Ultrasound in Subfertility: Routine Applications and Diagnostic Challenges K Jayaprakasan, Sonal Panchal
INDEX
Page numbers followed by b refer to box, f refer to figure and t refer to table.
A
Acquired immunodeficiency syndrome 181
Acquired urogenital abnormalities 162
Addison's disease 173
Adenomyosis 29, 35, 36, 36f
areas of 37
management of 37
sonographic features of 36b
uterus 50f
Adnexal
cyst 16f
mass 65f
pathologies 27, 105, 112
signs 65
torsion 148
Adrenal hyperplasia, congenital 173
Adrenogenital syndrome 173
Alara principle 14
Allis forceps 136
Amenorrhea 49
Ammonia, anhydrous 13
Anal canal 20f
Androgen Excess Society Criteria 96
Anechoic lacunae 36
Anesthesia 132
general 133
Anteverted uterus 30f
Antimicrobial solution, type of 18
Anti-Müllerian hormone 40, 80, 96
Antral follicles 5f, 25f, 85f
count 80, 82, 84, 85, 119
multiple 97f
Arcuate uterus 19f, 198f
Artery, diameter of 10f
Ascites, continuous autotransfusion system of 141
Ascitic fluid, aspiration of 132, 141
Asherman's syndrome 50, 50f, 54
Assisted reproduction
role of ultrasound in 188
treatment 79, 147
complications of 147
Assisted reproductive technology 123
Atrophic seminal vesicles 186
Automatic volume calculation 123
B
Bacterial contamination 13
Beam, depth penetration of 2
Benzyl or methyl alcohol 13
Bicornuate 40
uterus 39f, 51f, 55f, 67f
Biopsy guides 13
Bird's nest appearance 109f
Bladder 21f
endometriosis 110, 110f
Bleeding 153
Blood flow
high-resistance 126
subendometrial 57
Blood vessels 6
Borderline ovarian tumors 92, 102
Bowel
endometriosis 110, 111f
muscular layer of 22f
normal 22f
C
Calmette-Guerin therapy 183
Cannula, removal of 137f
Carcinoma in situ, development of 49
Caseous necrosis 184
Cervical canals, separate 51
Cervical ectopic pregnancy 159f
Cervix 22, 30f, 68
canal 29
longitudinal of 19f
Cesarean scar
pregnancy 160f
previous 160f
Chlamydia trachomatis 62, 157
Chromopertubation 66, 70
Clomiphene citrate 119
Color Doppler ultrasound examination 26
Conception
chances of 37
cycles 57
Congenital uterine anomalies
classification of 40t
management of 40
Contralateral pelvic wall 22
Contrast hysterography 56
Corpora lutea, ultrasound images of 26
Corpus luteum 25, 25f, 92, 93, 116, 116f, 117f, 157, 158f
hemorrhagic 94f
Corpus uteri 19, 22
Count antral follicles 86b, 86f
Cross-beam focusing 105
Crown-rump length 156
Cryptorchidism 168
Cumulus oophorus 122f
Cyclical maximum appropriate 46
Cyst
aspiration 132, 140, 164
technique 140b
hemorrhagic 95f
wall 95f
Cystadenoma 92, 99
borderline serous 102f
Cystic corpus luteum 25f 94f
Cystic structure 157f
Cystic teratoma 92, 100
Cytoreductive laparoscopic 37
D
Decidualized endometrium, thick 48f
Deep endometriosis 110f
Dermoid cyst, benign 100f
Diamniotic twin gestation 154f
Digital versatile disk 196
Distal hydrosalpinx 75f
Distal vasal obstruction 179f
Dominant ovary 25
Doppler angle 10, 11f
Doppler beam 10
Doppler gain 7
Doppler image, normal spectral 7f
Doppler sample volume 10f
Doppler spectrum 6
Doppler studies 5
Doppler ultrasound 57, 70
Double endometrial echo complex 38
Dysfunctional uterine 49
Dystrophic calcifications 183f
E
Echogenic polyp 2f
Ectopic pregnancy 147, 157
Ectopic trophoblast 159f
Ejaculatory duct 162, 164, 179, 182
cyst 179
obstruction 179
Ejaculatory volume, low 163
Electronic array transducers cost 13
Electronic transducers 2
Embryo
reduction 144f
transfer 50, 56, 132, 136, 136f, 137f, 197
abandon 50
day of 140
technique 136b, 138
Endocrine factors 162
Endogenous hormones, high levels of 51
Endometrial adhesions 49
Endometrial appearances 48
Endometrial assessment 50
Endometrial blood flow, analysis of 58
Endometrial cavity 43, 52, 54, 73f, 125
