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INTRODUCTION

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Definitions

  1. Infertility: the inability to conceive after 1 year of unprotected intercourse.

  2. IVF (in vitro fertilization): a medical procedure involving ovulation induction, guided follicular aspiration, and in vitro fertilization of zygote with transfer of fertilized zygote into uterine lumen.

  3. Ovarian hyperstimulation syndrome (OHSS): a group of symptoms including fluid shifts and possible electrolytic imbalance and symptomatology associated with ovarian enlargement and ascites precipitated by ovulation induction.

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Infertility, the inability of a couple to achieve pregnancy with unprotected intercourse for 1 year, affects approximately 10% to 15% of couples and is increasing in incidence. The evaluation and treatment of infertility has undergone dramatic advances in the recent decade. Concurrently, transvaginal sonography (TVS) has a vital role in the evaluation and management of infertility related to a variety of gynecologic disorders.1,2 Transvaginal ultrasound has revolutionized how we practice infertility over the last 2 decades.

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Specifically, TVS has its greatest clinical applications in follicular monitoring and guided follicular oocyte aspiration. Transabdominal sonography (TAS) and TVS are also significantly involved in guiding embryo transfers and in the initial evaluation of infertility. The initial evaluation of infertility consists of the assessment of pelvis, uterine cavity, and tubal patency. This baseline pelvic sonogram identifies any existing pathology such as fibroids, congenital uterine anomalies, and adnexal masses of ovarian or tubal etiologies (ie, endometriomas, dermoids, other neoplasms, hydrosalpinges, etc) that may impact fertility. Additionally, this baseline evaluation has become very helpful in determining the ovarian reserve for infertility counseling and for guiding the ovulation induction dosing. Sonography with the instillation of fluid can determine the presence of uterine filling defects and can assess tubal patency. Follow-up of disorders that may be related to infertility, such as endometriosis, fibroids, and ovarian cysts, can be monitored with TVS. This chapter emphasizes the most frequently used applications and, in particular, stresses the role of transvaginal transducer/probes.

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INSTRUMENTATION

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Transvaginal sonography is the method of choice for initial evaluation of the uterus and ovaries in most situations. The transvaginal transducer/probe allows a detailed depiction of the uterus and ovary because of the proximity of these structures to the transducer. In contrast to transabdominal scanning, however, transvaginal scanning displays images in nonconventional imaging planes. In addition, the regions of interest are limited to approximately 6 to 10 cm from the probe and do not afford as global a delineation of the pelvic structures in some cases as transabdominal scanning. TVS is typically performed with the bladder empty; in fact, a full bladder pushes the gynecologic structures away from view and may distort the anatomy. In TVS, surrounding bowel loops usually are not interposed between the probe and the adnexa. If they are, gentle manual abdominal palpation or manipulation of the probe, or both, can be used to displace adjacent bowel. Additionally, this technique can be used as an extension of the pelvic exam and may be coined as ...

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