What is Saline Infusion Sonohysterography? When You Need It and Why It Matters

If your doctor mentioned something called saline infusion sonohysterography, you're not alone in wondering what that actually means. It's a simple imaging procedure that uses sterile saline and a transvaginal ultrasound to get a clearer look at your uterine cavity—often to check for uterine abnormalities like polyps or fibroids.

According to the American College of Obstetricians and Gynecologists (ACOG), SIS is commonly used in fertility testing to identify issues that may affect infertility treatment outcomes. In this guide, we’ll break down how it works, when it’s done, and what you should expect—without the medical jargon.

What is Saline Infusion Sonohysterography?

Ever been told you might need something called saline infusion sonohysterography and felt totally lost? You're not alone. It sounds complex, but the idea is simple and safe.

This is a special imaging procedure that lets your doctor look inside your uterus using sterile saline and sound waves. It helps find things like uterine scarring, uterine septum, or scar tissue that regular ultrasounds might miss.

“SIS provides enhanced visualization of the uterine cavity compared to standard ultrasound, especially in patients with unexplained symptoms.”
— American College of Obstetricians and Gynecologists (ACOG)

When is a Saline Infusion Sonohysterogram Recommended?

Not every issue shows up on a regular ultrasound. That’s why your doctor might suggest a saline infusion sonohysterogram to get a closer look. It’s especially helpful when something’s going on inside the uterus that needs clearer answers.

A small amount of sterile saline is gently inserted through the cervix, expanding the uterine cavity. This gives the doctor easy access to spot anything that could be causing symptoms like vaginal spotting or pelvic pain.

According to Mayo Clinic, saline sonography can detect more than 90% of uterine abnormalities that affect fertility and bleeding.

1. Abnormal uterine bleeding

• Especially when there's no clear explanation
• Helps locate uterus lining irregularities

2. Suspected uterine fibroids or polyps

• Can show their size and location from different angles

3. Evaluation before fertility treatment

• Common step before an IVF cycle
• Can identify uterine scarring or cervical canal issues

4. History of recurrent pregnancy loss

• Used to check for a uterine septum or scar tissue

5. Monitoring uterine abnormalities

• Tracks changes over time with ultrasound images

6. Unexplained infertility

• May reveal many uterine abnormalities that weren't visible before

7. Follow-up after abnormal ultrasound findings

• Offers a clearer, fluid-enhanced view
• Especially useful when fallopian tubes or the vagina aren’t clearly visible

How is Saline Infusion Done during a Saline Sonogram?

If you’re wondering what actually happens during a saline sonogram, you’re not alone. The process might sound intimidating at first, but it’s a safe procedure that most patients tolerate well. Let’s walk you through it, step by step.

1. Preparing for the procedure

• You may be asked to arrive wearing comfortable clothing
• A special preparation includes possibly taking pain medication beforehand
• Your care team may request a urine sample to confirm you're not pregnant

2. Positioning and transvaginal ultrasound setup

• You’ll lie down with your knees bent, similar to a pelvic exam
• A transducer wand is inserted into the vagina
• This provides initial images of the inside of the uterus

3. Inserting the catheter into the uterus

• A small catheter is gently inserted through the cervix
• This part may cause mild discomfort, but it usually passes quickly
• There’s only a slight chance of pain beyond mild cramping

4. Infusing sterile saline into the uterine cavity

• Sterile saline is slowly pushed in through the catheter
• This helps open the uterine cavity for better views
• The fluid causes minimal pressure, not pain

5. Capturing real-time images with ultrasound

• The ultrasound transducer captures a moving image
• High frequency sound waves are used to spot any concerns
• The doctor checks from different angles for better clarity

According to Johns Hopkins Medicine, saline sonograms are over 95% effective in detecting uterine abnormalities when standard ultrasounds fall short.

6. Duration and comfort during the procedure

• It typically takes about 20–30 minutes
• You may feel mild pressure but not sharp pain
• Some women say they feel uncomfortable for only a minute or two

7. What happens immediately after the scan

• You’ll be given a sanitary pad for light discharge
• Most patients return to normal activities the same day
• If needed, taking pain medications like ibuprofen can help

What’s the Difference Between a Transvaginal Ultrasound and a Saline Ultrasound?

