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KEY TERMS

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Key Terms

  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 (on glass) fertilization of eggs and subsequent transfer of embryo(s) into uterine lumen cavity.

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

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INTRODUCTION

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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 in the United States 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 (sub-)/infertility as well as for a variety of gynecologic disorders.1,2 Transvaginal ultrasound has revolutionized how infertility specialists manage their patients over the last three decades.

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Specifically, TVS has its greatest clinical applications in the baseline evaluations of the pelvic organ as well as follicular monitoring and guided follicular oocyte aspiration. Transabdominal sonography (TAS) and TVS are utilized for in guiding embryo transfers and in the initial evaluation of infertility. The initial evaluation of infertility consists of the assessment of pelvic organs, uterine cavity, and tubal patency. The baseline pelvic sonogram identifies any existing pathology, such as fibroids, congenital uterine anomalies, uterine adhesions, and adnexal masses of ovarian or tubal etiologies (ie, endometriomas, dermoids, other neoplasms, hydrosalpinges) 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 into the uterus (saline hysterosonography) 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 patients. 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. The transvaginal transducer/probe allows a detailed depiction of the uterus and ovaries because of the proximity of these structures to the vaginally placed transducer. In contrast to transabdominal scanning, transvaginal scanning displays images in nonconventional imaging planes. One limitation of transvaginal scanning is the focal length of the probe; the regions of interest are typically within this limitation of approximately 6 to 10 cm from the probe. In TVS, surrounding bowel loops usually are not interposed between the probe and the adnexa. If they are, gentle manual abdominal palpation ...

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