Ultrasound is useful for evaluating the causes of infertility. It can identify uterine, ovarian, and tubal abnormalities. For the uterus, ultrasound can detect congenital anomalies, infections, synechiae, lesions, scarring, and alterations in endometrial thickness and vascularity. Hysterosonography allows clear visualization of the uterine cavity and detection of polyps, fibroids, and synechiae. Adenomyosis is identified by heterogeneous myometrial texture, poorly defined endometrial borders, and cysts. Three-dimensional ultrasound helps diagnose uterine anomalies. Overall, ultrasound is a first-line, non-invasive tool for evaluating infertility.

1. Dr. Muhammad Bin Zulfiqar
PGR IV FCPS Services Institute of Medical Sciences / Hospital
radiombz@gmail.com
ROLE OF US IN EVALUATION
OF INFERTILITY

2. AIMS
 To look for exact cause of infertility
 Uterine
 Ovarian
 Tubal

3. Infertility.
 Infertility is defined as failure to conceive a desired
pregnancy after 24 months of unprotected sexual intercourse.
 Approximate 10% of couple are infertile.
 Male and female are equally affected.
 Primary infertility is infertility in a couple who have never had
a child.
 Secondary infertility is failure to conceive following a
previous pregnancy. Infertility may be caused by infection in
the man or woman, but often there is no obvious underlying
cause.

4. Causes of infertility
Uterine causes:
 Congenital anomalies
 Infections
 Uterine synechiae
 Focal lesions
 Intra-uterine scar
 Cervical stenosis
 Reduced uterine perfusion
 Alteration of the endometrium thickness and
vascularity.

5. Causes of infertility
 Ovarian causes:
 Follicular and ovulation abnormalities
 Stromal vascularity
 Endometriosis.
 Tubal causes:
 Infection
 Obstruction.

6. Causes of infertility
 Hormonal Problems : These are the most common
causes of anovulation.
 The process of ovulation depends upon a complex
balance of hormones and their interactions to be
successful, and any disruption in this process can hinder
ovulation.

7. Imaging Modalities
 Conventional approach
 Hysterosalpingography
 Sonohysterography
 Pelvic US
 Abdominal
 TVS
 MRI
 Our focus is Ultrasound Imaging

8. Diagnostic armamentarium and its role
 USG ( TVS, TAS) : it is the first line investigation and can be
coupled with color Doppler and 3D/4D scan
 USG helps in determining morphology perfusion ,thickness
,volume, vascularity . It detects pathological lesions , tubal lesions
abnormalities of follicular maturation and ovulation .
 Tubal patency can be confirmed by sonosalphingography.

9. 2-D & 3-D Ultrasound
 3D ultrasound is a useful complement to 2D ultrasound
particularly in the diagnosis of uterine malformations.
 In suspicion of Mullerian duct anomalies, 3D ultrasound
be carried out.
 MRI can be performed for the assessment of the cervix
and vagina.
Behr et al. Imaging of Müllerian Duct Anomalies. RadioGraphics 2012; 32:E233–E250
Bermejo et al. Three-dimensional ultrasound in the diagnosis of Mullerian duct anomalies and concordance with magnetic resonance imaging.
Ultrasound Obstet Gynecol 2010; 35: 593–601.

10. Sonohysterography
 used to evaluate uterine pathology because of its
excellent diagnostic accuracy, minimal patient discomfort,
low cost, and widespread availability.
 With the addition of transvaginal sonography, colour
Doppler imaging, and sonohysterography, ultrasound has
become a sensitive technique for detecting endometrial
and myometrial pathology e.g. uterine synechiae,
endometrial polyps, submucosal leiomyomas.
 It helps in checking tubal patency.

11. Uterine Assessment

12. DIAGNOSTIC USE OF
ULTRASONOGRAPHY IN INFERTILITY
INVESTIGATIONS: THE UTERUS
 Congenital anomalies
 Infections
 Uterine synechiae
 Focal lesions
 Intra-uterine scar
 Cervical stenosis
 Reduced uterine perfusion
 Alteration of the endometrium thickness and vascularity.

13.  Fig. 8.3 The three orthogonal planes sagittal, transverse, and coronal
planes as well as the rendered image. The coronal image also portrays
the hypoechoic junctional zone of the myometrium
Behr et al. Imaging of Müllerian Duct Anomalies. RadioGraphics 2012; 32:E233–E250
Bermejo et al. Three-dimensional ultrasound in the diagnosis of Mullerian duct anomalies and concordance with magnetic resonance imaging.
Ultrasound Obstet Gynecol 2010; 35: 593–601.