If you're trying to understand the difference between a regular transvaginal ultrasound and a saline ultrasound, you're not alone.

Both tests use sound waves to look inside the uterus, but one gives a much clearer picture—especially when you're dealing with issues like infertility treatment or recurrent pregnancy loss.

Here’s a quick comparison to help you see how they differ.

Is Saline Infusion Sonohysterography part of Fertility Testing?

Yes, it often is. If you're going through fertility testing, your doctor might suggest saline infusion sonohysterography to get a better look inside the uterus.

It’s especially useful when your cycles seem regular but pregnancy isn’t happening.

This test is considered low risk and doesn’t take long. It helps your doctor evaluate for things like polyps, fibroids, or old pelvic infection that may not show up otherwise.

According to the American Society for Reproductive Medicine (ASRM), SIS increases the detection of uterine abnormalities by up to 25% in women with unexplained infertility.

• A small saline injection opens the uterine cavity for clearer imaging
• It can uncover issues behind unexplained bleeding or failed implantation
• Some may feel potential discomfort, but it's usually mild and short-lived
• Wearing comfortable clothes helps you relax during the process

Most patients say the procedure is manageable, and your doctor will explain everything ahead of time.

Can it Support Infertility Treatment or Recurrent Pregnancy Loss?

Yes, and it’s one of the reasons many specialists recommend it. If you're struggling to conceive or have had miscarriages, your doctor may suggest a saline infusion sonohysterography to take a closer look. It helps uncover issues that often go unnoticed on regular scans.

By gently expanding the uterus with saline, this test gives a clearer view of the cavity. That means doctors can detect things like fibroids, adhesions, or structural concerns that may be affecting your chances of a successful pregnancy.

The American College of Obstetricians and Gynecologists reports that SIS improves diagnosis of uterine causes in over 25% of women with recurrent pregnancy loss.

Why it helps:

• Identifies uterine factors that may impact embryo implantation
• Detects abnormalities like polyps or septum that may interfere with fertility
• Guides treatment planning before IVF or other procedures

While this test is generally safe, doctors do mention pelvic infection as the most common serious complication—though it's rare and usually preventable with standard precautions.

Does Saline Infusion Sonohysterography Carry Risks?

This procedure is considered safe for most patients. But like any medical test, there are a few things to be aware of so you feel more prepared. Your doctor will walk you through what to expect.

Some people feel mild cramping during or shortly after the test. You might also notice light vaginal discharge or spotting, which is completely normal and usually clears up within 24 hours.

1. Mild cramping or discomfort

Usually goes away quickly

Over-the-counter meds can help

2. Light spotting after the procedure

Using a sanitary pad is often recommended

Avoid tampons for a day

3. Risk of infection (rare)

This is the most common concern, but it’s still uncommon

If you notice a fever or unusual pain, call your doctor

4. Allergic reaction to saline (extremely rare)

Reactions are very rare but always reported before proceeding

5. When the procedure may be delayed or avoided

If you’re pregnant or showing signs of infection

Or if you’re still bleeding from your menstrual cycle

What Should You Expect After a Saline Sonohysterogram?

Most people are surprised by how quickly they bounce back after the test. The whole thing usually wraps up in about 30 minutes, and recovery is simple. But it’s still helpful to know what’s normal afterward.

You might feel a little mild cramping—kind of like period discomfort. That should ease up with rest or taking pain medications like ibuprofen if needed. A bit of vaginal spotting or discharge is common and nothing to worry about.

Aftercare tips and what’s normal:

• Mild pelvic pressure or cramps may last a few hours
• You can return to normal activities the same day
• Wear a sanitary pad in case of light spotting
• Avoid tampons or sex for 24 hours to reduce infection risk
• Reach out to your care team if you notice unusual pain or fever

It’s a good idea to plan the test after your menstrual cycle ends for best comfort and clearer imaging.

