OBGYN I - Role of Ultrasound in Evaluating Female Infertility

nonhostile

Role of cervix in fertility to provide ____ environment to harbor sperm

Cervical incompetence

Ultrasound used to evaluate cervical length during

pregnancy to assess for

Hysterosalpingography

can be used to evaluate internal os diameter

Cervical stenosis

Diameter <1 mm by HSG may indicate

Assess structural anatomy and endometrium

Two main objective of evaluating the uterus

Estrogen

In first half of menstrual cycle, mucosa begins to proliferate because of increasing

progesterone

After ovulation, _____ is secreted by corpus luteum

Secretory phase

Secretion of progesterone begins the

Thickened and echogenic

During secretory phase, endometrium becomes ____ and ____ as a result of stromal edema

6mm

Endo should have a thickness of at least ____ to achieve pregnancy

luteal phase deficiency

Lack of progesterone production known as

infertility and early pregnancy loss

Luteal phase deficiency is associated with

submucosal fibroids, polyps, and adhesions

Other things that can make endometrium appear irregular or more echogenic than normal are

Saline infusion sonography

can demonstrate fibroids, polyps and synechia.

isoechoic

Fibroids tend to have broad base and are more ____ to uterine myometrium

Hydrosalpinx

associated with 50% reduction in pregnancy rate and doubling of spontaneous miscarriage rate

blocked

If no spillage noted and patient complains of pain during injection, tube may be

1 to 3

Dominant follicle will grow at rate of approximately _____ until it reaches average diameter of 22 mm.

corpus luteuam cyst

Sonographic findings associated with ovulation are echoes within fluid left behind also known as

PCOS

condition that can inhibit release of FSH and LH

Oligoovulation, hyperandrogenism, polycystic ovaries

Diagnostic triad of PCOS

normal ovulation

In PCOS the production of estrogen and androgen inhibits pituitary gland’ s function and prevents

LH

In PCOS the pituitary gland produced more ___ than FSH

PCOS

A patient comes in with irregular bleeding and a thickened endo with hirsutism. Sono is a round ovary with multiple small immature follicles on peripher (2-9mm) with a string of pearls sign

adhesions and endometriosis

Peritoneal factors of infertility

peritoneal inclusion cyst

Sometimes fluid will collect in between adhesions, resulting in

Ovarian induction therapy

treatment in which ovarian stimulation achieved in controlled setting

Clomid and aromatase inhibitors

Ovarian induction therapy is usually accomplished by administering

10-14

Once therapy started, ultrasound used to monitor the number and size of follicles typically during day

>1cm

Sonographer needs to count and measure all follicles

16 and 20mm

Optimal mean measurement of mature follicle between

2-3mm to 12-14mm

Normal endometrial response associated with ovarian stimulation is increasing thickness from

In vitro fertilization (IVF)

method of fertilizing human oocyte outside body

Treatment plan for IVF

consists of ovarian monitoring, needle aspiration of oocytes, incubation of oocytes, fertilization, and transferring embryos into uterus

4

In IVF how many follicles are identified before triggering evaluation

Intrauterine inseminatiomn

used to treat male factor infertility

Therapeutic donor insemination

Referred to as artificial insemination using donor sperm

OHSS, multiple gestations, ectopic pregnancy

Complications associated with ovarian hyperstimulation syndrome

OHSS

syndrome that presents sonographically as enlarged ovaries with multiple cysts, abdominal ascites, pleural effusions

30%

Estimated about _____ of in vitro fertilization pregnancies result in multiple gestation

heterotopic pregnancy

ectopic pregnancy coexisting with intrauterine pregnancy

Unicornuate uterus

Anomaly where one mullerian duct never forms resulting with one horn abd is associated with infertility and pregnancy loss

Septate uterus

Anomaly where there’s incomplete reabsorption of the sagittal septum and is associated with increased incidence of 1st trimester miscarriage

Septate uterus

Which anomaly has the poorest reproductive outcomes of all mullerian duct abnormalities

T shaped uterus

Anomaly related to exposure to the drug diethylstilbestrol (DES) in utero and is associated with increased risk of spontaneous abortion