Fundamentals of Ultrasonic Diagnosis and Common Ultrasound Techniques in Female Reproduction

This chapter examines the principles and clinical applications of ultrasound in female reproductive diagnostics, focusing on its technological foundations and common modalities. Ultrasound imaging relies on interactions between high-frequency sound waves and tissues—including reflection, refraction, and scattering—to generate real-time anatomical data. This chapter emphasizes the utility of transabdominal, transvaginal, and specialized interventional probes for procedures such as embryo transfer, ovarian follicle monitoring, and uterine pathology assessment. Central to this discussion is the role of two-dimensional (2D) grayscale ultrasound as the cornerstone modality, providing structural visualization through variations in echo intensity. Doppler ultrasound is introduced as a complementary tool for evaluating vascular dynamics, such as uterine artery perfusion and endometrial blood flow. Three-dimensional (3D) imaging is highlighted for overcoming spatial limitations of 2D scans, particularly in diagnosing uterine anomalies (e.g., septate uterus), polycystic ovarian syndrome, and endometrial receptivity. This chapter further explores contrast-enhanced ultrasound, which employs microbubble agents to noninvasively assess tubal patency via hysterosalpingo-contrast sonography (HyCoSy). By integrating advances in real-time imaging, computerized analysis, and multimodal systems, this chapter underscores ultrasound’s evolving role as a safe, noninvasive, and versatile tool. Clinical correlations—spanning infertility evaluation, early pregnancy monitoring, and gynecologic pathology—are systematically addressed to bridge theory with practice. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

Watkin KL. Ultrasound and swallowing. Folia Phoniatr Logop. 1999;51(4–5):183–98. Ren W, Ma C. Basic and clinical application spectrum of ultrasound diagnosis. Chemical Industry Press; 2020. Jurkovic D, Geipel A, Gruboeck K, et al. Three-dimensional ultrasound for the assessment of uterine anatomy and detection of congenital anomalies: a comparison with hysterosalpingography and two-dimensional sonography. Ultrasound Obstet Gynecol. 1995;5(4):233–7. Bermejo C, Martínez TP, Cantarero R, et al. Three-dimensional ultrasound in the diagnosis of Müllerian duct anomalies and concordance with magnetic resonance imaging. Ultrasound Obstet Gynecol. 2010;35(5):593–601. Graupera B, Pascual MA, Hereter L, et al. Accuracy of three-dimensional ultrasound compared with magnetic resonance imaging in diagnosis of Mullerian duct anomalies using ESHRE–ESGE consensus on the classification of congenital anomalies of the female genital tract. Ultrasound Obstet Gynecol. 2015;46(5):616–22. Kougioumtsidou A, Mikos T, Grimbizis GF, et al. Three-dimensional ultrasound in the diagnosis and the classification of congenital uterine anomalies using the ESHRE/ESGE classification: a diagnostic accuracy study. Arch Gynecol Obstet. 2019;299(3):779–89. Teede HJ, Misso ML, Costello MF, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod. 2018;33(9):1602–18. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19(1):41–7. Sujata K, Swoyam S. 2D and 3D trans-vaginal sonography to determine cut-offs for ovarian volume and follicle number per ovary for diagnosis of polycystic ovary syndrome in Indian women. J Reprod Infertil. 2018;19(3):146–51. Garg N, Khaira HK, Kaur M, et al. A comparative study on quantitative assessment of blood flow and vascularization in polycystic ovary syndrome patients and normal women using three-dimensional power Doppler ultrasonography. J Obstet Gynaecol India. 