What Dr. Anshu Agarwal Says About Saline Infusion Sonohysterography

Dr. Anshu Agarwal is a highly experienced gynecologist and infertility specialist based in Ranchi, India, with over 18 years in reproductive healthcare. She holds an MS in Obstetrics & Gynaecology and has led departments at top hospitals including Safdarjung, Paras HEC, and Medica.

Her clinical focus includes fertility treatments, laparoscopic surgeries, and diagnostic procedures like saline infusion sonohysterography (SIS). She’s helped hundreds of couples conceive—many without the need for IVF—and is known for her compassionate, evidence-based approach.

You can learn more about her credentials and patient care philosophy at dranshuagarwal.com.

When it comes to SIS, Dr. Agarwal believes the value often goes beyond just identifying a problem.

“SIS isn’t just about detecting issues—it’s also about ruling out concerns with confidence. That peace of mind can make a huge difference for patients,” she shares.

She uses SIS when previous scans show unclear results or when patients have ongoing implantation failure despite normal reports.

“It helps us avoid unnecessary treatments by confirming what’s really going on,” she explains.

Dr. Agarwal stresses that SIS isn't for everyone—it’s recommended only when it brings diagnostic value, like in suspected endometrial irregularities or post-surgery follow-ups. Her goal? To reduce “testing fatigue” and keep the patient’s path forward clear.

She also highlights the emotional benefit of the procedure:

“Whether or not we find something, patients often feel more in control after an SIS. That mental clarity matters in fertility care.”

What makes her approach unique?

• Uses SIS to resolve contradictory or uncertain imaging results
• Helps avoid unnecessary hysteroscopies or exploratory surgeries
• Applies SIS in post-surgical follow-ups to confirm full healing
• Focuses on patient confidence—not just clinical data
• Avoids repeating diagnostic loops unless truly necessary

This approach reflects Dr. Agarwal’s belief that fertility testing should not only be accurate, but also supportive and intentional. If you’re considering SIS, speaking with a specialist like her can offer both clarity and comfort.

FAQs about SIS

1. What is a saline sonogram and how is it different from other ultrasounds?

A saline sonogram, or SIS, uses sterile saline to gently expand the uterine cavity. This gives doctors a clearer view than a standard transvaginal ultrasound, especially for spotting small issues like uterine polyps or scar tissue.

2. Is a saline sonogram necessary for IVF treatment?

Often, yes. It helps ensure the uterus is ready for embryo implantation by identifying any structural issues ahead of time.

3. What is the difference between HSG and SIS?

HSG checks the fallopian tubes using X-ray and dye, while SIS focuses on the uterine cavity using saline and ultrasound — and doesn’t involve radiation.

4. Does SIS improve fertility outcomes?

It doesn't treat fertility issues, but it helps detect problems that could prevent pregnancy, guiding better treatment.

5. Why does a saline sonogram feel painful for some people?

Some feel mild cramping during the saline infusion, but it’s usually brief and manageable.

6. Does insurance cover saline infusion sonohysterography?

Coverage varies. It’s best to check with your provider before scheduling.

7. Is saline infusion sonohysterography safe for everyone?

It’s a low risk, safe procedure for most, but not advised if you're pregnant or have an active infection.

8. How does saline infusion sonohysterography help in reproductive medicine and fertility care?

It’s a trusted tool in reproductive medicine, especially for evaluating unexplained infertility or recurrent pregnancy loss.

Conclusion

If you’ve been wondering whether saline infusion sonohysterography is right for you, this guide was meant to ease your mind and answer your biggest questions. It’s not just another test—it’s a tool that helps uncover what’s happening inside your body when you're dealing with fertility concerns, unexplained bleeding, or recurrent pregnancy loss.

Many patients walk into their SIS appointments feeling nervous, but walk out with a clearer picture and a stronger sense of direction. Whether the results confirm something or rule things out, the information gained is often key to making confident decisions about your next steps.

If your doctor has recommended SIS, take it as an opportunity to get answers, not a sign that something’s wrong. Every person’s experience is unique, so don’t hesitate to talk openly with your care team about what to expect, how to prepare, or any worries you may have—they’re truly there to help.