How USG Helps in the Early Diagnosis and Treatment of InfertilityDr Chaithra S.K

How USG Helps in the Early Diagnosis and Treatment of Infertility

Ultrasound (USG) is an excellent first-line investigation used to assess the cause of infertility and institute treatment accordingly. USG is an effective, safe, inexpensive, radiation-free, non-invasive, and readily available tool.

Role of ultrasound in female infertility

Ultrasound is used to evaluate the pelvic organs (uterus and ovaries), growing ovarian follicles, and cyclic uterine endometrial changes.

Evaluation of uterus

A) Structural anatomy – Using 3D ultrasound, congenital issues can be diagnosed and classified according to uterine anomalies' ESHRE/ESGE classification.

B) Pathologies

1) Fibroid: seen in 5-10% of infertile women. Distortion of the endometrial cavity, abnormal endometrial receptivity, altered hormonal milieu, and endometrial development are the causative factors for infertility in fibroids.

USG provides the number, exact location, and size of fibroids, thus helping in the thorough planning of surgical intervention if necessary.

2) Adenomyosis: Adenomyosis results in structural and functional defects of the uterine junctional zone and, thus, resulting in disturbed uterine peristalsis and sperm transport, increased inflammatory response in the endometrium, causing impaired implantation. All these factors contribute to subfertility and increased risk of miscarriage in Adenomyosis.

The ultrasonographic features of Adenomyosis are globular uterus, asymmetrical myohyperplasia, and myometrial cyst.

1)Follicular monitoring: This is an integral part of an investigation of subfertile women. Serial scans during the follicular phase evaluate the follicle’s growth and estimate the time of follicular rupture, the ideal time to trigger ovulation, and the occurrence of ovulation.

2)Antral follicular count: Estimate the day two of the menstrual cycle, follicles of 2- 8 mm size measured and counted in each ovary. Diminished ovarian reserve is diagnosed when AFC < 5. Early diagnosis of diminished ovarian reserve helps in planning proper treatment such as IVF, thus reducing the time to pregnancy.

Role of ultrasound in male infertility

Ultrasound of the scrotum evaluates abnormalities within the testis and the per testicular structures, such as varicoceles and epididymal abnormalities. Thus aiding in identifying causative factors for male factor infertility.

Transrectal ultrasound enables high-resolution imaging of the prostate, seminal vesicles, and vas deferens. It is the modality of choice in diagnosing congenital and acquired abnormalities implicated in the cause of obstructive azoospermia (OA).

Penile ultrasound is used to evaluate physical causes of erectile dysfunction, including structural penile abnormalities, problems with arterial inflow, and malfunction of the venous occlusive mechanism.