Saline Transvaginal Ultrasound & Sonohysterogram (SHG Test) in NYC

Ultrasound diagnosis (sonography) involves sending sound waves to specific body sites, which reflects them to create an image that can be observed on a monitor. An ultrasound may be used for routine monitoring during IVF, for diagnostic reasons if issues are found, or for surgical reasons to correct any issues. We provide saline ultrasounds, SHG tests, and more at our NYC fertility clinic. Learn more about the ultrasound procedures at New York Fertility & IVF Surgery Associates below, or request an appointment today using the form on this page.

What is a transvaginal ultrasound?

Transvaginal ultrasound of the pelvis is the most common ultrasound procedure for gynecology and infertility patients.

  • It records the condition of a site or an organ at the time of the ultrasound – in this case, the uterus and the ovaries.
  • The ultrasound probe (transducer), which is a slim cylindrical tube covered by a sterile protective sheath, is inserted by the physician directly into the vagina.
  • By gently moving it, the uterus and the ovaries can be seen together or individually.
  • Measurements can be taken of each organ and any structure of interest such as uterine fibroids, the uterine lining (endometrium), ovarian cysts or follicles, and any abnormal structure in the pelvis.
  • The images and measurements are recorded digitally and/or on ultrasound film as a permanent record of each ultrasound procedure done.

When is a transvaginal ultrasound necessary?

There are several different reasons why a transvaginal ultrasound may be needed in infertility patients.

Ultrasound Monitoring of Ovarian Stimulation

For patients undergoing any form of IVF, a transvaginal ultrasound will be done multiple times during the course of 10-12 days of ovarian stimulation, usually every other day in the first 5-6 days, and then daily as the follicles approach the size for egg retrieval.

  • A record is kept of the follicle sizes during each ultrasound, so the doctor can see at a glance how the follicles are growing.
  • The follicle sizes, along with the estradiol (E2) hormone level on the same day, help him to determine the daily dose of stimulation.

Ultrasound at Egg Retrieval

At egg retrieval, the needle used to puncture the ovarian follicles in order to aspirate the fluid containing the eggs is attached to the transvaginal probe.

  • The probe with attached needle is introduced into the vagina and moved about in order to identify each follicle to be punctured so that the needle can be introduced into the follicle. This allows the doctor doing the retrieval to see what he is doing through the images on the monitor.
  • The aspirated fluid is collected in sterile tubes through a thin tube attached to the needle.
  • As each tube is filled, it is handed to the embryologist who will identify the egg cell under a microscope and isolate it into a dish containing growth medium.

What is a sonohysterogram (SHG test)?

A sonohysterogram (SHG test) is a special ultrasound procedure that provides a detailed visualization of the uterine cavity. This type of procedure is often necessary if the hysterosalpingogram (HSG) or routine pelvic ultrasound shows the presence of:

  • A polyp (fleshy growth on the uterine lining which can cause bleeding)
  • A submucosal fibroid (which grows from the uterine muscle into the uterine lining and the uterine cavity itself)

SHG can also show the presence of adhesions (scar tissue) within the cavity as a result of a previous C-section or severe infection of the uterus by pelvic inflammatory disease (PID).

What happens during a sonohysterogram (SHG)?

During an SHG test:

  • First, a routine transvaginal ultrasound is done.
  • Then, the uterine cavity is filled with saline solution injected through the cervix. Normally, in a non-pregnant patient, the cavity is simply the separation between the two side walls of the uterus. The saline distends this potential space so that it can be seen in its entirety when the probe is re-inserted.
  • Like the hysterosalpingogram (HSG), SHG is done after your menstrual bleeding ends, so that the uterine cavity is already clear of the old lining that was shed as menstrual blood.
  • If the SHG identifies any unwanted structure, it will subsequently be addressed surgically, usually by hysteroscopy.

What is a hysteroscopy?

A hysteroscopy is a surgical procedure on the uterus that is best done in a hospital setting because it requires anesthesia (though it can sometimes be done as an in-office procedure). It can be diagnostic only, or both diagnostic and operative (therapeutic).

What happens during a hysteroscopy?

During a hysteroscopy:

  • The hysteroscope, a thin telescope with a magnifying mini-camera at its tip, is introduced through the cervix into the uterus.
  • The doctor looks through the eyepiece and surveys the interior of the uterus.
  • He identifies any abnormalities, including any structures he needs to remove.
  • He proceeds to do so with simple miniaturized cutting, shaving, or laser instruments attached to the hysteroscope.
  • Structures that may be addressed during a hysteroscopy may include:
    • Removal of polyps
    • Targeted treatment (scraping) of a submucosal fibroid so it no longer obtrudes into the uterus
    • Breaking up of scar tissue using the tip of the hysteroscope, or removal of the tissue if the scar tissue is more fibrous
  • The specimens are retrieved through the hysteroscope and sent to the laboratory for pathologic analysis.

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