Ultrasound in Subfertility: Routine Applications and Diagnostic Challenges

Author: Jayaprakasan K, Panchal Sonal

Ultrasound is an essential tool in the assessment and management of subfertile couples undergoing fertility treatment. Ultrasound allows a non-invasive, direct assessment of the pelvic organs. A baseline ultrasound assessment of the pelvis is performed to screen for any pelvic pathologies that are known to have a negative effect on fertility and early pregnancy. It is used on a daily basis in all the fertility units to monitor the response to treatment and to guide egg collection and embryo transfer in women undergoing IVF treatment. Pre-treatment ultrasound assessment also facilitates prediction of ovarian reserve. The use of ultrasound has extended to subfertile men also for evaluation of testicular morphology and lower genital tract and for guiding surgical sperm retrieval. Since the introduction of ultrasound as a medical diagnostic tool in the 1950s, there has been significant progress in the ultrasound technology. Development of high frequency probes and refinements of ultrasound machines and associated softwares have helped to produce high-resolution images and thereby improving diagnostic capabilities. Introduction of 3D ultrasound and automated techniques in the last decade have further improved image qualities and facilitated more objective and reproducible volume measurements. This improved grey scale ultrasound imaging along with Doppler technologies have been incorporated in almost all the fertility units around the world with an over all aim to improve the success of fertility treatments without compromising safety of subfertile couples. It is essential that all the health professionals involved in the care of subfertile couples are well-versed with pelvic ultrasound and its applications. This textbook is aimed to provide them a practical overview of how both basic and advanced ultrasound techniques can be applied in diagnosis and management of patients presenting to a fertility clinic. This book is a guide for both inexperienced and experienced ultrasound practitioners to perform a high quality ultrasound and includes plenty of ultrasound images and videos relevant to each clinical scenario to ease the learning process. A systematic approach is adopted as this book begins with basic ultrasound principles, taking through correct examination techniques during a pelvic assessment, ultrasound screening of various uterine and adnexal pathologies, evaluation of tubal and ovarian function and application of ultrasound in monitoring treatment response, in assessing complications of fertility treatment and in guiding assisted reproduction treatment procedures. Special chapters are dedicated to provide an overview on the role of ultrasound in managing male infertility and also on three-dimensional ultrasound techniques and its applications in subfertilty.

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