2018;68(2):136–41. Bozkurt M, Bozkurt DK, Kurban D, et al. 2-D and 3-D ultrasonographic characteristics of the ovary in women with PCOS and multifollicular ovaries. J Obstet Gynaecol. 2021;41(6):920–6. Brink HV, Pisch AJ, Lujan ME. A comparison of two- and three-dimensional ultrasonographic methods for evaluation of ovarian follicle counts and classification of polycystic ovarian morphology. Fertil Steril. 2021;115(3):761–70. Craciunas L, Gallos I, Chu J, et al. Conventional and modern markers of endometrial receptivity: a systematic review and meta-analysis. Hum Reprod Update. 2019;25(2):202–23. Bergh PA, Navot D. The impact of embryonic development and endometrial maturity on the timing of implantation. Fertil Steril. 1992;58(3):537–42. Tong R, Zhou Y, He Q, et al. Analysis of the guidance value of 3D ultrasound in evaluating endometrial receptivity for frozen-thawed embryo transfer in patients with repeated implantation failure. Ann Transl Med. 2020;8(15):944. Elsokkary M, Eldin AB, Abdelhafez M, et al. The reproducibility of the novel utilization of five-dimensional ultrasound and power Doppler in the prediction of endometrial receptivity in intracytoplasmic sperm-injected women: a pilot prospective clinical study. Arch Gynecol Obstet. 2019;299(2):551–8. Sini I, Handayani N, Harahap A, et al. Role of three-dimensional Doppler ultrasonography and leukemia inhibitory factor from endometrial secretion in predicting endometrial receptivity in IVF treatment: a pilot study. Arch Gynecol Obstet. 2022;306(1):259–65. Grigore M, Popovici R, Himiniuc LM, et al. The added value of three-dimensional ultrasonography in uterine pathology. Exp Ther Med. 2021;22(5):1261. Jiang X, Chen X, Li J, et al. Clinical application of three-dimensional transvaginal ultrasonography in the diagnosis of intrauterine adhesions. J Int Med Res. 2021;49(11):3000605211024520. Durand YG, Capoccia-Brugger R, Vial Y, et al. Diagnostic dilemma between angular and interstitial ectopic pregnancy: 3D ultrasound features. J Ultrasound. 2022;25(4):989–94. Graupera B, Hereter L, Pascual MA, et al. Normal and abnormal images of intrauterine devices: role of three-dimensional sonography. J Clin Ultrasound. 2012;40(7):433–8. Andrade CM, Araujo JE, Torloni MR, et al. Three-dimensional versus two-dimensional ultrasound for assessing levonorgestrel intrauterine device location: a pilot study. J Clin Ultrasound. 2016;44(2):72–7. Hricak H, Alpers C, Crooks LE, et al. Magnetic resonance imaging of the female pelvis: initial experience. AJR Am J Roentgenol. 1983;141(6):1119–28. Tanos V, Lingwood L, Balami S. The importance of the junctional zone of the endometrium in human reproduction. Hum Fertil (Camb). 2022;25(1):4–12. Imaoka I, Nakatsuka T, Araki T, et al. T2* relaxometry mapping of the uterine zones. Acta Radiol. 2012;53(4):473–7. Fusi L, Cloke B, Brosens JJ. The uterine junctional zone. Best Pract Res Clin Obstet Gynaecol. 2006;20(4):479–91. Kunz G, Beil D. Characterization of the uterine junctional zone prior to IVF/ICSI: an observational study. Arch Gynecol Obstet. 2010;281(5):945–53. Meylaerts LJ, Wijnen L, Ombelet W, et al. Uterine junctional zone thickness in infertile women evaluated by MRI. J Magn Reson Imaging. 2017;45(3):926–36. Lazzarin N, Exacoustos C, Vaquero E, et al. Uterine junctional zone at three-dimensional transvaginal ultrasonography in patients with recurrent miscarriage: a new diagnostic tool? Eur J Obstet Gynecol Reprod Biol. 2014;174:128–32. Kim A, Young Lee J, Ji Y, et al. Do endometrial movements affect the achievement of pregnancy during intrauterine insemination? Int J Fertil Steril. 