Infertility

Ultrasound has made significantimprovementin the modern management of infertility. It has a role in the initial assessment of the infertile woman, in monitoring of treatment cycles and the performance of ultrasound guided procedures.

Human Uterus And PolypsSubmucous Fibroid Pictures
Fig. 36.13 Appearance of a normal early pregnancy of 8 weeks 1 day gestation.

INITIAL ASSESSMENT

A TV ultrasound allows assessment of the uterus for any obvious abnormalities or for the presence endometrial polyps or submucous fibroids. With a skilled operator hystero-contrast-sonography (HyCoSy) has comparable results to hysterosalpingography (HSG). It should be considered in those women at low risk of tubal disease as it has the advantage of being able to assess the ovaries at the same time while avoiding the use of radiation. In this procedure TV ultrasound is performed with the instillation of an echogenic contrast medium into the uterine cavity. One of the limitations of HyCoSy is the difficulty in storing information; images need to be recorded in real time.

Assessment of the ovaries is important especially in women with oligomenorrhoea as one may find polycys-tic ovaries which have a typical ultrasound appearance with the presence of 12 or more follicles measuring 29 mm in one or both ovaries and an ovarian volume greater than 10 ml. [8] (Fig. 36.12). An ultrasound appearance of polycystic ovaries does not equate to a diagnosis of polycystic ovarian syndrome. This diagnosis can only be made if the patient is symptomatic. At present ultrasound is not recommended as a tool for assessing ovulation (NICE 2004).

Ultrasound has a significant role in the monitoring of women undergoing infertility treatment especially those patients undergoing superovulation; there are details in the chapter on IVF.

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