14. A B C
 Endometrium: spectrum of appearances. Transvaginal scans. A, Normal, thin,
early-proliferative endometrium. B, Normal, late-proliferative endometrium with triple-
layer appearance. Central echogenic line is caused by opposed endometrial surfaces
surrounded by a thicker hypoechoic functional layer, bounded by an outer echogenic
basal layer. C, Normal, early-secretory phase endometrium. The functional layer
surrounding the echogenic line has become hyperechoic
Carol M. Rumack, MD, FACR. DIAGNOSTIC ULTRASOUND (FOURTH EDITION 2011 by Mosby, Inc., an affiliate of Elsevier Inc.)
Continued

15. F D E
 Endometrium: spectrum of appearances. D, Normal, thick,
hyperechoic late-secretory endometrium. E, Normal, thin,
postmenopausal endometrium. F, Oval, well-defined polyp that is more
hyperechoic than surrounding periovulatory endometrium
Carol M. Rumack, MD, FACR. DIAGNOSTIC ULTRASOUND (FOURTH EDITION 2011 by Mosby, Inc., an affiliate of Elsevier Inc.)
Continued

16. G H I
 Endometrium: spectrum of appearances. G, Thickened
endometrium caused by multiple small polyps confirmed on
sonohysterogram. H, Thick, cystic endometrium caused by
hyperplasia in patient taking tamoxifen. I, Thick, cystic endometrium
caused by large polyp in patient receiving tamoxifen.
Carol M. Rumack, MD, FACR. DIAGNOSTIC ULTRASOUND (FOURTH EDITION 2011 by Mosby, Inc., an affiliate of Elsevier Inc.)

17. Uterine Anomalies
Bermejo et al. Three-dimensional ultrasound in the diagnosis of Mullerian duct
anomalies and concordance with magnetic resonance imaging. Ultrasound
Obstet Gynecol 2010; 35: 593–601.

18.  Congenital uterine abnormalities—Unicornuate uterus
Behr et al. Imaging of Müllerian Duct Anomalies. RadioGraphics 2012; 32:E233–E250
Bermejo et al. Three-dimensional ultrasound in the diagnosis of Mullerian duct anomalies and concordance with magnetic
resonance imaging. Ultrasound Obstet Gynecol 2010; 35: 593–601.

19.  Congenital uterine abnormalities—Arcuate uterus
Behr et al. Imaging of Müllerian Duct Anomalies. RadioGraphics 2012; 32:E233–E250
Bermejo et al. Three-dimensional ultrasound in the diagnosis of Mullerian duct anomalies and concordance with magnetic resonance
imaging. Ultrasound Obstet Gynecol 2010; 35: 593–601.

20.  Congenital uterine abnormalities—Subseptate uterus
Behr et al. Imaging of Müllerian Duct Anomalies. RadioGraphics 2012; 32:E233–E250
Bermejo et al. Three-dimensional ultrasound in the diagnosis of Mullerian duct anomalies and concordance with magnetic
resonance imaging. Ultrasound Obstet Gynecol 2010; 35: 593–601.

21.  Congenital uterine abnormalities—septate uterus with two
cervices
Behr et al. Imaging of Müllerian Duct Anomalies. RadioGraphics 2012; 32:E233–E250
Bermejo et al. Three-dimensional ultrasound in the diagnosis of Mullerian duct anomalies and concordance with magnetic resonance imaging. Ultrasound
Obstet Gynecol 2010; 35: 593–601.

22.  Figure 6 To distinguish
bicornuate uteri from septate
uteri with three-dimensional
ultrasound we used the
formula proposed by Troiano
and McCarthy15: a line was
traced joining both horns of
the uterine cavity. If this line
crossed the fundus or was ≤5
mm from it, the uterus was
considered bicornuate (a and
b); if it was >5 mm from the
fundus it was considered
septate, regardless of whether
the fundus was dome-shaped
(c), smooth or discretely
notched.
Behr et al. Imaging of Müllerian Duct Anomalies. RadioGraphics 2012; 32:E233–E250
Bermejo et al. Three-dimensional ultrasound in the diagnosis of Mullerian duct anomalies and concordance with magnetic resonance imaging. Ultrasound Obstet
Gynecol 2010; 35: 593–601.