shape of 44f
Endometrial columnar epithelium 124
Endometrial complexes 38f
Endometrial cycle 44
Endometrial evaluation 123
Endometrial hyperplasia 49f
resulting 48
Endometrial interface 49
Endometrial intramural fibroids, large 52
Endometrial malignancy 50f
Endometrial myometrial
border 21
interface 123
junction 124f, 125
Endometrial pattern 129
Endometrial polyp 52, 53f, 54f, 56f, 58, 199
assessment of 55
Endometrial proliferation 50
Endometrial receptivity 203
Endometrial stripe 29
Endometrial synechiae 68f
Endometrial texture 55
Endometrial thickness 19f, 21f, 23f, 45, 49, 55, 126, 128, 129
assessment of 43
measuring 21, 47
Endometrial ultrasound
morphology 23
reporting on 55b
Endometrial vascularity
pulse Doppler of 126f
zones 125f
Endometrioma 92, 99, 108f, 109f
ground glass appearance of 108f
small 99f
three-dimensional power Doppler of 109f
ultrasound features of 109
Endometriosis 105, 106f
deep infiltrating 20
deep retroperitoneal 110
superficial 106, 107f
Endometriotic lesions, types of 105, 106
Endometriotic nodule 100f, 111f
signs of 20
Endometrium 4f, 6f, 19f, 49f, 55, 57, 116, 124, 125f
abnormalities of 48
B-mode features of 123
grade B, multilayered 124f
histogram of 127f
morphology of 124
protrusions of 36f
thin 45f
ultrasound examination of 44b
Endomyometrial junction 50f
zone 36
Enlarged heterogeneously hypoechoic epididymis 184f
Enterobacteriaceae 13
Epididymal calcification 174, 178f
Epididymal cysts 182
Epididymal tail, tapering of 174
Epididymis 162, 163, 184
absence of 174
dilated tubules in 180, 182
ectasia of 179
enlarged 163
tail of 185f
tuberculosis of 183
tubular ectasia of 174
Epididymitis 173
chronic 173
Epididymo-orchitis 173
Epithelial ovarian tumors 102
Escherichia coli 62
European Association of Urology on Male Infertility 168
European Society for Gynaecological Endoscopy 198
European Society for Human Reproduction and Embryology 39
Excision, method of 37
F
Fallopian tube 44, 56, 61, 62f, 71f
anatomy of 61
inflammatory lesions of 62
Femoral region 170
Fertility
practitioners 51
treatment 30
background 147
Fertilization 122
Fetal intrathoracic position of needle tip 143f
Fetal reduction 132, 141
Fibroid 40f, 52, 198
affects pregnancy rates 35
degenerated 33
in subfertile patient, management of 35
mapping 32f
multiple 32f
subserosal 34f
uterus 37f, 56f
Doppler of 34f
Fibrosis 184
Fimbrial cyst 64, 64f
Fire, ring of 158
Flow index 122f
Focal nodular heterogeneous lesion 185f
Focal zones, multiple 4
Follicle
and endometrium
Global vascularity of 128, 129
maturation of 119
aspiration equipment 134f
in normal ovary, mature 46f
increasingly produce estrogen 45
peripheral distribution of 96f
stimulating hormone 80, 93, 115, 164, 201
higher 35
Follicular cysts 148
Follicular diameter 119
Follicular monitoring 204
Follicular volume 123
Food endometrial receptivity 126
Frank bicornuate uterus 51
Frozen embryo cycle 50
Fundal endometrial polyp 57f
Fundus uteri 23f
G
Gain amplifies returning waves 3
Gardnerella vaginalis 62
Gel infusion sonography 71
Genital tract
infection 162
tuberculosis 180
Gestational sac 49f, 65, 160f
Gestations, multiple 155
Gland margin, lateral 164
Gonadotropin
normal 164
releasing hormone 35, 84, 93, 147
stimulated cycle 119
Granuloma
formation 184
healing of 183f
Ground glass appearance 99f
H
Haemophilus influenzae 62
Halo sign 94f
Hemiuterus, noncommunicating horns of 52
Hemodynamic parameter 116
High frequency probes 29
High-resistance flow 117f
High-resolution ultrasound systems 26
High-velocity blood flow 7
Hormonal preparations 44
Hormone, adrenocorticotropic 173
Human chorionic gonadotropin 47, 89, 120, 203
Hycosy 72, 77
over, advantage of 56
