Sonohysterography in reproductive medicine

Sonohysterography (SHG) is a simple, cost-effective, safe, minimally invasive ultrasound (US) imaging technique for the evaluation of congenital and acquired uterine abnormalities. The goal of SHG is to visualize endometrial cavity in more detail than is possible with routine 2D or 3D transvaginal ultrasound (TVUS). Sterile saline is injected to distend the uterine cavity and serve as a contrast for its US visualization. Synonym names for this procedure are saline infusion sonography (SIS), hysterosonography (HSN), and gel instillation sonography (GIS, where gel is used instead of saline). Randomized control trial, systematic reviews, and meta-analyses have all shown that with the increased resolution of US, SHG has comparable sensitivity, specificity, and accuracy in diagnosing intrauterine abnormalities to hysteroscopy (the former gold standard for intrauterine evaluation). Published guidelines by AIUM and ACOG are easy to implement in routine gynecological and reproductive medicine practice. While using thin flexible catheters, placing them inside the cervix, and injecting the warm saline slowly, this procedure can be pain free. SHG can serve as a first-line test for screening and evaluation of the uterine cavity for the diagnosis of infertility and before ART.