23.  Congenital uterine abnormalities—Didelphic uterus
Behr et al. Imaging of Müllerian Duct Anomalies. RadioGraphics 2012; 32:E233–E250
Bermejo et al. Three-dimensional ultrasound in the diagnosis of Mullerian duct anomalies and concordance with magnetic resonance imaging. Ultrasound
Obstet Gynecol 2010; 35: 593–601.

24.  Congenital uterine abnormalities—septate complete
bicornuate uterus
Behr et al. Imaging of Müllerian Duct Anomalies. RadioGraphics 2012; 32:E233–E250
Bermejo et al. Three-dimensional ultrasound in the diagnosis of Mullerian duct anomalies and concordance with magnetic resonance imaging. Ultrasound
Obstet Gynecol 2010; 35: 593–601.

25.  Congenital uterine abnormalities—Partial bicornuate
uterus
Behr et al. Imaging of Müllerian Duct Anomalies. RadioGraphics 2012; 32:E233–E250
Bermejo et al. Three-dimensional ultrasound in the diagnosis of Mullerian duct anomalies and concordance with magnetic resonance
imaging. Ultrasound Obstet Gynecol 2010; 35: 593–601.

26.  septate uterus with pregnancy on right side
Behr et al. Imaging of Müllerian Duct Anomalies. RadioGraphics 2012; 32:E233–E250
Bermejo et al. Three-dimensional ultrasound in the diagnosis of Mullerian duct anomalies and concordance with magnetic resonance
imaging. Ultrasound Obstet Gynecol 2010; 35: 593–601.

27.  FIGURE 15-21. Endometritis: varying appearance in two patients.
Transabdominal sagittal scans. A, Fluid-fluid level (arrow) within
endometrial canal in patient with pelvic inflammatory disease; B, bladder.
This resolved after antibiotic therapy. B, Multiple linear hyper echogenic foci
with shadowing caused by gas are seen within a distended endometrial
canal in a febrile postpartum patient.
Carol M. Rumack, MD, FACR. DIAGNOSTIC ULTRASOUND (FOURTH EDITION 2011 by Mosby, Inc., an affiliate of Elsevier Inc.)

28. Fibroids (leiomyomata)
May interfere with implantation
S.M.Kelly et al. investigation of infertile couple—A one stop ultrasound based approach. Human reproduction
vol.16, No 12 pp2481-2484, 2001

29.  Fig. 21. Intramural leiomyomata are frequently
visualized. Examples of fibroids which
compromise the contours of the endometrial
cavity are shown (A–D). Refraction artifacts
resulting from tissue density interfaces and the
texture of the fibroids often aid in their
identification.
Chizen, D, Pierson, R, Glob. libr. women's med., (ISSN: 1756-2228) 2010; DOI 10.3843/GLOWM.10326
S.M.Kelly et al. investigation of infertile couple—A one stop ultrasound based approach. Human reproduction vol.16, No
12 pp2481-2484, 2001
C.K. Chen, H.M. Wu, Y.K. Soong. Clinical Application of Ultrasound in Infertility: From Two-dimensional to Three-
dimensional J Med Ultrasound 2007;15(2):126–133

30. Adenomyosis
 Heterotopic endometrial glands and stroma: Small
echogenic islands
 Smooth muscle hyperplasia.
 Areas of decreased echogenicity

31. Adenomyosis—Features
 Myometrium:
 Heterogeneous echotexture
 Echogenicity: decreased relative to that of the dorsal
myometrium
 Myometrial cyst (curved arrow)
 Asymmetrical uterine enlargement
 Endometrium:
 eccentric endometrial cavity
 indistinct endometrial-myometrial border

32. Adenomyosis—Diagnostic criteria
 Bromley et al (2000) 2 or more of the followings:
1. Mottled heterogeneous myometrial texture: All cases.
2. Globular uterus: 95% of cases.
3. Small myometrial lucent areas: 82%.
4. “Shaggy” indistinct endometrial strips: 82%.
 The most predictive: ill-defined heterogeneous
echotexture within the myometrium (Brosen et al, 2004)

33. A B C
 Adenomyosis on transvaginal scans: spectrum of appearances. A,
Subendometrial cyst (arrowhead, endometrium). B, Cysts and heterogeneity in
anterior myometrium with poorly defined anterior endometrial border
(arrowhead). C, Myometrial heterogeneity with poorly defined endometrial
borders (arrowheads).
Continued
Carol M. Rumack, MD, FACR. DIAGNOSTIC ULTRASOUND (FOURTH EDITION 2011 by Mosby, Inc., an affiliate of Elsevier Inc.)

