One of our initial steps in creating your personalized treatment plan is to determine the cause of your infertility issues. We may recommend an evaluation of the cervix and/or uterus to help make this determination. The two diagnostic procedures described below cause very little discomfort and provide a wealth of information.


A sonohystogram, or saline sonogram, is a method of evaluating the inside of the uterus to determine if there are any abnormalities such as polyps, fibroids or scar tissue that may play a role in a patient having difficulty getting pregnant. It is performed for abnormal uterine bleeding and prior to an In Vitro Fertilization (IVF) cycle to ensure that there are no abnormalities that would interfere with an embryo implanting.

We perform the sonohystogram by instilling sterile saline inside the uterine cavity with a thin, flexible tube. A transvaginal ultrasound follows. The uterine walls normally touch each other, but the placement of saline expands the inside of the uterus and allows us to see anything that may be protruding into the otherwise collapsed uterine cavity. For this reason, a sonohystogram gives us far more information than a transvaginal ultrasound alone.

If the sonohystogram is performed prior to an IVF cycle, a mock embryo transfer is typically performed at the same time to gather necessary information about the anatomy of the cervix and uterus prior to the actual embryo transfer. Typically, a sonohystogram is not painful and does not require any pain medication.

Flexible Hysteroscopy

Hysteroscopy is a procedure in which a tiny camera is inserted through the cervix into the uterus to allow for direct visualization of the inside of the uterine cavity. Hysteroscopy is a highly accurate method of evaluating the inside of the uterine cavity. Depending on ultrasound findings or past medical history, your physician may recommend a hysteroscopy instead of a saline sonogram to evaluate the uterus.

We use a very small, flexible hysteroscope, which allows for the procedure to be performed in our clinic without IV anesthesia. We do give some pain medications prior to the procedure to ensure our patients are comfortable, so patients require someone to drive them after the appointment. The flexible hysteroscopy is a diagnostic procedure only and if any abnormalities are found, a subsequent operative hysteroscopy–performed with a larger instrument in the operating room–would be scheduled at a later date.