Ultrasound is an indispensable pert of Infertility treatment .In modern times its spectrum of use has been broadened,

1. ROLE OF USG IN
INFERTILITY
DR NABANEETA
FEMELIFE FERTILITY FOUNDATION

2. UTERINE/ENDOMETRIAL FACTOR
 Endometrial thickness obtained by two-
dimensional sonography is considered the
most important parameter of endometrial growth
a very thin endometrium (below 7 mm) seems to
be accepted as a reliable sign of suboptimal
implantation potential
 Endometrial pattern is defined as the relative
echogenicity of the endometrium and the
adjacent myometrium as demonstrated on a
longitudinal ultrasound scan.

3. • The endometrial pattern does not appear to be
influenced by the type of ovarian stimulation
and it is of prognostic value in both fresh IVF,
as well as frozen embryo transfer cycles

4. Normal endometrial pattern-
proliferative vs secretory

5. • volume of the endometrium using 3D
ultrasound may help to correlate cycle
outcome with a quantitative parameter rather
than endometrial thickness

7. UTERINE PERFUSION
• In anovulatory cycles, a continuous increase of
the uterine artery RI has been detected
• in some infertile patients, an end-diastolic
flow is absent
• absent diastolic flow might be associated with
infertility and poor reproductive performance.

10. MULLERIAN ANOMALIES
 Congenital uterine malformations are variable in
frequency and are usually estimated to represent
3–4%
 septate uterus- During the first trimester of
pregnancy, the risk of spontaneous abortion in
this group is between 28% and 45%, while during
the second trimester the frequency of late
spontaneous abortions is approximately 5%.
 Hysteroscopic treatment is currently proposed as
the procedure of choice for the management of
these disorders

12. 3D ultrasound for the diagnosis
of the septate uterus

13. Complete septum

14. • contrast 3D hysterosonography offers a more
comprehensive overview of
the uterine cavity and surrounding
myometrium, and gives access to planes
unobtainable by conventional 2D ultrasound
examination.

15. Bicornuate uterus

16. ENDOMETRIAL POLYP
• Endometrial polyp is the anatomic defect that
is implicated in the etiology of arecurrent
pregnancy loss and infertility.
• Polyps appear as diffuse or focal thickening
ofthe endometrium

19. SUBMUCOUS LEIOMYOMAS
• their significance depends on their size and
location
• Large intracavitary myomas, which distort the
shape of the uterine cavity and interfere with
the endometrium are usually removed
hysteroscopically
• Sonographic texture ranges from hypoechoic to
echogenic, depending on the amount of
smooth muscle and connective tissue

20. Submucos fibroid

21. • Color doppler demonstrates myometrial blood
vessels at its periphery
• A significant difference was shown in blood
flow characteristics for leiomyoma supplying
vessels between entirely subserosal versus
intramural or submucosal myoma

23. ADENOMYOSIS
• A diffusely enlarged uterus without discrete
fibroids, an intact endometrium and multiple
small cysts in the myometrium have been
reported as a suggestive appearance of
adenomyosis
• Disordered echogenicity of the middle layer of
the myometrium is present

24. indistinct junctional zone between the endometrium and
the myometrium, inhomogeneity of the myometrium, a
thick posterior myometrium, and myometrial cysts.

25. Swiss cheese appearance

26. ENDOMETRITIS
• Chronic endometritis is characterized with
increased echogenicity, thickness and
vascularity of the endometrium
• calcified pelvic lymph nodes or smaller
irregular calcifications in the adnexa, and
deformity of the endometrial cavity suggestive
of adhesions in the absence of a history of
prior curettage or abortion

27. ASHERMAN’S SYNDROME
• Destruction of the endometrium may result in
scarring and the development of bands of scar
tissue, or synechiae within the uterine cavity
• occur as a result of a vigorous curettage of the
uterus following an abortion or, more often,
after curettage of an advanced pregnancy.

28. • Intrauterine synechiae do not present
increased vascularity on color Doppler
examination. Threedimensional ultrasound
demonstrates a significant reduction of the
endometrial cavity volume

29. OVULATORY FACTORS OF
INFERTILITY
 Transvaginal sonography is considered the
most reliable method for monitoring the
follicular growth. It enables accurate
prediction of ovulation and detection of the
ovulation abnormalities
 Documentation of ovarian stromal vascularity
at the initial baseline scan may be
important and may provide useful
information for assisted reproduction
techniques

31. POLYCYSTIC OVARIAN SYNDROME
• Polycystic ovarian syndrome (PCOS) is one of
the causes of anovulation and amenorrhea. In
its classic form it is characterized by
infertility, oligo and amenorrhea, hirsutism,
acne or seborrhea, and obesity.
• ultrasonographic diagnosis of polycystic
ovaries: multiple (n>10), small (2–8 mm)
peripheral cysts around a dense core of stroma
in enlarged (≥8 ml) ovaries

33. LUTEINIZED UNRUPTURED FOLLICLE
SYNDROME
• Luteinized unruptured follicle (LUF) syndrome
is characterized with regular menses and
presumptive ovulation as suggested by a cyclic
hormonal profile, similar to that seen in
normal ovulatory women but without release
of the ovum.
• lower concentrations of estradiol and
progesterone in peritoneal fluid compared
with normal ovulatory cycles

34. • diagnosis is most commonly made on
ultrasound examination, in which there is
persistence of the ovarian follicle with
progressive loss of its typical echo-free cystic
appearance and accumulation of internal
echogenicity

35. LUTEAL PHASE DEFECT
• The formation of corpus luteum is an
important event in reproductive cycle and one
of the crucial factors in early pregnancy
support
• lack of progesterone, luteal phase of the cycle
shorter than 11 days, and when related to
endometrium, an outof- phase endometrium
by 2 or more days

36. • corpus luteum abnormalitycan be detected by
color Doppler ultrasonography
• increased RI in both ovaries was associated
with a nonviable pregnancy outcome.

38. TUBAL FACTOR OF INFERTILITY
• The normal Fallopian tubes are narrow and
usually not seen by transabdominal or
transvaginal ultrasound unless they contain
fluid within their lumina or area surrounded by
fluid
• Chronic hydrosalpinx is the ultimate remnant
of the PID: the tube is occluded, thin-walled
and filled with fluid

40. PERITONEAL FACTOR
• Endometriosis is caused by foci of secretory
endometrium outside of the uterus

41. Ultrasound Markers of
Implantation

44. Ovarian sonography
Follicular cyst Hemorrhagic cyst
Dermoid cyst
Paraovarian cyst

45. Endometriosis
 Endometriosis is defined as the presence of
endometrial tissue outside of the
endometrium and myometrium
 Endometriotic foci may appear as punctate
spots or patches of variable color, with a
slightly raised or puckered surface, forming
nodules, cysts, or both. In one-third to
onehalf of cases, ovarian endometriotic cysts
are bilateral
 The cysts rarely exceed 15 cm in diameter

47. conclusion
 Sonography can play a critical role in the diagnosis
and treatment of fertility disorders.
 transvaginal color Doppler and 3D ultrasound with
power Doppler facilities have made a significant
improvement in the assessment of infertility
 Absent subendometrial an
intraendometrialvascularization on the day of hCG
administration appears to be a useful predictor of
failure of implantation in IVF cycles
 Quantification of endometrial volume by 3D
ultrasound in combination with blood flow studies
contributes to the assessment of endometrial
receptivity and has a potential to predict pregnancy
rates in assisted reproductive techniques

48. Thank you
FEMELIFE IVF TEAM
www.femelife.com