34. *+
C D E
 Adenomyosis on transvaginal scans: spectrum of appearances. D,
Multiple subendometrial cysts and echogenic nodules (arrow). E, Diffuse
heterogeneous myometrium with multiple cysts and poorly defined
endometrial borders (cursors). F, Large area of myometrial heterogeneity
producing a focal mass effect and displacing endometrium (arrowhead).
This may mimic a fibroid.

35. THE EVALUATION OF THE UTERINE
CAVITY
 By using hysterosalpingosonography we can confidently
detect endometrial and myometrial pathology e.g. uterine
synechiae, endometrial polyps, submucosal leiomyomas.
Chizen, D, Pierson, R, Glob. libr. women's med., (ISSN: 1756-2228) 2010; DOI
10.3843/GLOWM.10326
S.M.Kelly et al. investigation of infertile couple—A one stop ultrasound based approach. Human
reproduction vol.16, No 12 pp2481-2484, 2001
C.K. Chen, H.M. Wu, Y.K. Soong. Clinical Application of Ultrasound in Infertility: From Two-
dimensional to Three-dimensional J Med Ultrasound 2007;15(2):126–133

36.  Fig. 22. Midsagittal image of the uterus with a hysterosalpingosonography
catheter demonstrating correct placement of the balloon cuff. Instillation of
saline has been initiated and the tip of the catheter is observed in the fluid
to the left of the cuff.
Chizen, D, Pierson, R, Glob. libr. women's med., (ISSN: 1756-2228) 2010; DOI 10.3843/GLOWM.10326

37.  Fig. 23. Midsagittal (A) and transverse (B) images of a
normal uterine cavity following instillation of saline. The
fluid-endometrium interface is smooth and symmetrical.

38.  Fig. 26. Transverse image of a bicornuate uterus taken
during sonoHSG. The nature of the uterine cavity is
revealed by the instillation of saline.

39. Endometrial polyps
 Persistent hyperechogenic areas with variable cystic
spaces. Distort the cavity contour.
 Best seen in midcycle
 Not seen clearly in the midluteal phase or in stimulated
cycles.

40.  Fig. 25. Images of endometrial polyps and
adhesions recorded during
hysterosalpingosonography (A–D). sonoHSG
is very helpful in identifying small and large
lesions that are difficult to appreciate on
unenhanced ultrasonography.


41.  Fig. 11.1 Endometrial polyps. A
single polyp located in a lateral wall
at midcorpus, shown in two
dimensional transvaginal
ultrasonographic view ( a ) and in 3D
imaging ( b ). Multiple polyps and
submucosal fi broids (by Pathology)
shown by 2D US ( c ) and by 3D US
( d )

42.  Endometrial Polyp

43. Ovarian Assessment

44. Ovarian Assessment
 Preovulatory follicle
 Atretic follicle
 Sequences of follicular maturation
 Corpus hemorrhagicum
 Corpus albicans

45. PREOVULATORY
FOLLICLES
 Fig. 1. Normal ovary during a natural menstrual cycle demonstrating normal follicle
population and distribution on day 12 postmenstruation. A dominant follicle is
visualized in the central portion of the image and several subordinate follicles from
the wave (2–5 mm) are observed in the left lateral aspect of the ovary.


46.  Fig. 2. Atretic follicle of preovulatory diameter. Note the thin follicle
walls and sharp transition at the fluid-follicle wall interface. The
shape of the large atretic follicle is compromised by small
peripheral follicles.

47.  Fig. 3. Color flow Doppler image demonstrating perifollicular vascularity around a
preovulatory follicle. Visualization of the complete paths of vascular flow around
large follicles is challenging owing to the tortuous path of the vascular supply to the
dominant follicle.

48.  Sequence of images (A–I) recorded during ovulation in situ. The images in the sequence were taken
to represent the times at which 90%, 80%, 70%, and so on of the follicle fluid was extruded from the
follicle. Time code markers are displayed in the lower left portion of the images.

49.  Power flow Doppler image of a mature, mid-cycle luteal gland
demonstrating marked periluteal vascular flow.


50.  Power (A) and color (B) flow Doppler images of recently ovulated
follicles/new luteal glands on the day of ovulation.


