The cavity of the womb can be seen better with Sonohysterography when the womb is distended with clear sterile fluid than with the normal ultrasound alone when the cavity of the womb is collapsed. This enables a more accurate confirmation or exclusion of an endometrial or fibroid polyp when it has been suspected on routine scans.
What is Saline Hysterography?
This simple procedure is usually done in the ultrasound scan room in an out-patient environment. It is an ambulatory procedure so you do not require hospital admission. All aseptic precautions are taken as we would when performing biopsies from the womb but a clean room or theatre facility is not needed. There is also no need for pain relief or sedatives.
A speculum is inserted in the vagina to visualise the neck of the womb (like in a smear test). The neck of the womb (cervix) is thoroughly cleaned with an anti-septic and then a small soft catheter is passed gently through the neck of the womb into the cavity of the womb, just as we would do and embryo transfer. This catheter has a small balloon at its end which is inflated with a small amount of fluid. This effectively seals the neck of the womb and prevents back flow. This catheter also has a separate cahnnel through which the fluid is injected into the cavity of the womb. An internal scan allows the lining of the womb to be seen clearly whilst some warm saline (salt water) is passed through the soft catheter. Relevant measurements can then be taken.
Why is this done?
Polyps and fibroids can have a negative impact on the ability of an embryo to implant and they may also increase the risk of miscarriage. They can be associated with bleeding pattern abnormalities but this is not always the case.
If on routine ultrasound, we suspect polyps or fibroids within the lining of the womb then sonohysterography will more decisively confirm or exclude this. If there has been previous womb or tubal surgery (for example removal of fibroids or removal of tube) then the womb may be weakened with significant risk to a pregnancy. Sono-hysterography may be used to define such weakened areas so that strengthening treatment can be planned. More accurate measurement and assessment will allow us to plan precise and definitive management.
In this way patients not confirmed to have polyps/fibroids will have a rapid reassurance and resolution to their problem and they can progress to their treatment with out delay. In a large number of cases sonohysterography may eliminate the need for further more invasive investigations and treatments.
It also means that patents requiring further intervention have clear information on what is needed and why. Only patients confirmed to have polyps or fibroids will be put on the waiting list for a hysteroscopy and resection of the polyp or the fibroid. This when performed needs a general anaesthetic, operating theatre facility, specific equipment and hence can entail some delay to your treatment in the assisted conception unit. By removing those who do not need this help, we expedite progress of those who do.
Are there any side effects or possible complications?
There may be some cramping lower abdominal discomfort similar to period type ache. This usually settles as soon as the procedure is finished which itself does not take more than 5 minutes to complete. Simple relief such as Nurofen or Paracetamol can be useful. Rarely patients may feel faint during the procedure. This is usually related to the manipulation in the neck of the womb. The procedure would stop immediately and recovery is often quick.
Occasionally the procedure is not successful because the fluid leaks rapidly too quickly to allow accurate measurements. This is rare.