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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.

Role of TVS in Infertility

During Infertility testing ultrasound provide information on:

• 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.

• 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.

• 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:

• 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).

• 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.