51.  Corpus hemorrhagicum demonstrating thick walls of
peripheral luteal tissue and a central hemorrhagic clot
with an interspersed fibrin network.

52.  Corpus albicans resulting from regression of a luteal structure from a
previous cycle. Corpus albicans are typically visualized as hyperechoic
structures within the ovary and they may occasionally appear to be more
pronounced owing to the presence of surrounding follicles.

53. Ovulation failure

54.  Images from a woman who developed hemorrhagic anovulatory follicles during a study
of natural cycle folliculogenesis and ovulation (A, B). There is evidence of extravasated
blood in the lumen of the structures and the walls are thin did not develop any visual
evidence of luteinization. Progesterone levels were below those accepted as clinically
normal.

55.  Failure of ovulation and development of “cystic” follicle. The follicle typically
grows larger than the mean preovulatory follicle diameter of 23 mm, thin
atretic follicle walls are observed and small flecks of particulate matter are
frequently seen in the lumen or aggregated at the side of the structure.

56.  Image of a hemorrhagic anovulatory follicle. Extravasated blood
and an interspersed fibrin network are observed within the lumen.
The walls of this structure are thin, echoic, and do not have the
appearance of luteal tissue.

57. BENIGN OVARIAN NEOPLASIA
 Dermoid Cyst
 Endometrioma

58.  Images of a small intraovarian dermoid cyst (A, B). The cyst is completely
embedded in the ovary and is surrounded by focal areas of hyperechoicity.
Small follicles are observed in the surrounding stroma. Folliculogenesis and
ovulation were impaired in this ovary. The contralateral ovary demonstrated
compensatory hypertrophy.


59. Endometriosis
 Ovary m/c secondaily involves other pelvic structures .
 Usg shows a typical endometrioma locate in the ovary cystic lesion
with low level internal echoes ( chocolate cyst of ovary)
 The tubes may be involved in form of hematosalphinx or with peritubal
adhesions, a posteriorly displaced uterus , kissing ovaries ,angulated
small bowel loops , elevated posterior vaginal fornices , multilocuilated
fluid collections are indirect indicator of pelvic adhesions

60. Endometriosis
 Endometriosis is found in 25%–50% of infertile women, and
30%–50% of women with endometriosis are infertile
 Laparoscopy is the mainstay for diagnosis

61.  Images of ovarian endometrioma (A, B). The structure is
hypoechoic and exhibits low amplitude uniformly
distributed echotexture in the cavities of the cysts.

62. A B C
 Endometriosis: spectrum of appearances. Transvaginal scans. A to D,
Uniform low-level echoes within a cystic ovarian mass. A, Typical
peripheral echogenic foci. B, Fluid-fluid level. C, Avascular marginal
echogenic nodules.
Continued

63. D E F
 Endometriosis: spectrum of appearances.
Transvaginal scans. D, Bilateral disease. E, Endometriotic
plaque on posterior surface of uterus (arrows). F, Filling
the pouch of Douglas (arrows). U, Uterus.

64. Premature Ovarian Failure
 Fig. 14. Image from a woman in premature ovarian failure. Only the stroma of the ovary is identified. A very few
follicles of less than 1 mm diameter can be observed on the inferior aspect of the ovary.

65. Polycystic Ovarian Syndrome
 Characterised by combination of
 multiple clinical manifestations
( hirsutism, anovultory cycle and infertility)
 hormonal imbalance

66. Polycystic Ovarian Syndrome
 The diagnosis of polycystic ovarian syndrome is based on
hormone imbalance and laboratory findings
 USG rounded ovaries , normal or increased volume .
Multiple subcentrimetric follicles ( 15) with no dominant
follicle ( string of pearl appearance ) . Thickened walll and
echogenic and Vascular stroma)

67.  Images from women with differing
expressions of the four major subtypes of the
metabolic syndrome associated with
polycystic ovary syndrome (A–D). The
images exhibit quite differing ultra
sonographic appearances in the size and
distribution of follicles within PCOS ovaries. A
recent corpus luteum is clearly visible in the
ovary in panel (D).

68.  An image of an oviduct visualized from the uterine cornu to the fimbria. The
ampulla, infundibulum and very fine interfaces representing the fimbria may
be appreciated on the superior aspects of the ovaries.


