Aqua Scan (Saline Infusion Sonography – SIS): Accurate Uterine Cavity Evaluation with Ultrasound

What Is Aqua Scan (Saline Infusion Sonography – SIS)

Aqua Scan, also known as Saline Infusion Sonography (SIS), is a specialized diagnostic ultrasound examination used for the detailed evaluation of the uterine cavity. It is a modern and minimally invasive procedure during which a small amount of sterile saline solution is infused into the uterus through a thin catheter in order to improve the visibility of the internal uterine structures.

The presence of the fluid gently expands the uterine cavity, allowing the doctor to identify possible abnormalities or structural changes with greater accuracy, including findings that may not always be visible during a standard transvaginal ultrasound. In this way, Aqua Scan provides high-resolution imaging of the endometrium and contributes significantly to accurate diagnosis.

This examination is widely used in fertility investigations, as the normal structure of the uterine cavity is essential for successful embryo implantation. At the same time, it is a valuable diagnostic tool for evaluating gynecological symptoms such as abnormal uterine bleeding, providing reliable information about the anatomy and condition of the uterus.

What Does Aqua Scan Evaluate?

Aqua Scan is a key diagnostic tool for detecting intrauterine abnormalities that may affect fertility or cause gynecological symptoms.

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Through this examination, the following conditions can be identified with high accuracy:

Uterine polyps, which may interfere with embryo implantation
Submucosal fibroids that distort the uterine cavity
Intrauterine adhesions (Asherman syndrome)
Congenital uterine abnormalities (such as uterine septum)

The detailed visualization of the uterine cavity makes Aqua Scan especially valuable in infertility investigations and in planning the most appropriate treatment approach.

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When Is Aqua Scan Recommended?

Aqua Scan is an essential examination for the detailed evaluation of the uterine cavity, especially when there is suspicion that the structure of the uterus may affect fertility or be associated with gynecological symptoms. It is often used as the next diagnostic step when a standard transvaginal ultrasound cannot provide sufficiently clear findings.

It is mainly recommended in cases such as:

Unexplained infertility, where intrauterine factors affecting implantation need to be excluded
Recurrent miscarriages, in order to identify abnormalities of the uterine cavity such as adhesions or uterine septum
Preparation before In Vitro Fertilization (IVF), to ensure the endometrium is suitable for embryo implantation
Abnormal uterine bleeding, such as bleeding between periods or heavy menstruation, where polyps or fibroids may be suspected
Follow-up or confirmation of findings from previous examinations when greater diagnostic accuracy is required

The timely and appropriate use of Aqua Scan allows the identification of conditions that may affect fertility, contributing to the selection of the most suitable treatment strategy.

How Is the Aqua Scan Examination Performed?

Aqua Scan is a short, safe, and minimally invasive procedure performed in the doctor’s office without the need for anesthesia. Proper timing is essential, which is why the examination is usually scheduled between the 6th and 12th day of the menstrual cycle, after the end of menstruation and before ovulation.

The procedure includes the following steps:

The patient is positioned in a gynecological examination position, similar to a standard ultrasound examination
After an initial transvaginal ultrasound, a thin and flexible catheter is inserted through the cervix
Sterile saline solution is gradually infused into the uterine cavity, gently expanding the uterine walls
At the same time, using transvaginal ultrasound imaging, the doctor monitors the uterus in real time and identifies any abnormalities

The examination lasts approximately 10–15 minutes and is well tolerated by most women. After the procedure, mild discomfort or slight fluid leakage may occur, but no recovery time is required.

Advantages of Aqua Scan

Aqua Scan is considered one of the most reliable and accurate methods for evaluating the uterine cavity, offering significant diagnostic advantages compared to other examinations. The use of saline solution combined with ultrasound imaging allows clear visualization of the uterine walls and possible pathological findings.

The main advantages include:

High diagnostic accuracy in detecting uterine polyps, submucosal fibroids, and intrauterine adhesions
Improved visualization of the uterine cavity compared to standard transvaginal ultrasound
No radiation exposure, making the procedure safe for repeated use
Minimally invasive procedure without the need for anesthesia or medication
Well tolerated by patients, with only mild discomfort during the examination
Immediate return to daily activities without restrictions
Ability to provide immediate evaluation and real-time medical decision-making

The combination of safety, accuracy, and speed makes Aqua Scan an essential tool in the modern approach to infertility evaluation and the diagnosis of uterine conditions.

Frequently asked questions about Aqua Scan (Saline Infusion Sonography – SIS)

Is Aqua Scan a safe examination?

Aqua Scan is considered a highly safe diagnostic examination because it does not use radiation and relies exclusively on ultrasound imaging and sterile saline solution. The procedure is minimally invasive and performed in a controlled medical environment, significantly reducing the risk of complications. In rare cases, mild discomfort or slight bleeding may occur, but these symptoms usually resolve quickly without treatment. The risk of infection is very low and is minimized through proper medical evaluation before the examination.

Is Aqua Scan painful?

Most women describe Aqua Scan as a well-tolerated examination with mild discomfort similar to light menstrual cramps. This sensation is mainly caused by the infusion of saline solution into the uterus and lasts only a few minutes. No anesthesia is required, and after the procedure the patient can immediately return to her daily activities. In cases of increased sensitivity, a mild pain reliever may be recommended before the examination if advised by the doctor.

What is the difference between Aqua Scan and a regular ultrasound?

A standard transvaginal ultrasound provides a general view of the uterus, but in many cases it cannot accurately identify small intrauterine abnormalities. In contrast, Aqua Scan uses saline solution to gently expand the uterine cavity, allowing clearer separation of the uterine walls and improved visualization of possible abnormalities. This means that Aqua Scan can detect uterine polyps, fibroids, or adhesions with greater accuracy than a standard ultrasound.

Can Aqua Scan identify the cause of infertility?

Aqua Scan plays an important role in infertility investigation because it focuses on evaluating the uterine cavity, which is essential for successful embryo implantation. It can identify pathological conditions such as uterine polyps, fibroids, or adhesions that may negatively affect fertility. However, it does not evaluate fallopian tube patency or other infertility factors, which is why it is often part of a comprehensive fertility assessment.

When is the best time to undergo Aqua Scan?

The examination is ideally performed immediately after menstruation and before ovulation, usually between the 6th and 12th day of the menstrual cycle. During this phase, the endometrium is thinner, allowing better visualization, while pregnancy can also be safely excluded. Proper timing is essential for reliable results and is always determined in consultation with the treating physician.

Are there any side effects after Aqua Scan?

After the examination, mild abdominal discomfort, slight fluid leakage, or light spotting may occur. These symptoms are considered normal and usually resolve within a few hours. Serious complications are extremely rare. Patients are advised to contact their doctor if they experience severe pain, fever, or prolonged bleeding, although such cases are uncommon.

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Dr. Chrysostomos (Makis) Papadopoulos Obstetrician – Gynecologist, MD, PhDc, MIC I

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Dr. Chrysostomos Papadopoulos - Specialist in Infertility, Endocrinology & Menopause in Athens

Dr. Maria Oikonomou Obstetrician – Gynecologist

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