Infertility can be a heart-wrenching experience for many couples, and finding the root cause can often feel like looking for a needle in a haystack. However, with the advancements in medical technology, tools like Transvaginal Sonography (TVS) have become indispensable in diagnosing and treating infertility. TVS acts as a detailed “torch” that shines light into the dark areas of the female reproductive system, providing vital information for infertility investigations.

In this article, we’ll take a deep dive into the role of TVS in infertility, exploring how it helps in diagnosing uterine, ovarian, and fallopian tube abnormalities and how it aids in fertility treatments like IUI and IVF.

What is TVS (Transvaginal Sonography)?

TVS is a specialised form of ultrasound imaging that involves inserting a small probe into the vagina to capture detailed images of the internal reproductive organs. Unlike abdominal ultrasounds, TVS provides a much clearer, more detailed view of the uterus, ovaries, and fallopian tubes.

This method uses high-frequency sound waves to create real-time images, offering healthcare professionals a non-invasive yet accurate way to examine a woman’s reproductive system. It’s a safe, simple, and cost-effective diagnostic tool that plays a significant role in infertility investigations.

Importance of TVS in Infertility Diagnosis

TVS is crucial for infertility check-ups because it provides an in-depth view of the reproductive organs that cannot be obtained through a physical examination alone. Much like a torch helps you navigate a dark room, TVS illuminates the hidden conditions that could be causing infertility, such as fibroids, cysts, or blocked fallopian tubes.

With TVS, doctors can identify issues early, ensuring a more targeted approach to fertility treatments and enhancing the chances of successful conception.

Role of TVS in Uterus Evaluation

Assessing the Endometrial Cavity

The uterus is where pregnancy grows, and TVS helps assess the endometrial cavity—the part where the embryo implants. By evaluating the endometrial size, shape, and thickness, TVS gives doctors valuable insight into the health of the uterus. An ideal endometrial lining is crucial for embryo implantation, making this a key factor in infertility treatment.

Endometrial Polyps and Uterine Septum

TVS plays a vital role in ruling out uterine abnormalities, such as endometrial polyps or uterine septum. If present, these conditions can impede implantation and cause miscarriage. TVS identifies these problems, enabling doctors to plan treatments like hysteroscopic removal before embryo transfer.

Fibroids and Adenomyosis

Fibroids and adenomyosis are common causes of infertility and pregnancy loss. TVS helps detect these conditions by providing clear images of the uterus. By spotting fibroids early, doctors can suggest treatments to improve fertility outcomes.

3D Imaging of Uterus

3D imaging has revolutionised how doctors assess the shape and volume of the uterus. It allows for the detection of any developmental defects or structural issues that could affect conception. This detailed view is crucial for creating a tailored treatment plan.

Adhesions and Asherman’s Syndrome

Adhesions, often caused by infections or previous surgeries, can disrupt fertility. TVS helps identify these scars, as well as Asherman’s Syndrome (a condition where scar tissue forms inside the uterus), both of which can prevent pregnancy.

TVS and Ovarian Assessment

Evaluating Ovarian Reserve

Ovarian reserve refers to the number and quality of eggs in the ovaries. TVS helps evaluate this by counting the number of antral follicles (AFC). Along with hormonal tests like AMH (Anti-Müllerian Hormone), TVS aids in determining the best course of action, whether it be IUI, IVF, or egg donation.

Types of Ovarian Cysts

TVS can identify various types of cysts in the ovaries, including:

• Simple cysts: Fluid-filled sacs that may or may not interfere with fertility.
• Hemorrhagic cysts: Blood-filled cysts that can cause pain or affect ovulation.
• Chocolate cysts (Endometrioma): Cysts formed by endometriosis, which can negatively affect fertility.

Pelvic Pathology: T-O Mass

TVS helps detect pelvic masses, such as the T-O Mass (Tubo-Ovarian Mass), which can interfere with fertility. By identifying these masses early, doctors can decide on the most effective treatment.

TVS in Fallopian Tube Evaluation

While healthy fallopian tubes are not visible on TVS, this technology can help detect abnormalities such as hydrosalpinx—where the tubes are swollen or filled with fluid. Hydrosalpinx can impair the fertilisation process, making TVS a valuable diagnostic tool.

Role of TVS in Fertility Treatment

For Uterus

• Endometrial Thickness: In IVF and IUI cycles, TVS is used to monitor the thickness of the endometrium to ensure it is suitable for embryo implantation.
• Embryo Transfer: During IVF, ultrasound is used to guide the catheter during embryo transfer to ensure precise placement in the uterus.

For Ovaries

• Follicular Monitoring: TVS helps track the growth of follicles in natural, IUI, and IVF cycles. Once a follicle reaches the optimal size (18-22mm), it’s time for timed intercourse or insemination.
• IVF Stimulation: During IVF, TVS is used to monitor the ovaries’ response to hormone injections, ensuring that the follicles grow to the right size before egg retrieval.

For IVF and OPU

• Egg Retrieval: Ultrasound guidance is crucial during OPU (Oocyte Pick-Up) to remove eggs from the ovaries. A fine needle is guided into the ovaries to retrieve the eggs, under anaesthesia.

Advantages of TVS in Fertility Testing and Treatment

TVS is a non-invasive, cost-effective, and time-efficient method for assessing fertility. It eliminates the need for more invasive procedures, such as laparoscopy, making it an excellent first-line diagnostic tool. Furthermore, it can be used multiple times throughout the treatment process, providing real-time updates and guiding doctors in making informed decisions.

Conclusion

TVS has proven to be a game-changer in infertility diagnosis and treatment. It offers a clear, detailed view of the uterus, ovaries, and fallopian tubes, allowing doctors to identify and address issues early. By providing critical information, TVS helps create personalised treatment plans, improving the chances of conception and successful pregnancy.