Techie Tuesday: SHG (Sonohysterogram)

Welcome to another techie Tuesday.  I am going to spend a few moments providing links to some IF techie things. I want to state pretty clearly that I am not a medical professional.  I am a computer geek/IT professional with over 20 years in the computer and biotech industries. A geeky gal who likes to research her condition/situation/whatever. My supreme computer nerdiness has enabled me to dig up some good places on the net where I have found some good info.  I wanted to provide those links so others who are in the same situation as I have been.  Desperate and wanting to find out as much as you can about the procedures that have been recommended to you.  I get it.  I’ve been there.  I am still there.
After getting my HSG check earlier in the month. I was also scheduled at the RE’s office to get checked out with a SHG (sonohysterogram).  Sonohysterogram is a fancy way to say “ultrasound-whoohaa-checker-upper”.  My doctor recommended this test in addition to the HSG because this tests gives the doctors a better look at the inside walls of the uterus while it has been expanded with sterile saline. 

Here is a some good description on HSG from my clinic's website:

Sonohysterogram (SHG)
The sonohysterogram (SHG) is similar to the hysterosalpingogram (HSG) in that it helps us to evaluate the uterine cavity. But, with the SHG, saline rather than an X-ray dye is instilled into the uterus and the progress of the saline is tracked with ultrasound rather than X-ray. The SHG provides clear views of the uterine muscle along with the endometrial cavity. Thus, we are able to see abnormalities like fibroids by SHG that cannot be seen by HSG. Also, by using ultrasound, we can utilize new 3D ultrasound technology that allows us to rotate the image of the uterus to obtain the best diagnostic picture. Even the most subtle abnormalities can be clearly seen with SHG allowing for accurate treatment planning. Unfortunately, the SHG does not provide any information on the fallopian tubes so it cannot replace the HSG.

I also found that this article has a good description of the procedure

Why would your Dr. recommend a SHG?

Well the way I see it, your RE clinic should perform this test to determine the following thing:

1. Do you have any uterine abnormalities that may be causing your infertility?
A few years ago it was with a combination HSG/SHG that we found a fibroid that was likely to be a source our infertility.  After it was surgically removed, a new SHG test showed some adhesions (scar tissue) and polyps that may cause PID (pelvic inflammatory disease).  This can also affect whether or not you can become and stay pregnant.  Some ladies who have unfortunately miscarried have had fibroids found that may been attributed to their loss.  I don’t have endometriosis or PCOS, so I can’t talk on those subjects, but if anyone has a blog that discusses the methods of their diagnosis, I would  be happy to provide a link.

Here is a good web article about using ultrasound to diagnose IF problems:

How does an SHG feel? What is involved from the patient's point of view?

Going through a SHG for me was relatively easy.  You are asked to arrive at the doctor’s office with a full bladder.  OK. Well, good point.  Trying to go through your day getting enough liquid in your system to make a “full bladder” without overdoing it, desperately hoping you don’t piddle on the floor like some excited cocker spaniel can be a bit tricky.  But I digress…

After taking off your clothes below the waist, you are given what I call “the paper hula skirt” to wrap around you for privacy/modesty/who are we kidding?  Then you enter the ultrasound room and are asked to sit in the exam chair (y’know the one with the stirrups).  In my RE’s office I have never had a technician perform the ultrasounds.  It has always been one of the 4 RE docs who perform and interpret the exam.  I like this aspect a lot.  They get to see first hand what is going on.  This is yet another reason why I dig my RE’s office.  I have been poked and prodded by all of the doctors at one time or another.  I find that they are all stellar professionals.
And now on to the fun part…once in the exam chair, they put the ultrasound goop on your belly then smear it around with the barcode reader looking thingy.  When that is in place, a speculum is used to access the cervix and a catheter with saline solution is introduced.  Then the speculum is removed and they insert the dildocam (what is the real name for this thing anyway?  The vagascope? Pooterviewer?).  I was able to watch while they inflated the uterus with saline and DocO pointed out some fleshy bits where the endometrial lining was supposed to be smooth.  “Yup.  It looks like a few polyps and adhesions.  The good news is that I don’t see any new fibroids affecting the cavity.  A simple D&C and polypectomy will take care of that.  Then I expect we can get a really good looking lining to help with implantation for the IVF.”
How did it feel?  A little uncomfortable, but mostly because they are moving the wands around inside and out while your bladder is full.  The saline push didn’t cause me any discomfort, especially since the HSG earlier in the month was quite uncomfortable, but this was because they were trying to open up the constricted fallopian tubes.  All and all I was very happy with the result.  Knowing a cause to something that may have negatively affected the results of my earlier IUIs made me feel better and helped me keep optimistic that things would look better in the future.

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