the visual created from the dye. 

Sonohysterogram and Pregnancy

The best time to get a sonohysterogram is between the end of your period and ovulation. This is usually between days 6 and 11 of your cycle with day one being the day you started bleeding. 

You should NOT get a sonohysterogram if you are pregnant. You may still get pregnant the same cycle as your sonohysterogram; however, try to schedule your procedure before you ovulate. This will minimize the risk of “flushing out” a released egg or developing embryo with the saline solution. 

How Do You Prepare for a Saline Ultrasound?

Because it is a simple procedure, there is not much preparation required for the ultrasound. There are a few things to keep in mind to make sure you have a seamless and easy experience: 

  • Schedule: Plan your procedure for the days immediately following your period. This is when the doctor will have the best chance of having a clear picture. It is best to call your OB the first day of your period to schedule your appointment. 
  • Nourish: It is important to eat and drink as usual before the procedure. 
  • Dress appropriately: Wear comfortable, loose-fitting clothing that is easy to remove. You may also want to bring an absorbent pad to wear after the procedure in case of spotting and vaginal discharge. 

Saline Ultrasound IVF

Medical providers will often recommend or require a uterine evaluation via saline ultrasound before beginning IVF treatments. The goal is to make sure that your uterine cavity is a healthy and unobstructed place that can support a pregnancy. 

Next Step for Pregnancy After Sonohysterogram

Sonohysterography can be very helpful in determining the next step in your pregnancy journey. If a condition or abnormality is detected by the exam, your provider will be able to guide you on the next step and how to move forward toward a healthy pregnancy.

If your results were clear, it is possible for you to get pregnant during the same cycle, or your doctor may give you the green light to move forward with your IVF cycle. 

Related Questions:

Can a Sonohysterogram Detect Cancer?

A sonohysterogram can be a method used to detect uterine cancer. Biopsies, CT scans, and hysteroscopies are commonly done as well for further investigation and more accurate results. 

Do I Need a Full Bladder for Saline Ultrasound?

No, quite the opposite actually! Saline ultrasounds are done when your bladder is completely empty. Your provider will have you use the bathroom before beginning the procedure. 

Closing Thoughts 

Saline ultrasounds are a common, simple, and minimally invasive way to get a lot of answers about your reproductive and uterine health. Knowledge is power, and thanks to procedures such as this one, doctors are becoming more and more capable of diagnosing and treating women in need. 

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