Sonography Gynecology Infertility Assessment, Protocols, and Interpretation

Excerpt

Infertility is defined as the inability to conceive after one year of unprotected sexual intercourse in women under 35 and 6 months of unprotected intercourse in women older than 35. Infertility affects about 15.5% of women. The etiologies of infertility include tubal factor (14%), defects in ovulation (21%), and male factor (26%), and are often unexplained by traditional testing (28%). The basic workup for infertility involves evaluating ovarian reserve, tubal and uterine assessment, thyroid problems, prolactin disorders, confirmation of polycystic ovarian syndrome (PCOS), semen parameters, and additional assessment to confirm that the patient is medically fit and ready for pregnancy. This document will discuss the role of sonography in the evaluation and management of female infertility.

Different types of ultrasound scanning for infertility include:

1. Baseline or screening ultrasound to assess the pelvic anatomy of the uterus, including uterine lining and bilateral ovaries. All abnormal findings are measured and characterized, such as fibroids, uterine malformations, hydrosalpinges, and ovarian cysts.

2. Follicular monitoring ultrasounds are used to track follicles that are maturing and measure the endometrial thickness and also note the endometrial consistency.

3. Saline Infusion Sonograms (SIS) with or without 3D assessment are used to assess the uterine cavity for any abnormalities and can also be used for tubal patency assessment.

4. Abdominal ultrasound may be needed with any of the above scanning modalities to better assess the pelvic structures that cannot be fully seen with transvaginal scanning or can be used for virginal/ young girls undergoing fertility preservation or female to male transgender patients undergoing fertility treatments to limit feelings of gender dysphoria. In addition, abdominal scanning is used to guide Intrauterine Inseminations, embryo transfers, endometrial biopsies, and hysteroscopic uterine procedures to allow the surgeon a better appreciation of the uterine anatomy.