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Ultrasound and Infertility

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First-Trimester Ultrasound

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Abstract

Infertility is growing in prevalence, estimated to affect between 8% and 12% of reproductive-aged couples worldwide, with 1 in 8 women receiving infertility services (Carson and Kallen, JAMA 326:65–76, 2021). As such, there is a continued and growing emphasis on the ability of the physician to provide an up to date, evidence-based approach to the evaluation and management of the infertile and subfertile female patient. The initial workup includes a baseline evaluation of the pelvic anatomy and ovarian reserve, as well as the description and monitoring of any structural pathologies which can contribute to, or affect, fertility and reproductive outcomes.

Ultrasound remains an integral and essential part of the modern investigation of female infertility, revealing essential information about the anatomy and morphology of pelvic organs. Ultrasounds are predominantly performed trans-vaginally, and recent technological advances such as 3D and Doppler imaging enhance our comprehensive understanding of ovarian function and uterine environment. The breadth of evaluation includes both two and three-dimensional ultrasound to examine appearance and shape of the endometrium, endometrial cavity, myometrium, assessment of any Müllerian anomalies, fibroids, adenomyosis, and polyps. The adnexae can be evaluated utilizing grayscale ultrasound and Doppler, looking for ovarian masses or cysts, as well as signs of tubal disease. Evaluation of ovarian follicles is a key component of ovarian reserve assessment as well as evaluation of response to ovarian stimulation. The cul-de-sac can be imaged to look for masses, features of endometriosis, and free fluid. Various imaging techniques can reveal mobility or lack thereof of the uterus and ovaries, suggestive of adhesions or endometriosis.

In more recent literature, it has been recommended that ultrasound be used in conjunction with comparative technologies including sonohysterography to allow for more detailed evaluation of the endometrial cavity, endometrium, and to assess for the presence of intracavitary pathology. We also have seen the rise of various approaches to use of sonography for the evaluation of tubal patency, including real time assessment during sonohysterogram by introducing air and saline or contrast and imaging the Fallopian tubes (HyCoSy). Lastly, ultrasound is critical to ovarian follicular monitoring of fertility treatments and for ultrasound assistance in oocyte aspirations and embryo transfers, key elements of assisted reproductive technology treatment. Ultrasound as a technology has significantly impacted and advanced the diagnosis and management of infertility.

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Authors and Affiliations

  1. The University of Chicago, Chicago, IL, USA

    A. Musa Zamah, Robyn Power, Ryan E. Longman & Jacques S. Abramowicz

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Correspondence to A. Musa Zamah .

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  1. University of Chicago, Chicago, IL, USA

    Jacques S. Abramowicz

  2. University of Chicago, Chicago, IL, USA

    Ryan E. Longman

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Zamah, A.M., Power, R., Longman, R.E., Abramowicz, J.S. (2023). Ultrasound and Infertility. In: Abramowicz, J.S., Longman, R.E. (eds) First-Trimester Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-031-24133-8_3

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  • DOI: https://doi.org/10.1007/978-3-031-24133-8_3

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  • Print ISBN: 978-3-031-24132-1

  • Online ISBN: 978-3-031-24133-8

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