2015;8(4):399–408. Rasmussen CK, Glavind J, Madsen LD, et al. Repeatability of junctional zone measurements using 3-dimensional transvaginal sonography in healthy fertile women. J Ultrasound Med. 2016;35(7):1497–508. Maged AM, Ramzy AM, Ghar MA, et al. 3D ultrasound assessment of endometrial junctional zone anatomy as a predictor of the outcome of ICSI cycles. Eur J Obstet Gynecol Reprod Biol. 2017;212:160–5. Liu Y, Wang L, Wang M, et al. A study on the prediction of reproductive outcomes in frozen embryo transfer cycles by calculating the volume of uterine junctional zone with three-dimensional ultrasound. Ultraschall Med. 2023;44(2):e126–35. Choi BI, Kim AY, Lee JY, et al. Hepatocellular carcinoma: contrast enhancement with Levovist. J Ultrasound Med. 2002;21(1):77–84. Frinking P, Segers T, Luan Y, et al. Three decades of ultrasound contrast agents: a review of the past, present and future improvements. Ultrasound Med Biol. 2020;46(4):892–908. Zhao H, O’Quinn R, Ambrose M, et al. Contrast-enhanced echocardiography has the greatest impact in patients with reduced ejection fractions. J Am Soc Echocardiogr. 2018;31(3):289–96. Wang S. Clinical application and progress of hysterosalpingo-contrast sonography. Chin J Med Ultrasound. 2020;17(2):100–2. Yuan K, Huang YJ, Mao MY, et al. Contrast-enhanced US to improve diagnostic performance of O-RADS US risk stratification system for malignancy. Radiology. 2023;308(2):e223003. Kotopoulis S, Popa M, Mayoral SM, et al. SonoVue® vs. Sonazoid™ vs. Optison™: which bubble is best for low-intensity sonoporation of pancreatic ductal adenocarcinoma? Pharmaceutics. 2022;14(1):98. Sontum PC. Physicochemical characteristics of Sonazoid™, a new contrast agent for ultrasound imaging. Ultrasound Med Biol. 2008;34:824–33. Honoré GM, Holden AE, Schenken RS. Pathophysiology and management of proximal tubal blockage. Fertil Steril. 1999;71(5):785–95. Zamah AM, Power R, Longman RE, et al. Ultrasound and infertility. In: First-trimester ultrasound. Cham: Springer; 2023. Geng J, Tang J. Contrast-enhanced ultrasound in the diagnosis of endometrial carcinoma: a meta-analysis. Exp Ther Med. 2018;16(6):5310–4. Zhang J, Xiang JD, Jia C, et al. Contrast-enhanced ultrasonography for transabdominal and transrectal ultrasound in staging cervical cancer: a reliability study. Ultrasound Med Biol. 2023;49(10):2283–90. Xu C, Tang Y, Zhao Y, et al. Use of contrast-enhanced ultrasound in evaluating the efficacy and application value of microwave ablation for adenomyosis. J Cancer Res Ther. 2020;16(2):365–71. Zhang M, Yin C, Jiang J, et al. Application value of contrast-enhanced ultrasonography in the treatment of uterine fibroids by high-intensity focused ultrasound ablation: a retrospective study. J Clin Ultrasound. 2023;51(1):113–20. Author information Authors and Affiliations Editor information Editors and Affiliations Rights and permissions Copyright information © 2025 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. About this chapter Cite this chapter Li, D., Wang, X. (2025). Fundamentals of Ultrasonic Diagnosis and Common Ultrasound Techniques in Female Reproduction. In: Li, D., Na, Z., Wang, X., Zuo, N. (eds) Ultrasonography of the Female Reproductive System. Springer, Singapore. https://doi.org/10.1007/978-981-95-1373-4_2 Download citation DOI: https://doi.org/10.1007/978-981-95-1373-4_2 Published: Publisher Name: Springer, Singapore Print ISBN: 978-981-95-1372-7 Online ISBN: 978-981-95-1373-4 eBook Packages: MedicineMedicine (R0)