69.  The fimbria of the oviduct are clearly visualized in free
fluid surrounding the ovary following ovulation or
hysterosalpinography.

70.  Transvaginal ultrasound image of a woman with moderate OHSS.
Both ovaries are enlarged and are observed in the posterior cul-de-
sac. The ovaries are in close contact and displace the uterus
anteriorly. Both ovaries contain several large unruptured follicles.

71.  Ultrasound guided oocyte retrieval. The oocyte collection
needle is visualized entering into a large follicle. Etching
around the tip of the needle enhances its visualization. The
image is presented in the standard medical imaging
orientation. (Image courtesy of Dr Roger Stronell.)

72. A B C
 Hemorrhagic cysts on transvaginal scans: spectrum of appearances.
A, Acute hyperechoic hemorrhagic cyst. B, Acute hemorrhagic cyst
mimicking a solid lesion. C, Color Doppler ultrasound shows peripheral
ring of vascularity (ring of fire), typical of a corpus luteum, but no
vascularity within the cyst
Continued

73. D E F
 Hemorrhagic cysts on transvaginal scans: spectrum of appearances. .
D, Large cyst containing multiple internal low-level echoes. E, Reticular
pattern of internal echoes and septations within cyst. F, Reticular pattern.
Continued

74. G H I
 Hemorrhagic cysts on transvaginal scans: G, H, and I,
Variations in clot retraction. The clot in I suggests a solid
mass. Lack of color Doppler ultrasound signal supports its
benign nature.

75. Tubal Assessment

76. Anatomy and Physiology of Fallopian Tubes
 The fallopian tubes connect the peritoneal cavity to the extra
peritoneal world
 Conduction of sperm from the uterine end toward the
ampulla, conduction of ova in the other direction from the
fimbriated end to the ampulla, and support as well as
conduction of the early embryo from the ampulla into the
uterus for implantation
Chizen, D, Pierson, R, Glob. libr. women's med., (ISSN: 1756-2228) 2010; DOI 10.3843/GLOWM.10326
S.M.Kelly et al. investigation of infertile couple—A one stop ultrasound based approach. Human reproduction vol.16, No 12 pp2481-
2484, 2001
C.K. Chen, H.M. Wu, Y.K. Soong. Clinical Application of Ultrasound in Infertility: From Two-dimensional to Three-dimensional J Med
Ultrasound 2007;15(2):126–133

77. Fallopian Tubes
 length from 7–16 cm
(average, 12 cm
1-
2cm
2-
3cm
5-
8cm
trumpet-
shaped
The fallopian tubes have three segments that are visible at
hysterosalpingography: the interstitial portion, which traverses
the myometrium; the isthmic portion, which courses within the
broad ligament; and the ampullary portion, which is adjacent to
the ovary

78. Tubal disease
 Destruction or obstruction and peritubal adhesions
 Hsg is useful for assessing tubal patency. Mri is superior to usg in
assessing tubal disease
 Dilated tube appear as fluid filled tortuous sausage shaped masses
adjacent to the uterus with incomplete septae appearing as hyperechoic
mural nodules ( beads of string sign) and short linear projections (
cogwheel appearance)
 the presence of partially effaced longitudinal folds inside the masses is
specific for fallopian tubes on MRI.
 The presence of a normally appearing ipsilateral ovary is a clue to the
presence of tubal masses

79. Sonographic Tubal Assessment
 Normal tubes not visible
 Hydro salpinges can be clearly delineated
 Hystero-contrastsonography (HyCoSy) provide similar
information regarding tubal patency and uterine cavity
when compared to HSG

80.  Free fluid collection in the cul-de-sac following successful
demonstration of oviductal patency. Oviductal fimbria are
clearly observed in the collected fluid.

81.  ( a ) “Waist sign” of a hydrosalpinx, marked by the
asterisks , as seen with 2-D ultrasound. ( b ) “Beads on a
string” sign of a hydrosalpinx demonstrated by 2-D
ultrasound

82.  Images of hydrosalpinx (A, B). Hydrosalpinx is usually easily
diagnosed as well-constrained fluid accumulation in the
adnexae. In some cases, adhesions between the oviduct and
ovary may be visualized.

83. TAKE HOME MESSAGE
 US (Abdominal, TVS and Doppler US) is an excellent
imaging modality to diagnose cause of infertility.
 It is equally effective in suggesting infertility management
when compared with HSG and MRI.

84. THANK YOU