A SIS (saline infusion sonogram) is an ultrasound study of the uterus and uterine lining (endometrium) that identifies abnormalities that may interfere with embryo implantation and fertility. The test is done between days 5-9 of the menstrual cycle and shows abnormalities such as fibroids, uterine polyps, and scarring. No preparation is needed for the procedure, and it is not done under any form of sedation. A small catheter is placed in the cervix, and sterile saline is inserted into the uterus to distend and better visualize the uterine cavity, while an ultrasound is performed.
The purpose of this test is to identify intrauterine abnormalities which can contribute to infertility, miscarriage and abnormal uterine bleeding. Conditions that may be found include a polyp, myoma (fibroid), intrauterine adhesion (scar tissue), uterine septum or other pathology. If an abnormality is discovered with this test, corrective surgery may be recommended. The entire procedure should take no more than 10-15 minutes.
(Note: The SIS is usually a test most patients do before a transfer to optimize transfer success. This procedure is usually covered by insurance. It is performed in the clinic between 10:00am and 12:00pm. Lastly, you will be prescribed a 3 day course of Doxycycline, which is an antibiotic that will help prevent infection)
After the procedure:
You should feel well enough afterward to drive yourself home or back to work.
You may resume normal activities right away.
Expect to have minimal vaginal spotting.
A small amount of sterile water may leak out as well.
If you develop any fever, unusual pain or heavy vaginal bleeding, call the office immediately for prompt evaluation.
What to expect: Mild cramping is the most commonly reported side effect.
A hysteroscopy (hysto) is a minimally invasive surgery that allows a physician to view the inside of the uterus. A long, thin, lighted device called a hysteroscope is inserted into the uterus, which projects an image of the uterus on a screen. Saline is also inserted into the uterus via a catheter to expand the uterus for better visualization. The physician can then look for uterine growths or scars and remove them if they are present. This procedure is performed between days 5-9 of the menstrual cycle and is done under IV sedation. To prepare for a hysteroscopy, one should refrain from eating 6 hours prior to the procedure and refrain from drinking fluids 3 hours prior to the procedure. Light vaginal bleeding and cramping are the most commonly reported side effects of a hysteroscopy. Drowsiness and nausea are common side effects from IV sedation, and we have a nurse monitor our patients until they are ready to be discharged. One will not remember the procedure or be aware of the procedure as it’s happening due to the IV sedation.
(Note: You will be prescribed a 7 day course of Doxycycline, which is an antibiotic to help prevent infection. This test is usually not performed if your SIS results are normal. )
After the procedure:
- You may experience spotting or bleeding for the next 7-10 days, this is normal. Spotting or bleeding may stop and restart during this time. Do not use a tampon, instead use a sanitary pad or panty liner in order to assess the bleeding.
- You will probably have mild to moderate lower abdominal cramps (similar to menstrual cramps), this is normal. This is best treated with Tylenol (Acetaminophen) or Motrin/Advil (Ibuprofen) which are sold over the counter. You may take up to 1000mg of Acetaminophen every 6 hours (if you have any kidney problems you make take up to 500mg of Acetaminophen every 6 hours) and 600mg of Ibuprofen every 6-8 hours. The two medications may overlap, as long as they are taken 2 hours apart.
An Endometrial Receptivity Analysis (ERA) test involves taking a small sample of endometrial lining (endometrial biopsy) and testing it to determine the optimal day for an embryo transfer. This test is done in the cycle prior to an embryo transfer cycle, and the uterus is primed using the same medications that are used in a frozen embryo transfer cycle. The sample taken during the biopsy is sent to an outside lab (Igenomix) that performs a molecular analysis to assess the endometrial receptivity of the sample. No preparation is required for the procedure itself, and it is not done under any form of sedation. Mild discomfort and cramping may be experienced while the biopsy is performed.
It is important to transfer an embryo into the uterus at the optimal time. The timing of the transfer must be in sync with the endometrium, which is the tissue lining the uterus. This is where the embryo would implant.
There are three potential results from the biopsy:
Pre-receptive: This indicates that at the time the endometrial biopsy was taken, the endometrium was not yet ready to receive a potential embryo and transfer at this time may not be optimal. During the frozen embryo transfer cycle, the timing is adjusted to be later than when the endometrial biopsy was performed.
Receptive: This indicates that the time the endometrial biopsy was taken was an optimal time to transfer an embryo.
Post-receptive: This indicates that at the time the endometrial biopsy was taken, the endometrium had already reached the stage for optimal embryo transfer and gone past it. During the frozen embryo transfer cycle, the timing is adjusted to be earlier than when the endometrial biopsy was performed.
Additionally, the fee for the ERA test is $1,200:
- $600 is the procedural fee paid to Generation Next Fertility
- $600 is for the biopsy examination fee that is paid to Igenomix
If this test is performed, the fee of $1,200 will be due on the day of the procedure. Please be advised if payment is not received in full, procedure will be cancelled.
An Endometrial Biopsy can also be performed in which a small piece of tissue from the lining of the uterus (the endometrium) is removed for examination under a microscope. The removed tissue is examined for endometrial inflammation or endometritis.
(Note: To help with cramping and discomfort, Motrin can be taken prior to the procedure)