Role of 3D ultrasound in Improving pregnancy rates


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Is 3D ultrasound of value for infertile couples? can it improve pregnancy rates. This talk may answer these questions

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Role of 3D ultrasound in Improving pregnancy rates

  1. 1. { 4D Ultrasound & Infertility Hesham Al-Inany, PhD
  2. 2. What is 4D Ultrasound? 4D fetal ultrasounds are similar to 3D scans, with the difference associated with time: 4D allows a 3- dimensional picture in real time, rather than delayed, due to the lag associated with the computer constructed image, as in classic 3- dimensional ultrasound
  3. 3. Uterine cavity assessment  The main advantage of pre cycle assessment using 3D is the coronal view of the uterine cavity to exclude;  Mullerian anomalies  Uterine cavity lesions such as submucous fibroids , endometrial polyps & IU Synechiae
  4. 4. Do We have to manage Mullerian anomalies before the IVF cycle  All studies available on excision of septum prior to IVF are retrospective no RCS are available ( Bendifallah 2013)  Cochrane review 2013 on;Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities; insufficient evidence.
  5. 5. Mainly for the Obstetric Outcome High incidence of Preterm Birth in Unicornuate, Septate and Bicornuate uterus
  6. 6. General consensus that fibroids do affect IVF outcome, submucous, intramural & subserous in decreasing order of importance ( decreases live birth rate, and myomectomy increases pregnancy rate by 50%.( somilgliana 2007)
  7. 7. Comparing 3D sonohysterography to Office hysteroscopy found substantial concordance between both techniques with less time of exam and less pain(Negm 2012)
  8. 8. Basal Ovarian Volume and AFC
  9. 9. Ovarian volume calculation  Three D ultrasound is more accurate in determining ovarian volume using the Virtual Organ computer-aided Analysis (VOCAL, GE Kretz) technique .  This technique employs a rotational method which involves the manual delineation of the ovarian volume throughout several planes as the data set is rotated through 180 degrees in a consecutive series of rotations ( angle dependant on number of planes chosen could range from 6 ◦ to 30◦ ) , until a calculated volume is generated
  10. 10.  Basal antral follicle count shows 5-11 small follicles < 10mm in diameter .  Number of follicles at the early follicular phase has been reported to be a good test for prediction of ovarian response (Kwee 2007, Jayaprakasan 2008) . All follicles < 10mm are measured using 2D ultrasound in the longitudinal and transverse planes, however 3D techniques are now available for automatic calculation (SonoAVC) (Raine-Fenning 2008).
  11. 11. SonoAVC  A new automated ultrasound software technique has recently been developed which relies on volume calculation using 3- dimensional VOCAL technique and on colour coding of each follicle (SonoAVC, GE ) (Raine Fenning 2008).  A 3D volume is obtained of the stimulated ovary, and using the software will give mean diameter and volume of the hypo echoic areas within the ovary representing the follicles, it will then colour code each follicle differently allowing studying each one separately .
  12. 12.  Greater accuracy  Quick  Reproducible  Correlates well with aspirated fluid volume
  13. 13. The main possible implantation markers that stuided by real time ultrasonography • Endometrial thickness, • Endometrial volume • Endometrial morphological patterns. • Endometrial Vascularity : 1. Uterine Artery PI 2. Endometrial and Subendometrial Vasculature
  14. 14. { Ultrasound Parameters in Favour of Implantation
  15. 15. > 7 mm TRILAMINAR > 2ml PI < 3 FI > 20% VFI > 20 % Endometrial &subendometrial flow
  16. 16. Using ultrasound imaging in implantation Optimal conditions of implantation could be:-  Endometrium > 7 mm,  Endometrial volume > 2 ml  Hypoechogenic endometrium with 3 well delinated layers,  Uterine PI < 3,  Presence of sub-endometrial vascular flow.  High VI,FI&VFI in endometrial & sub- endometrial zone.
  17. 17. THANK YOU