Hydrosalpinx 63, 63f, 64, 64f, 67
aspiration of 132, 141
diagnostic of 63f
Hyperechogenic endometrial edge 125
Hyperechoic lesion 31
Hypoechogenic simple cyst 95f
Hypoechoic mass 186f
multiple 186
single 186
Hypoechoic nodules 185
multiple small 185f
Hypoechoic ovary, heterogenously 149f
Hypopituitary disorders 172
Hypothalamo-pituitary ovarian 43
Hystero-contrast-salpingography 70
Hystero-contrast-sonography 56
Hystero-contrast-sonosalpingography 64, 72b, 72f, 73, 76
Hysterosalpingography 66, 67
I
Implantation potential maximum 127, 138
In vitro fertilization 35, 50, 79, 119, 132, 147, 202
Infertility tests, armamentarium of 43
Inguinal canal 169f
Inguinal pouch, superficial 170
Inner myometrium 36f
International ovarian tumor analysis 100
Intra-abdominal testis 173f
Intracavitary fibroid 52, 53f
multiplanar of 199f
Intracytoplasmic sperm injection 162
Intramural extension, degree of 35
Intramural fibroids 31f
Intraovarian lesion, beak sign of 63f
Intrauterine
adhesions 54, 54f
device 54
in situ 55f
insemination 118
population 53
pregnancy 54, 65f
Invasive investigative procedures, replace routine 29
Invasive procedures 29
Iodine 13
compounds 13
Ischemia 172
J
Junctional zone alteration 37
K
Kidney
left 177
right 177
L
Laparoscopy 29
Leiomyosarcoma 33
Lesion, malignant nature of 33
Liver cirrhosis 172
Lower-pregnancy rates 51
Low-frequency sound 2
Low-velocity blood flow 7
Luteinizing hormone 83, 93, 115, 164, 201
Lymph node, abdominal 2
M
Male infertility
evaluation of 162
nonobstructive causes of 164
obstructive causes of 174
Malignant lesions, typical vascular morphology of 66f
Mass, heterogenous 158f
Mature follicle, B-mode features of 119
Mechanical transducers 2
Mediastinum testis 163
Menstrual cycle 21, 24f, 25f, 44
different phases of 25f
secretory phase of 27
Menstrual period, last 43
Methanol 13
Miscarriage, second trimester 37
Mock transfer 139
Monochorionic 154
diamniotic 154, 155
Monozygotic 154
Mucinous cystadenocarcinoma 101, 101f
Mullerian duct cysts 179
Multifetal pregnancy reduction 132
Multifrequency probes 29
Multiple pregnancy 141, 147, 153
Mycoplasma hominis 62
Myomas 31
Myometrial cysts 36
Myometrium
amount of 37
heterogeneous 36
N
National Institute for Health and Clinical Excellence 76
National Institute of Clinical Excellence 167
National Institutes of Health 95
Natural cycle, monitoring 115
Neisseria gonorrhoeae 62
Neurovascular bundle 164
Nonobstructive azoospermia 174
Nonpalpable testes 162, 168
Numerous cystic spaces 163
O
Obstructive azoospermia, cause of 163
Oligozoospermia, severe 163
Oocyte retrieval 56
complications of 147, 151
technique 135b
Oral contraceptive pill, combined 95
Orchitis and epididymo-orchitis 173
Ovarian blood flow 86
Ovarian cysts 147, 201
functional 92, 95
simple 201f
Ovarian dysfunction, premature 26
Ovarian endometrioma 107, 202f
Ovarian follicle 121f
tracking 115
Ovarian hyperstimulation syndrome 79, 95, 119, 132, 149, 151
Ovarian pathology 92
malignant 92, 100
Ovarian reserve 202
assessment of 79
tests 79, 80
Ovarian stroma 151
blood flow 119
Ovarian tissue, rim sign of 63f
Ovarian torsion 92, 98
Ovarian vascularity, three-dimensional power Doppler assessment of 88f
Ovarian volume 80, 119
Ovary 17f, 25f, 26f, 27, 199
benign cystadenoma of 99f
hyperstimulated 92, 97
inversion mode of 202f
three-dimensional multiplanar display of 85f
tomographic ultrasound images of 194f
transvaginal ultrasound images of 25f
two-dimensional pulse wave Doppler of 87f
P
Pampiniform plexus, dilatation of 165
Paracervical block 133
Paraovarian cyst 102, 194f
Paratubal cyst 64
Peak systolic velocity 11, 87, 117
Pedicle sign 54f
