Ultrasonography of the endometrium

Richard P. Dickey
In: Ultrasonography in Reproductive Medicine and Infertility · 2010 · pp. 97–102 · doi:10.1017/cbo9780511776854.014 · W136158587
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⚙ AI-generated summary by claude@2026-06, 2026-06-13 ⓘ

Sonohysterography, often preceded by transvaginal sonography, accurately diagnoses intracavitary uterine abnormalities like myomas, polyps, and synechiae, matching hysteroscopy's diagnostic ability.

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This chapter reviews ultrasonographic assessment of the endometrium in reproductive medicine, with emphasis on ovulation induction and assisted reproduction cycles. It notes that when clomiphene citrate is used for ovulation induction, endometrial thickness often decreases during and immediately after the days of clomiphene dosing due to an antiestrogen effect, and it describes the reported requirement of a triple-line endometrial pattern on the day of hCG administration in controlled ovarian hyperstimulation cycles. In IVF cycles, a triple-line endometrial pattern on the day of hCG is reported to relate to serum estradiol level, the number of mature oocytes, and the number of top-quality embryos but not to serum progesterone levels, and the chapter links preclinical miscarriage and clinical miscarriage to inadequate endometrial development. The paper is a chapter within a reproductive ultrasonography book and provides summarized associations without detailing specific study designs or quantitative effect sizes as limitations. This paper is not centrally about endometriosis or adenomyosis; it is about ultrasonography of the endometrium in infertility, and it includes separate chapters on pelvic endometriosis and adenomyosis within the same volume.

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Abstract

In most practices, sonohysterography is immediately preceded by high-frequency transvaginal sonography (TVS). Exact menstrual dating and latex allergy are documented first, and a negative pregnancy test is obtained, along with a signed informed consent, when appropriate. The purpose of the baseline ultrasound is to confirm all pelvic findings prior to the fluid enhancement study. Although sonohysterography provides an indirect look inside the uterus, its ability to accurately diagnose intracavitary filling defects, such as myomas and polyps and adhesions and even malformations, matches that of the gold standard hysteroscopy. This chapter lists out specific imaging examples for submucous myoma, endometrial polyp, blood clot, endometrial malignancy, intrauterine synechia and congenital uterine anomaly. It outlines three-dimensional saline infusion sonohysterography (SIS), sonosalpingography or hysterosalpingo-contrast sonography, operative SIS, and sonovaginography. Combining TVS with vaginal saline infusion may improve the ability to image structures surrounding the vagina, such as the rectovaginal septum for endometriosis.
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- Ultrasonography in Reproductive Medicine and Infertility - Ultrasonography in Reproductive Medicine and Infertility - Copyright page - Dedication - Contents - Contributors - Foreword - Preface - Acknowledgments - Section 1: Imaging techniques - Section 2: Ultrasonography in infertility - Chapter 8 3D Ultrasonography and infertility - Chapter 9 Ultrasonography and diagnosis of polycystic ovary syndrome - Chapter 10 Ultrasonography and the treatment of infertility in polycystic ovary syndrome - Chapter 11 Ultrasonography of uterine fibroids - Chapter 12 Ultrasonography of the endometrium - Chapter 13 Ultrasonography of the cervix - Chapter 14 Color Doppler imaging of ovulation induction - Chapter 15 Ultrasonography of pelvic endometriosis - Chapter 16 Adenomyosis - Chapter 17 Congenital uterine malformations - Chapter 18 Uterine septum - Chapter 19 Ultrasonography and incidental ovarian pathology - Chapter 20 Scrotal ultrasonography in male infertility - Chapter 21 Transrectal ultrasonography in male infertility - Chapter 22 Ultrasonographic evaluation of acute pelvic pain - Chapter 23 Ultrasonographic evaluation of chronic pelvic pain - Section 3: Ultrasonography in assisted reproduction - Section 4: Early pregnancy after infertility treatment - Index from Section 2: - Ultrasonography in infertility Published online by Cambridge University Press: 07 September 2011 Edited by Book contents - Ultrasonography in Reproductive Medicine and Infertility - Ultrasonography in Reproductive Medicine and Infertility - Copyright page - Dedication - Contents - Contributors - Foreword - Preface - Acknowledgments - Section 1: Imaging techniques - Section 2: Ultrasonography in infertility - Chapter 8 3D Ultrasonography and infertility - Chapter 9 Ultrasonography and diagnosis of polycystic ovary syndrome - Chapter 10 Ultrasonography and the treatment of infertility in polycystic ovary syndrome - Chapter 11 Ultrasonography of uterine fibroids - Chapter 12 Ultrasonography of the endometrium - Chapter 13 Ultrasonography of the cervix - Chapter 14 Color Doppler imaging of ovulation induction - Chapter 15 Ultrasonography of pelvic endometriosis - Chapter 16 Adenomyosis - Chapter 17 Congenital uterine malformations - Chapter 18 Uterine septum - Chapter 19 Ultrasonography and incidental ovarian pathology - Chapter 20 Scrotal ultrasonography in male infertility - Chapter 21 Transrectal ultrasonography in male infertility - Chapter 22 Ultrasonographic evaluation of acute pelvic pain - Chapter 23 Ultrasonographic evaluation of chronic pelvic pain - Section 3: Ultrasonography in assisted reproduction - Section 4: Early pregnancy after infertility treatment - Index When clomiphene citrate (CC) is used for ovulation induction, endometrial thickness is often decreased compared with spontaneous cycles during and immediately following the days CC is taken, because of its antiestrogen effect. A triple-line pattern on the day of human chorionic gonadotropin (hCG) administration has been reported to be necessary for implantation in controlled ovarian hyperstimulation (COH) cycles, where human menopausal gonadotropin (hMG) or follicle stimulating hormone (FSH) is administered. A triple-line endometrial pattern on the day of hCG administration in in-vitro fertilization (IVF) cycles is related to serum estradiol level, the number of mature oocytes, and the number of top-quality embryos and is unrelated to serum progesterone levels. Preclinical miscarriage, also referred to as biochemical pregnancy, in which quantitative hCG levels initially indicate pregnancy but decrease before a gestational sac can be seen on ultrasound, and clinical miscarriage of embryos with karyotype is the result of inadequate endometrial development. - Type - Chapter - Information - Ultrasonography in Reproductive Medicine and Infertility , pp. 97 - 102Publisher: Cambridge University PressPrint publication year: 2010 Accessibility compliance for the HTML of this chapter is currently unknown and may be updated in the future. - 2 - Cited by To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle. Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. Find out more about the Kindle Personal Document Service. - Ultrasonography of the endometrium - - Book: Ultrasonography in Reproductive Medicine and Infertility - Online publication: 07 September 2011 To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox. - Ultrasonography of the endometrium - - Book: Ultrasonography in Reproductive Medicine and Infertility - Online publication: 07 September 2011 To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive. - Ultrasonography of the endometrium - - Book: Ultrasonography in Reproductive Medicine and Infertility - Online publication: 07 September 2011

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