Fellowship in Infertility The use of ultrasound in the management of infertility is now routine practice not just as an aid in the diagnosis of ovulation but as an essential tool in the management of the infertile couple ID: 1047068
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1. ULTRASOUNOGRAPHY IN IUISimin.Zafardoust.M.D.Fellowship in Infertility
2. The use of ultrasound in the management of infertility is now routine practice, not just as an aid in the diagnosis of ovulation, but as an essential tool in the management of the infertile couple. AbdominalUltrasound Vaginal
3. All relevant anatomic structures in the pelvis should be identified first by transabdominal technique, and then, more detailed evaluation of the deep pelvic structures should be performed by transvaginal technique. In specific situations in which transvaginal evaluation cannot be performed or tolerated, trans rectal or transperineal evaluation can be very useful.
4. It must be emphasized that ultrasound examinations should be performed with the use of transvaginal probes.The use of abdominal ultrasound probes is outdated, inaccurate and uncomfortable for patients; it lacks detail and is indicated only when a large mass in the pelvis.
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6. Uterine factors
7. The evaluation of pelvic structures usually starts with the assessment of the uterus.The midline endometrial echo, where the anterior and posterior uterine walls are apposed to each other, are studied from the internal os to the fundus, and any discontinuity and distortion of this echo should be noted. Longitudinal and oblique scans are performed to study the region of the tubal ostia.
8. Transvaginal sonogram inthe sagittalplane showing the corpus(UI and fundusIf)of the uterus.Endometrial canal (vertical arrow) basal layer of the endometrium
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11. The impact of fibroids on fertility is dependent on their size and location.Submucous fibroids distort the midline echo and are best diagnosed in the periovulatory phase.Submucous fibroids typically distort the uterine cavity by interrupting the continuity of the smooth endometrial surface
12. A. Small intramural fibroid appearing as a round hypoechoic massSonogram of a fibroid demonstrating peripheral calcification
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17. EndometriumAssessment of the endometrium is performed in a sagittal plane.Variations of the appearance of the endometrium with different phases of the menstrual cycle and with hormonal supplementation should be consideredSaline infused sonography (SIS) or, as it is often referred to, sonohysterography, is an innovative technique to evaluate a variety of endometrial and myometrial processes, which involve the endometrial canal.
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21. Ovarian factors
22. Ovarian SizeAFCOvarian CystsOvulationFollicles
23. Ovarian SizeA normal ovary usually measures 2.5 X2.2 X2.0 cm Ovaries with diameters in excess of 3.5 cm should be considered as abnormal. The mean volume of a normal ovary is 5.4 ml (range 4.0-7.0ml).In some women, the ovaries may contain ten or more cystic structures distributed peripherally around a central core of stroma. Such ovaries have been termed polycystic.
24. The dominant follicle appears to be identifiable on the basis of size at approximately day 7 postmenstruation and grows at a rate of approximately 2 mm per day.The follicles appear as echo-free structures amidst the more echogenic ovarian tissue.
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26. Monitoring follicular development in ART
27. Tubal factors
28. Normal Fallopian tubes are not seen on routine ultrasound examinations.The presence of hydrosalpinges is easily detected.Sometimes, hydrosalpinges surround the ovary and can be mistaken as ovarian cysts.Presence of pseudo-septa or incomplete septa (not loculatious) can be helpful in diagnosis of hydrosalpinges.
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