Iris Publishers_World Journal of Gynecology & Womens Health (WJGWH)

State-Of-The-Art Ultrasound in the Management of the Infertile Couple

Abstract

Ultrasound is vital tool for imaging women and men with infertility as it is inexpensive, accessible and non-invasive, providing crucial information to allow quick diagnosis. It also helps to facilitate an interactive discussion with the patient where findings can instantly be seen and acted upon. Additionally, US is indispensable for assisting IVF and ICSI treatment especially with the introduction of 3D technology ensuring the best quality oocytes are used to strive for the best outcomes. The diagnosis and treatment of infertility can be extremely distressing for patients and we must ensure we provide the highest level of care with the use of US playing a key role in management. Furthermore, all contemporary trainees aspiring for a career in reproductive medicine should be trained and competent in advanced ultrasound.

Keywords: Female infertility; Male infertility; Ultrasound; 3D imaging; Ovarian reserve; Assisted reproductive technology; Oocyte quality; Oocyte retrieval; Embryo implantation; Embryo transfer

Introduction

Infertility affects 1 in 7 heterosexual couples in the UK and is diagnosed when a woman of reproductive age has not become pregnant after at least 12 months of timed unprotected intercourse or 6 cycles of donor insemination. Earlier evaluation after 6 months may be required in certain circumstances such as, maternal age over 36 years or known history of predisposing factors to infertility [1]. Ultrasound (US) plays a crucial role in all aspects of the management of the infertile couple with the introduction of three-dimensional (3D) imaging and the use of doppler US greatly improving our knowledge on ovarian function and quality [2]. The purpose of this article is to summarize the crucial role US has in the investigation and diagnosis of the infertile couple as well as assisting in the creation and implantation of an embryo in assisted reproductive techniques.

Discussion

Investigation of the infertile couple

Ovarian Reserve: Ovarian reserve is determined by the number and quality of primordial follicles and is reflective of a woman’s reproductive potential. There is no universal consensus to define decreased ovarian reserve but is usually understood as a reduced response to either ovarian stimulation or regular intercourse in women who are ovulating and trying to conceive [3].

There are no existing tests to estimate the true ovarian reserve, but this can be indirectly estimated using US to measure the ovarian antral follicle count (AFC) [4]. Primordial follicles grow in diameter from less than 0.05mm (impossible to see on US) to 2mm, when they develop an antral cavity lined by granulosa cells, capable of producing estrogen, and are consequently called antral follicles.

AFC is measured using transvaginal US (TVUS) and is reported as the total number of antral follicles measuring 2 to 10mm in diameter from both ovaries [5]. With the recent novel use of 3D US and advancements in image resolution, follicles less than 2mm in diameter can be counted, however there is debate on whether they should be included as such small follicles would not respond well to follicle-stimulating hormone(FSH) [6]. Unfortunately, the technique to count antral follicles is not standardized and can result in differences secondary to the operator and the type of equipment used [7]. Table 1 summarizes the different US modalities to count antral follicles.

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