Pedunculated intracavitary fibroids protrude 52
Pelvic
assessment 15f
endometriosis 105
enhance delineation of 12
floor 18f
inflammatory disease 62, 112
organs, normal appearances of 27
Perifollicular vascularity of dominant follicle 120
Perifollicular vessel 121f
Perineal region 170
Perineal testis 170f
Periprostatic region 181
Peritoneal implants 20
Persistent noncyclical hormonal stimulation 48
Pie, apex of 17, 18f
Polycystic ovarian syndrome 82, 92, 95, 96, 124, 199
Polycystic ovary 97f, 98f
Polyethylene glycol 13
Polyp 53, 200f
Polypectomy
controlled study of 53
simple 53
Postmenopausal 44
bleeding, history of 21
ovaries 26f
uterus 26
Postmenses thin endometrium 48f
Postmenstrual appearance 48
Postmenstrual uterus 45f
with thinned endometrium 45f
Postoocyte collection ovary 151
Potassium chloride injection 142
Pouch of Douglas 4f, 20, 21f, 27, 98, 152f, 158
Power Doppler studies 12
Pregnancy
extrauterine 65f
heterotopic 160
Premature rupture of membranes 143
Premenopausal 44
Preovarian block 133
Preovulatory follicle 116f, 120f-122f
measurement of 120f
Preovulatory scan 119
Preovulatory uterine artery waveform 126f
Prevotella bivia 62
Progesterone 115
Proliferative endometrium 30f, 45f
Prostate
apex of 164
gland 164
normal 165f
systematic survey of 164
Prostatic utricle, cyst of 179
Pseudogestational sac 66f
Pseudosac 65, 157
Pulsatility index 87, 117
Pulse repetition frequency 7, 121, 166
Pyosalpinx 64, 64f
R
Randomized controlled trials 168
Rectal endometriosis 111f
Rectovaginal endometriosis 111f
Rectum 20
Renal tract anomalies 52
Residual uterine septum 40, 41f
Resistance index 87, 109, 117
Rete testis 181, 182
Retrograde ejaculation 162
Royal College of Obstetricians and Gynaecologists 150
Rudimentary horn
unicornuate with 40
unicornuate without 40
S
Saline 68
Saline infusion
salpingography 69f
procedure 68f
sonography 31, 40f, 54, 54f, 56, 57f, 66
sonohysterography 38
sonohysteroscopy 31
sonosalpingography 67
Salpingitis 62
acute 62, 63
chronic 64
Scanning technique 106
Scrotum, perineum posterolateral to 170f
Secretory endometrial integrity 47
Secretory endometrium 116f
Seminal vesicle 164, 179f, 186f
left 186f
normal 165f
right 186
sections of 187f
tuberculosis of 186
Septate uterus 67f
complete 198f
Septated mucinous cystadenoma 99f
Serosal surface 31
Serous cystadenocarcinoma 101
lying behind uterus 101f
Shallow internal fundal indentation 38
Sildenafil citrate 51
Sim's speculum 136
Singleton intrauterine pregnancy 153f
Smooth multilocular solid tumor 101
Solid component 16f
Sonographic anatomy, normal 163, 164
Sonographic features 166
Sonographic technique 166
Sonography-based automatic volume count 85
Sonohysterosalpingography 67
Sonosalpingography 68
Sophisticated ultrasound 115
Speckle reduction imaging 105
Spectral Doppler measurements 10
Sperm
abnormal 162
parameters, abnormal 162
Spermatic cord 168, 186
Spermatozoa 162
Spontaneous conception, chance of 35
Staphylococcus aureus 13
Stimulated cycles, monitoring of 118
Stimulated ovary, automated evaluation of 196f
Stimulates regeneration 45
Stimulation complication 147
Strictly speaking 52
Stromal arteries 7
Subendometrial blood flow 125
Submucosal fibroid 31, 32f- 34f, 41, 52f
presence of 33, 40
Submucosal type, suspicion of 40f
Subseptate uterus, partial 198f
Subserous fibroids, removal of 35
Supraphysiological levels 124
Surgery, role of 37
Symmetrical endometrial thickness 65f
Systematic examination technique 27
Systematic scanning technique 18
T
Testicular artery 173f
Testicular atrophy 172
Testicular dysfunction 162
Testicular ectopia, transverse 170f
Testicular sperm aspiration 188
ultrasound-guided 188
Testicular tuberculosis 183
