Role of TVS in Infertility.

TVS is just like a torch, we use to see in the dark room. It is same in infertility checkup. We use it to see inside the female body.

During Infertility testing ultrasound provide information on:

UTERUS:

  • Assess endometrial cavity where actual pregnancy grows i.e., endometrial size, shape & thickness
  • Rule out Endometrial polyps & uterine septum (partial/complete). If found on ultrasound we can plan hysteroscopic removal prior embryo transfer.
  • Rule out Adenomyosis & Fibroid which are responsible for Infertility & pregnancy loss.
  • 3D imaging of uterine shape & volume, rule out uterine developmental defects.
  • Adhesions, Asherman’s Syndrome.

OVARIES:

  • Evaluate ovarian reserve (anterior follicle count) so that further mode of management (IUI/IVF-OPU/OD) can be decided & discussed with couple after correlating with AMH level.
  • Rule out type & size of cyst (simple/hemorrhagic/chocolate/ endometrioma) also rule out pelvic pathology like T-O Mass.

FALLOPIAN TUBES:

  • Normal healthy fallopian tubes cannot be visualized on ultrasound.
  • Partial or complete Hydrosalpinx can be diagnosed if it is swollen or filled with fluid.

For fertility treatment, Ultrasound used:

UTERUS:

  • To assess endometrial thickness in natural/ IUI cycle/ IVF cycle.
  • Embryo Transfer is done under abdominal ultrasound guidance in IVF. A catheter is inserted in uterine cavity to place embryo for transfer.
  • To study effect of estrogen on endometrial thickness in IVF cycle.
  • To confirm pregnancy on ultrasoungd after the positive result, rule out intra or extra uterine pregnancy, number of pregnancies (single or multiple).

OVARIES:

  • In natural cycle, to monitor follicle development & once any follicle achieves size of 18 to 22mm, advice patient for timed intercourse. Also we can confirm on ultrasound whether growing follicle has ruptured or not.
  • In IUI cycle, follicular monitoring is from day 2 of menstrual cycle with oral/ injectable ovulation inducing drugs. Trigger is given when optimum size of any single follicle is achieved then IUI is planned accordingly.
  • In IVF (OPU) cycle:
    • On day 2 of period a baseline ultrasound is performed, to examine ovaries, number of follicles are counted and their size is measured, depending on that a dose is decided (considering age, BMI, AMH)for hormonal stimulation.
    • Monitor response to stimulation of injection by transvaginal route frequently. Once adequate size of maturation of follicles is achieved 18 to 22mm final maturation trigger is given by HCG/ Decapeptryl depending on cohort number.
    • 36 hours after taking trigger shot, oocyte retrieval is done which involves removing eggs from ovary under anesthesia using transvaginal ultrasound with fine needle.

Ultrasound is non-invasive, easier, safe, cheap, & less time consuming modality for fertility testing & treatment. It has revolutionized the investigative approach and treatment of an infertile couple.

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