Sonographic Imaging in Infertility and Assisted Reproduction

Infertility can be defined as the inability to conceive a pregnancy after 1 year of unprotected intercourse or after 6 months in a woman over 35 years old. It affects between 6% and 10% of couples in the United States. Because fertility peaks in the third decade and subsequently declines, the age of the female partner is an important variable in the treatment of infertility. The use of sonography, in particular EVS, has become an integral component of the evaluation and treatment of infertility. The transvaginal approach allows high-resolution assessment of the uterus, ovaries, and fallopian tubes. EVS plays a critical role in the diagnosis and treatment of infertile women in combination with serologic testing, physical examination, and careful assessment of medical and surgical history, as well as evaluation of the male partner. Initial baseline ultrasound examination is used primarily to identify structural abnormalities that might affect fertility such as uterine anomalies, endometrial polyps or submucosal leiomyomas, endometrial adhesions/synechiae, or hydrosalpinges. Sonography is also used to assess for possible underlying pathologic processes associated with infertility such as adenomyosis, endometriosis, polycystic ovary syndrome (PCOS), and low antral follicular count. If the baseline pelvic sonogram is inconclusive or noncontributory, further anatomic evaluation can be obtained by means of pelvic magnetic resonance imaging (MRI), hysterography, sonohysterography, or even hysteroscopy and laparoscopy, as indicated. It is estimated that ovulatory defects are the primary cause of infertility in 20% to 40% of infertile women. Structural abnormalities of the female reproductive tract account for approximately 30% of cases; male factors up to 35%; and cervical mucosal, peritoneal, or unexplained abnormalities account for approximately 10% to 15%. Once a treatment plan has been established, sonography plays an important role in monitoring response, particularly in assessing folliculogenesis and endometrial receptivity. In addition, ultrasound imaging is crucial for guiding infertility treatment such as oocyte retrieval and in assessing posttreatment complications. This chapter will review the role of sonographic imaging in the diagnosis and treatment of women presenting with infertility.