Infertility Powerpoint

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Role of ___ in infertility is to provide a nonhostile environment to harbor sperm.


Hysterosalpingography (HSG)


_____ can be used to evaluate internal os diameter. Diameter less than 1 mm by ___ may indicate cervical stenosis.


(1) assess structural anatomy

(2) assess endometrium

Evaluating Uterus:

2 main objectives for evaluating the uterus: ____, and ____

Assessing for (1)___ refers to evaluating uterine shape (unicolis, bicornuate, congenital malformations) and evaluating echogenicity.



____ can be measured throughout the menstrual cycle to look for appropriate changes.

Thickness encompasses thickness for both anterior and posterior ____ layers in the sagittal plane.



Endometrium thickness of at least ___mm appears to represent central threshold for achieving pregnancy.

If not enough progesterone = thin endo; lack of progesterone production known as "luteal phase deficiency" and may be associated with infertility and early pregnancy loss.


Submucosal fibroids, polpys and adhesions

Saline infusion sonography (SIS)

Other things that can make endometrium appear irregular or more echogenic than normal are _____, _____ and ____.

____ can be used in these situtations to further delineate anatomic structure of endometrium.



____ tend to have broad base and are more isoechoic to uterine myometrium. Also tend to have circumferential flow around them.

SIS can demonstrate fibroids and polyps by outlining endometrial cavity.


Fibroids and polyps

____ and ____ can potentially impede implantation.

If found, can be removed to enhance fertility.

SIS can be used to evaluate uterine cavity for synechiae, scars from uterine trauma.



Evaluating Fallopian Tube:

Hydrosalpinx associated with ___ reduction in pregnancy rate and doubling of spontaneous miscarriage rate.

Removal of such damaged tubes can dramatically improve invitro fertilization success.


Tubal patency

Evaluating Fallopian Tube:

____ is assessed by injecting saline into fallopian tube and looking for spillage of fluid into cul-de-sac or by using contrast to evaluate for spillage.

If no spillage is noted and patient complains or pain during injection, the tube may be blocked. Adhesions can obstruct a fallopian tube.


Follicular, 5

Follicle-stimulation hormone

1-3, 22

Evaluating Ovaries:

During the ovarian ___ phase, there are several antral follicles on the ovary less than __mm in diameter.

Follicle selected to develop into dominant follicle in response to ____.

Dominant follicle will grow at rate of approx. __-__mm/day until it reaches average diameter of ___mm.



Evaluating Ovaries:

Once reaching a mean diameter of ___mm the dominant follicle will rupture. Rupture may be associated with increase or decrease in size.

Sonographic findings associated with ovulation are echoes within the fluid left behind (corpus luteum cyst) or free fluid in peritoneal cavity.




Evaluating Ovaries:

Women with ___ may often present with irregular bleeding, and thickened endometrium as result of chronic elevation of estrogen.

Because of chronic elevations of androgens, some women may have ___.



Evaluating Ovaries:

Follicles in PCOS measure __ to __mm in diameter.

Round ovary with multiple small immature follicles on the periphery.

Has been described as "string of pearls"


Peritoneal factors, 25%


___ may be a cause for as many as __ of infertility cases.

___ factors are adhesions and endometriosis.

Sometimes fluid will collect in between adhesions, resulting in peritoneal inclusion cyst. Adhesions are bands of scar tissue that can obstruct the fimbriated end of fallopian tube.


Ovarian Induction Therapy


___ refers to treatment in which ovarian stimulation achieved in controlled setting.

If cyst measuring greater than __mm detected, could represent persistent follicular activity that could interfere with response to ovarian stimulation medication. Rule out ovarian cysts and assess for dominant follicles.


Oral contraceptives

Early proliferative

Ovarian Induction Therapy:

If serum estradiol is elevated and large ovarian cyst present, ____ may be indicated to suppress follicular activity before starting ovarian stimulation therapy.

Optimal time to assess for intracavity masses (polyp, fibroid), since lining of the uterus is usually at its thinnest during the ____ phase.


Clomid (clomiphene citrate)


Ovarian induction therapy is usually accomplished by administering ____ or human menopausal gonadotropins.

Once therapy started, ultrasound is used to monitor number and size of follicles in days __to__ (follicular phase) of menstrual cycle.



16 and 20

Ovarian Induction Therapy:

Sonographer needs to count and measure all follicles greater than ___ cm in long and trv planes. Optimal mean measurement of mature follicles is between __ and __ mm.

During this time ultrasound can be correlated with serum estradiol levels if follicular growth corresponds with adequate E2 production.


Human Chorionic Gonadotropin (hCG)

Ovarian Induction Therapy:

Correct measurement of follicles is important because ____, substitute for LH, may need to be given intramuscularly to trigger ovulation.


2-3; 12-14

Normal endometrial response associated with ovarian stimulation is increasing thickness from __ to __ mm to __ to __mm.

Measure endometrial thickness- TVS uterus transvaginally in long and measure AP


Invitro Fertilization

___ is a method of fertilizing human oocyte outside the body. Mature oocytes are collected and mixed in a dish with a sample of sperm. Resulting embryos are then places back into the uterus.

Treatment plan for ___ consists of ovarian monitoring, needle aspiration of oocytes, incubation of oocytes, fertilization, and transferrring embryos into the uterus.


2; 4

Invitro Fertilization:

Ovarian monitoring performed as described in ovarian induction therapy section, with on difference: instead of evaluating for __ optimal follicles, __ follicles are identified before triggering evaluation.

Oocyte retrieval is accomplished with transvaginal ultrasound guidance.


Intrauterine insemination

___ is a technique used to treat male factor infertility. With ___ a catheter containing sperm is placed into the uterine fundus.

Sperm preparation may be from a donor. It is referred to as artificial insemination using donor sperm, or therapeutic donor insemination (TDI)


Ovarian Hyperstimulation syndrome, multiple gestations, and ectopic pregnancy

List complications associated with assisted reproductive technology (3)


Ovarian hyperstimulation syndrome

____ presents sonographically as enlarged ovaries with multiple cysts, abdominal ascites, and pleural effusions.

Often seen in patients who have undergone ovulation induction after administration of follicle-stimulating hormone or GnRH analogue followed by hCG.


Ovarian hyperstimulation syndrome

More severe cases of ___ will present with leg edema, ascites, pleural effusions, hypotension, and polycythemia.

Sonographic findings in severe ___ cases will demonstrate enlarged ovaries, with multiple cysts, ascites, and pleural effusions.


Multiple gestations

Patients who undergo invitro fertilization are at increased risk for having ___. Estimated about 30% of invitro fertilization pregnancies result in ____. Concern with ___ is that if there are 3 or more fetuses, increased risk of fetal and/or neonatal morbidity and mortality.


Ectopic pregnancy

Patients who undergo assisted reproductive technologies are at increased risk for ____.

___ is pregnancy implanted outside of uterus. Patients also at risk for having heterotopic pregnancy; ____ coexisting with intrauterine pregnancy.