Examination

Sonohysterography (SHG)

What is saline infusion sonohysterography (SHG)?

Sonohysterography is an ultrasound procedure to evaluate the inside of a woman's uterus, where a small volume of saline is inserted into the womb, through the cervix. Sonohysterography may discover hidden causes of different genital problems, such as abnormal uterine bleeding, infertility or recurrent misscariages.

This method can detect:

  • Abnormal formations within the uterine cavity (fibroids or polyps)
  • Endometrial adhesions / synechiae
  • Malignant lesions / growths
  • Congenital uterine defects

How SHG is performed ?

SHG is typically performed in the first part of the menstrual cycle, after menstruation. The procedure starts with a transvaginal ultrasound examination, after which a narrow catheter is inserted into the uterine cavity, through the cervix. Ultrasound examination is continued while sterile saline is injected into the uterus.

Risks and complications of the procedure:

The test may cause mild cramps, bleeding or vaginal discharge. Some women may experience cramps for several hours. The most common sever complication of SHG is the pelvic infection; however it occurs in less than 1% of cases. You should contact your doctor if you experience pain and/or fever within the first 2 days after SHG. Some doctors prescribe painkillers and/or antibiotics before the procedure.

Consultation, Anamnesis

During this stage, the doctor usually has a discussion with the patients regarding the history of the infertile couple, previous or ongoing diseases, medical and surgical interventions and recommended examinations.

If necessary, the doctor offers brief information about the existing infertility problems.

Blood collection, Laboratory testing

Practically this means blood collection. Usually, it is required on day 3 and 20-21 of the cycle. Besides the general blood test different hormonal levels are checked.

It is critical to establish the serum level of the hormone which stimulates ovulation (follicle stimulating hormone, FSH). In case of some diseases which lead to infertility, it is also important to establish the so-called luteinizing hormone (LH) which is responsible for creating the corpus luteum. Furthermore, measuring the ratio of the two above mentioned hormones is fundamental.  Establishing the serum level of the female hormone produced by the ovary, the so-called estrogen (E2) helps choosing the drugs which would effectively stimulate the ovary. Assessing the serum level of the hormone called prolactin which is responsible for lactation and the control of the thyroid function before starting any therapy has a similar importance.

During the second part of the cycle, the hormone secreted by the corpus luteum (progesterone) makes the uterine lining suitable for fixing the fertilized egg, and therefore in cases with low progesterone levels repeated abortion can occur.

In many women with hormonal disorders and with lack of ovulation various chromosomal differences can be found in the background.

In addition to blood testing measuring basal body temperature is a useful tool in the assessment of hormonal changes. This is a very simple test that can be done by women at home by themselves at home. As basal body temperature rises after ovulation, the test can provide important information regarding the occurrence of ovulation.

Besides hormonal examinations individuals suffering from different viral infections (hepatitis, HIV) can be detected by blood testing.

General gynecological examination

It is an ordinary gynecological exam.

Anatomical alterations behind infertility are indicated most frequently by pelvic pain and the abnormal results of gynecological exam. It is worthmentioning the fact that in the case of a severe ovarian inflammation (which is not just a simple inflammation of the ovarian tissue, but it also commonly affects the fallopian tubes), the fallopian tube obstruction has a probability of 11%, and in the event of repeated inflammatory processes this rate increases to 54%.

Ultrasound examination

This exam must be performed several times during examination and treatment. On the one hand ultrasound scan can be useful in the detection of different anatomical abnormalities of the genitalia, and on the other hand it could assess the ovarian follicular status and growth during ovarian stimulation therapy.

Ultrasonography can also indicate if ovulation has occurred. In order to exclude any organic infertility, ultrasound imaging should include the uterine cavity, the fallopian tubes, and the area surrounding the fallopian tubes, to check for any possible adherences. There are several conditions that predispose to organic infertility: previous or chronic infections (after appendicitis, infection of the fallopian tubes, sexually transmitted diseases, abortion followed by complications), or they can be of non-infectious origin, for example the congenital lack of the fallopian tube, benign tumors of the uterus (myoma) or endometriosis.

Hysterosalpingosonography (HyCoSy), which can be performed during the first part of the cycle in ambulatory settings, without hospitalization, is considered to be a modern ultrasound imaging method. During the exam, a thin flexible catheter is passed through the cervix in the endometrial cavity and then an ultrasound contrast agent is injected through the catheter into the uterus and into the fallopian tubes. The transvaginal ultrasound is used to display the image of the womb and both adnexa. The procedure is suitable for assessing the patency of the fallopian tubes, as well as for the detection of anatomical abnormalities of the uterus. The advantages of the method include that it does not require anesthesia, it is a simple and rapid outpatient exam that does not require X-rays and it provides a thorough and quick assessment of the uterus and of the fallopian tubes.

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