Testicular tumor 174, 177f
Testis 166, 170f
adrenal rest in 173, 177f
enlarged 185, 185f
left 164f
normal 163f, 164f
posterolateral aspect of 163f
transverse scan of both 182f
undescended 162, 168
Thin endometrium, heterogenous 50f
Three-dimensional ultrasound imaging 123f, 191
Time-gain compensation 3
Tissue
harmonic imaging 3
heterogeneous 36f
Tomographic ultrasound imaging 106, 193
Torsion 172
Total intravenous anesthesia 133
Transvaginal ultrasound scan image 134f
Transabdominal gynecological ultrasound examination 22
Transabdominal scan 30f
Transabdominal sonography 29
Transabdominal transducers 2
Transabdominal ultrasound examination 22
Transrectal examination 22
Transrectal ultrasonography 162, 163, 187f
reveals 186
Transvaginal color flow Doppler ultrasonography 29
Transvaginal oocyte retrieval 147
Transvaginal probe 15
Transvaginal scan 2, 29, 30f
Transvaginal sonography 29, 106
Transvaginal three-dimensional 30
Transvaginal ultrasound 92, 115
examination 18, 27
image 23f, 134f
Trauma 172
Trilaminar endometrium 30f
Triple-layered proliferative phase morphology 4f
True perifollicular vessel 121f
Tubal assessment 204
Tubal ectopic pregnancy 159
Tubal evaluation 62
Tubal neoplasms 66
Tubal patency assessment, tests of 61, 66
Tubal pathologies, diagnosis of 61, 62
Tubal pregnancy 64
direct signs of 65
indirect signs of 65
Tuberculosis, extrapulmonary 186
Tuberculous abscess 185f
Tuberculous epididymitis 184, 184f
Tuberculous orchitis 185
Tubo-ovarian mass 64f
Tunica vaginalis 184
Twin growth discrepancy 156
Typical corpus luteum 47f
U
Ultrasound, safety of 12
Ultrasound-guided procedures 132, 204
Uniform ultrasound morphology 26
Unruptured follicle, luteinized 117f
Unstimulated endometrial echo 45
Unstimulated endometrium comparable 48
Ureaplasma urealyticum 62
Ureteral endometriosis 110
Urethra 21f, 164, 188f
observe 21
stricture 187
Urinary bladder 5f, 20, 21f, 27, 187f
normal 21f
Urinary tuberculosis 180
Urogenital abnormalities, congenital 162
Uropathy, obstructive 110
Uterine anomalies, congenital 29, 30, 37, 41, 197
Uterine artery 7, 7f, 118, 126
Doppler of 58f
embolization 35
flow 118
pulse Doppler analysis of 126
Uterine cavity
assessment of 43
distortion of 39f
normal 30f, 67f
Uterine contractions 128
Uterine cornu 139f
Uterine fibroids 29, 31
Uterine monitoring 117
Uterine septum, presence of 40
Uterine signs 65
Uterocervical junction 44f
Uterosacral ligament endometriosis 112
Uterus 21f, 23f, 30f, 38f, 41f, 45f
abdominal ultrasound images of 23f
adenomyomatous 37f
anterior posterior diameter of 23f
congenital abnormalities of 51
coronal view of 36f
demonstrates periodic contractile activity 128
detailed evaluation of 29
fundus of 160f
multiplanar of 192f
normal 27, 197, 198f
ultrasound morphology of 23f, 26f
retroverted 30f, 159f
structural abnormalities of 51
subseptate 39f
three-dimensional multiplanar of 7f
transverse section of 44f, 52
ultrasound 29
scanning of 55
unicornuate 38f
with linear echo 44f
V
Vagina, introitus of 18f
Vaginal canal 29
Vaginal progesterone 128
Vaginal septum 52
Vaginal stripe 29
Vaginal wall, insertion of 19f
Vanishing twin syndrome 156
Varicocele 164
classification of 167
ultrasound classification of 168t
Vas deferens 162
obstruction 178
Vasa deferentia, tuberculosis of 186
Vascular flow index 122f
Vascular index 122f
Vascular morphology, evaluation of 12
Veins of varicocele 167f
Viagra 51
Virtual organ computer-aided analysis 80, 88, 119, 193, 194f, 195
Vocal-imaging program 96
Volume contrast imaging 106
Volume sonography 191
W
Wall motion filter 9, 9f
Whirlpool sign on color Doppler 149f
Wolffian duct 102
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