This ppt is made to teach the art of doing trans vaginal sonography and what all to look for in early follicular phase.

1. Chairperson: Haryana Chapter Of ISAR ,2011-2014
Director: LOOMBA HOSPITAL AND IVF CENTRE ,
Ambala Cantt. HARYANA since 1988
Ex consultant at central hospital ,Arar,
Saudi Arabia
Ex senior resident Ganga Ram Hospital
New Delhi.
Graduate from GOMCO ,Patiala.1985.
Awards: President’s gold medal at university level.
Affiliations: ASRM,RCOG,FOGSI,ISAR,ACOG,,IAGE,
ASPIRE,Foetal Medicine Foundation
regular attendee at many national
and international conferences.
Achievements: First IVF/ART centre in haryana in 2003
with more than 1500 babies born through
ART
Trained at CLEVELAND CLINIC U.S.A in
IVF/ICSI
Trained at HARVARD in advanced
ultrasound in fetal medicine
Advanced laparoscopy training at Kiel,
Germany.
Specialised : Infertility/ART, Fertility related
Fields Laparoscopic surgeries, Fetal medicine
Recurrent pregnancy loss
www.loombahospital.
com
Dr.Poonam Loomba
M.D.
loombapoonam
@gmail.com
www.loombaivf.com

2. Poonam Loomba ,M.D.
Director and Consultant
Loomba hospital and IVF Centre

3.  Discuss the role of ultrasound in the
evaluation of infertility
 Discuss the abnormalities within the uterus
tubes and ovaries regarding infertility
 Know the limitations of ultrasound in the
infertility evaluation.

5.  Best done in the early follicular time(cycle day 3)to avoid
distortion of ovarian volume caused by growing follicle
 High frequency probe with trans vaginal approach is used.
 Use a systematic approach
Empty bladder
Watch as you are placing the transducer
Look at the bladder,and cervix(length and
location
Cervico uterine angle
Uterus:Orientation,size,endometrial thickness
Ovaries:location,size,and number of follicles
.
 Document and save your findings electronically.
.

7. Base Line Scan

10. Measuring endometrial thickness

14. A trace of fluid within the cavity is seen which normally
disappears in 24 hrs

17. Power doppler imaging

19.  Minimal and mild endometriosis
 Flimsy pelvic adhesions
 Some tubal abnormalities.
 But we can use the probe actively during exam
to assess the mobility of pelvic structures in
relation to each other.This gives us an idea of
whether or not there are adhesions.

20. SLIDING ORGAN SIGN

21.  20% of infertile women have cavitary
abnormalities including arcuate
uterus,polyps,septate uterus,s/m myomas,and
adhesions.
 HSG Low sensitivity and specificity
 TVUS Low sensitivity and specificity
 SIS 81.3% and 100%
 Hysteroscopy 87.5% and 100%
 Gold standard is hysteroscopy.

24. Seen in 4 % women with infertility and 15% with RPL

26. Gives additional information regarding the
intrauterine pathologies
Adhesions
S/m myomas
Polyps
Focal hyperplasia
Congenital anomalies
Tubal patency

30.  Asymmetry of
endometrial
echo
 Areas of
endometrium
<2mm
 Echogenic area
in the uterus
 TVS sensitivity
is 52%
 TV SIS is 93.5
to 99.% accurate.

31. The high incidence of cavitary abnormalities
and the potential improvements in pregnancy
outcomes after hysteroscopic surgery
highlights the importance
of cavitary assessment

32.  Ovarian volume and AFC ….measures of
ovarian reserve
 PCOD
 Ovarian masses
 Ovulation studies with series of scans

33. Physiologic
 Follicular
 Simple
 Corpus luteum
Pathologic
 Endometrioma
 Mature cystic
teratoma
 Borderline
 Malignancy
We recommend further evaluation of the mass prior to stimulation(repeat
US ,LAPROSCOPY

37.  Volume is affected by cigarette smoking OCP
age and cysts
 Superior to day3 FSH
 Small volume predicts fewer follicles and low
PR independent of age(syrop 1999)
 Large volume>10ml is associated with
increased OHSS.(10% TO 23.5%)

40. 3 D Inversion Tecnology

41. Follicle diameter

42.  Number of scans depend upon the response of
the patient
 Hcg is delayed till majority reach maturation
 Eggs can be retrieved from as small as 14mm
and as large as 24mm.
 Decreased quality of oocytes from follicle
24mm.>
 No difference in quality of oocytes from
follicles 18-22mm in size.

44. A. PERIFOLLICULAR
VASCULARIZATION.
B. PERIFOLLICULAR RI 0.4 – 0.48
C. FOLLICULAR PSV > 10 CMS/SEC
Diameter predicts maturity and
perifollicular vascularization
predicts the quality of oocyte at
retreival

45.  GRADE 1 < 25%
 GRADE 2 < 50%
 GRADE 3 < 75%
 GRADE 4 > 75%

47. Haemorrhagic cyst Endometriomtic cyst

48.  Normally not seen
Hydrosalpinx appearances
 Retort shaped cystic structure
 Cogwheel sign
 Waist sign
 Incomplete septae

50.  TVS provides a degree of image magnification
as if we were doing ultrasound through a low
power microscope.
 Accuracy of SIS matches that of hysteroscopy
in detecting intra cavitary anomalies
 Design more studies to incorporate new
markers for success with SET.

51. THANK YOU