Sonohysterogram (SHG)

What is an SHG?

Sonohysteropraphy (SHG) is a technique in which fluid is injected through the cervix into the uterus, and an ultrasound is used to make images of the uterine cavity. The fluid shows more detail of the inside of the uterus than when ultrasound is used alone.

Why is an SHG done?

A sonohysterogram can find the underlying cause of many problems, including abnormal bleeding, infertility and repeat miscarriage. The procedure can detect the following conditions:

  • Abnormal growths inside the uterus, such as fibroids or polyps
  • Scarring inside the uterus
  • Abnormal uterine shape

How is an SHG Performed?

A speculum is placed in the vagina. It holds the vagina open. Your doctor will pass a swab through the speculum to clean the cervix.

Next, a thin tube called a catheter is inserted through the vagina. It is placed in the opening of the cervix or in the uterine cavity. The speculum then is removed.

The transducer is placed in the vagina again. A sterile fluid is slowly passed through the catheter. Cramping may occur as the fluid goes into the uterus.

When the cavity is filled with fluid, ultrasound images are made of the inside of the uterus and uterine lining.

My Experience

When I first saw my RE, one of the first things she wanted to do was perform a saline sonogram (SHG) on my uterus to see if there were any structural abnormalities. After my second loss I asked my OB if we should perform this kind of testing and she said no, the likelihood something was wrong was very low given that I had been easily getting pregnant, and nothing abnormal showed up on my ultrasound. Luckily my RE disagreed and encouraged me to have it done because it was during the SHG we discovered I had a uterine septum, which was very likely to have contributed to my losses. Had I only listened to my OB by skipping the test and just “tried again” I would very likely suffered a third loss (I mention this just to emphasize the importance of being our own advocate, pushing back on doctors when needed, and getting as much testing down as you can).

For me, the procedure was not painful, although I know the experience can vary from person to person. My SHG felt similar to a pap smear, but a bit longer and more uncomfortable. I took a few Motrin before the procedure, which helped as it’s common to experience some cramping. I have a tricky cervix, and the hardest part for me was waiting while the doctor got the catheter through my cervix. Once that was done she released saline solution into my uterus. The uterus does not like foreign substance and can contract in an attempt to reject it. This is why cramping might occur (for me, it was mild; I suddenly felt how I do when I’m about to get my period). My RE took a few photos on the ultrasound machine, and we sat and discussed what she found once I was dressed again. I had no pain after she was done.

My RE saw what she suspected to be a small septum in my uterus (an upside-down, triangular shaped piece of tissue which divides all or part of the uterine cavity in two. The septum does not have proper blood supply, so if an embryo were to implant over the septum it would likely result in miscarriage). In order to be sure, she’d need to perform a hysteroscopy, where a camera would be inserted into my uterus under general anesthesia. If there was indeed a septum, she would remove it by clipping it out. I underwent the surgery the following month, where it was found that I did indeed have a uterine septum and it was much larger than what even the ultrasound showed. My RE estimated it took up approximately 50% of my uterus.

If you have any questions about my SHG or hysteroscopy, please feel free to email me at twelveweeketernities@gmail.com.

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