Sonohysterography (SHG) in Reproductive Medicine

Sonohysterography (SHG) is a simple ultrasound (US) imaging technique to visualize the 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 US visualization. Saline infusion sonohysterography (SIS), hysterosonography (HSN), and gel instillation sonography (GIS, where gel is used instead of saline) are synonym names for SHG. SHG has been demonstrated to be a safe, cost-effective, and minimally invasive method for the evaluation of congenital and acquired uterine abnormalities. Randomized control trials, systematic reviews, and meta-analyses have all demonstrated that SHG has comparable sensitivity, specificity, and accuracy in diagnosing intrauterine abnormalities to hysteroscopy. Therefore, SHG is comparable to hysteroscopy as gold standard for intrauterine evaluation. Published guidelines by ASRM, AIUM, and ACOG on SHG are easy to implement in routine reproductive medicine and/or gynecological practice. Gynecologists performing SHG should undergo education and training, be skilled in the transcervical placement of catheters, and demonstrate competence in interpreting SHG. By using thin flexible catheters, placing them inside the cervix and injecting the warm saline slowly, this procedure can be pain-free. SHG can be also used to assess tubal patency. SHG has been established as the initial test for screening and evaluation of the uterine cavity for the diagnosis of infertility; recurrent pregnancy loss, before ART; and the evaluation of abnormal uterine bleeding (AUB).