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HSG / Saline Sonogram

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in Fertility Care

An X-ray test with contrast dye used to check the uterus and fallopian tubes. It helps detect blocked tubes or uterine abnormalities that may cause infertility.
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HSG / Saline Sonogram

What is HSG/SHG?

Hysterosalpingogram (HSG):
An X-ray test with contrast dye used to check the uterus and fallopian tubes. It helps detect blocked tubes or uterine abnormalities that may cause infertility.
Sonohysterogram (SHG) / Saline Infusion Sonography (SIS):
An ultrasound test where sterile saline is placed in the uterus to make the uterine cavity easier to see. It helps diagnose fibroids, polyps, abnormal bleeding, or uterine shape problems.
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When to Consider HSG (Hysterosalpingogram)

You may need an HSG if your doctor is evaluating fertility problems, especially to check the fallopian tubes.
Consider HSG if you have:
  • Difficulty getting pregnant (infertility evaluation).
  • History of pelvic infections, endometriosis, or pelvic surgery (risk of blocked tubes).
  • Need to confirm results of a tubal ligation (tube tying) or its reversal.
  • Suspected uterine abnormalities (e.g., scarring, abnormal shape).

When to Consider SHG (Sonohysterogram / Saline Infusion Sonography)

You may need an SHG if your doctor is checking for uterine cavity problems, often linked to bleeding or miscarriage.
Consider SHG if you have:
  • Abnormal uterine bleeding (between periods, heavy periods, or after menopause).
  • Recurrent miscarriages (to check for uterine defects).
  • Fibroids or polyps suspected on ultrasound.
  • Infertility work-up (to assess uterine cavity more clearly).

Types of HSG (Hysterosalpingogram)

Conventional HSG (X-ray HSG)

  • Uses X-rays + iodine-based contrast dye.
  • Standard, widely used method.

Fluoroscopic HSG

  • Uses real-time X-ray (fluoroscopy) during dye injection.
  • Allows the radiologist to watch the contrast flow through uterus and tubes live.

Sonohysterogram-based HSG (Sonohysterography with contrast for tubes)

  • Uses ultrasound with saline + air bubbles or foam contrast (instead of X-ray).
  • Sometimes called Sonohysterography with contrast (HyCoSy – Hysterosalpingo-Contrast Sonography).
  • Avoids radiation and iodine dye.

MRI HSG (less common)

  • Uses MRI with contrast for very detailed imaging.
  • Usually reserved for complex uterine anomalies.

Types of SHG (Sonohysterogram / Saline Infusion Sonography)

Standard SHG (Saline Infusion Sonography, SIS)

  • Uses saline solution to expand the uterine cavity.
  • Best for detecting polyps, fibroids, adhesions, or abnormal shape.

Contrast Sonohysterography (Saline + Air Bubbles or Foam)

  • Also called Saline Infusion Sonohysterography with Contrast.
  • Helps highlight cavity abnormalities more clearly.
  • Can also be adapted (HyCoSy) to assess fallopian tube patency.

3D Sonohysterography

  • Uses 3D ultrasound imaging with saline contrast.
  • Provides a 3D reconstruction of the uterine cavity for more accurate diagnosis.

Procedures of HSG (Hysterosalpingogram)

Step 1 : Preparation
  • Done after menstruation but before ovulation (day 7–12 of cycle).
  • Patient lies on the X-ray table in frog-leg position.
  • A speculum is inserted to visualize the cervix.
  • Cervix is cleaned with antiseptic solution.
  • A thin catheter or cannula is gently placed through the cervix into the uterus.
  • Iodine-based contrast dye is slowly injected.
  • X-ray/fluoroscopy images are taken:
  • Uterus filling phase → shows shape of uterus.
  • Tubal filling & spill phase → dye flows into fallopian tubes and spills into abdominal cavity if tubes are open.
  • Instruments removed.
  • Patient may feel mild cramping.
  • Results are often available immediately.
Duration: 5–10 minutes (plus setup time).

Procedure of SHG (Sonohysterogram / Saline Infusion Sonography)