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2011-12-03 17:26:28

The role of ultrasound in evaluating female infertility
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  1. infertility
    • inability to concieve within 12 months or regular coitus or 6 months if over 35 yrs.
    • 40% female
    • 40% male
    • 20% unknown
  2. male infertility factors
    • little amt of sperm
    • decreased motility of sperm
    • obstructed spermatic ducts/vas deferens
    • scrotal varicolceles
  3. evaluating the cervix
    • role of cervix is to provide nonhostile place for sperm to harbor
    • secretes mucous and crypts to hold sperm
    • US evaluates cervical legnth/incompetence
    • hysperosalpingography- eval in/ex os
    • <1mm may be cervical stenosis
  4. evaluating the uterus
    • 1. structual anatomy
    • shape/ecogenicity, fibroids?
    • 2. acsess endometrium
    • thickness, echogenicity, lesions
  5. Congenital uterine anomalies
    • 1% women effected
    • result of defecs in mullerian duct dev.
    • septate uterus-infertility (implantation)
    • t-shaped- DES cervical incompetencebicornuate- 2 uterine, 1 cervix (not infertile)
    • didelphys- 2 uterine, 2 cervix (not infertile)
  6. evaluating the endometrium
    • measured through menstral cycle for changes
    • saline infused sonography (SIS)-submucosal fibroids, polups, adhesions, synechiae (scars) minimum 6mm endomet needed for preg.
  7. evaluating the fallopian tubes
    • acess if blocked- fill with saline to cul-de-sac
    • hysrosalpinx 50% reduction in preg rate
  8. hydrosalpingography
    flouroscopic imaging of injecting contrast into uterine cavity
  9. evaluating the ovaries
    • dominant follicle ruptures at 24-35 mm
    • 4-8 follicles on ovary per cycle
    • harvested at 20-22mm
    • LH rises just before ovulation
    • PCOS- inhibit release of lh and fsh no mature ova
  10. peritoneal factors
    • adhesions (scar tissue at fallopian tube ends) and endometriosis (ectopic endo tissue)
    • lapraoscopy- best way to evaluate both
  11. Ovarian Induction Therapy
    • treatment by controlled ovarian stimulation
    • administer Clomid (human menopausal gonadotropins) which enlarge multiple follicles.counted/measured/monitor in days 8-14. hcg given to sub for lh to trigger ovulation
  12. Monitoring the endometrium
    • normal 2-14mm
    • tv in a sagittal plane
    • hyper to hyper
    • at least 6mm for fertility
  13. In vitro fertilization (IVF)
    • fertilize the oocyte outside the body and put back into uterus (embryo transfer)
    • optimal placement w/in 2 cm apex of fundus
  14. intrauterine insemination
    • used to treat male factor infertility
    • catheter with sperm placed into fundus
  15. ZIFT
    Zygote intrafallopian transfer

    transfer of fertilized egg outside the body into fallopian tube laproscopically
  16. GIFT
    gamete intrafallopian tube transfer

    eggs and sperms are put into fallopian tube by laproscope, unfertilized
  17. Complications with assisted reproductive technology (ART)
    ovarian hyperstimulation syndrome (OHSS)

    • multiple gestations 30%
    • 3 or more they reduce with potassium chloride to heart

    • ectopic pregnancy/heterotropic preg
    • ectopic and iup at same time (1:100)
  18. Ovarian hyperstimulation syndrome (OHSS)
    enlarged ovaries 5-10 cm, multiple cysts, abd ascites, pleural effusion

    ovulation induction- given fsh or gnrh then hcg