Ultrasound assessment of the ovary in the infertile woman

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This article discusses the use of transvaginal ultrasound for evaluating the ovary in infertile women, covering its applications in assessing pathology, ovarian reserve, and therapeutic decisions during stimulation cycles.

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This review article examines the utility of transvaginal ultrasound in evaluating the ovaries of infertile women, highlighting how higher-frequency probes have improved diagnostic resolution. It discusses the application of ultrasound for determining ovarian reserve through metrics such as antral follicle counts and ovarian volume, which help predict responses to gonadotropins during assisted reproduction cycles. The text also covers the use of Doppler techniques to assess perifollicular vascularity and notes the impact of specific pathologies, including polycystic ovaries and endometriomas, on treatment outcomes. Relevance to endometriosis: mentioned as a factor impacting assisted reproduction outcomes via ovarian endometriomas, though the paper's main focus is general infertility assessment.

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Abstract

Few would argue that the introduction of transvaginal ultrasound (TVUS) revolutionized the practice of assisted reproduction. For example, full-bladder follicular scanning and laparoscopic oocyte retrievals were converted to TVUS-guided procedures. The application of higher-frequency scanning probes provided greater resolution and improved the clinician's ability to evaluate the ovary for pathologic conditions, for determination of ovarian reserve, and for therapeutic decisions during ovarian stimulation cycles. All these uses of TVUS of the ovary will be discussed in this article.
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Abstract

Few would argue that the introduction of transvaginal ultrasound (TVUS) revolutionized the practice of assisted reproduction. For example, full-bladder follicular scanning and laparoscopic oocyte retrievals were converted to TVUS-guided procedures. The application of higher-frequency scanning probes provided greater resolution and improved the clinician's ability to evaluate the ovary for pathologic conditions, for determination of ovarian reserve, and for therapeutic decisions during ovarian stimulation cycles. All these uses of TVUS of the ovary will be discussed in this article.

Keywords

Ultrasound - ovary - infertility - ovarian reserve - IVF

References

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Antral follicle count in the prediction of poor ovarian response and pregnancy after in vitro fertilization: a meta-analysis and comparison with basal follicle-stimulating hormone level. Fertil Steril. 2005; 83 291-301 - 11 Sharara F I, McClamrock H D. Use of microdose GnRH agonist protocol in women with low ovarian volumes undergoing IVF. Hum Reprod. 2001; 16 500-503 - 12 Hammadieh N, Afnan M, Papaaioannou S, Ola B. Women with small ovarian volume and microdose GnRH agonist protocol [Letter to editor]. Hum Reprod. 2001; 16 2030 - 13 Danninger B, Brunner M, Obruca A, Feichtinger W. Prediction of ovarian hyperstimulation syndrome of baseline ovarian volume prior to stimulation. Hum Reprod. 1996; 11 1597-1599 - 14 Balen A H, Laven J SE, Tan S-L, Dewailly D. Ultrasound assessment of the polycystic ovary: international consensus definitions. Hum Reprod Update. 2003; 9 505-514 - 15 Jonard S, Robert Y, Cortet-Rudelli C, Pigny P, Decanter C, Dewailly D. Ultrasound examination of polycystic ovaries: is it worth counting the follicles?. Hum Reprod. 2003; 18 598-603 - 16 Gupta S, Agrwal A, Agarwal R, de Mola J RL. Impact of ovarian endometrioma on assisted reproduction outcomes. Reprod Biomed Online. 2006; 13 349-360 - 17 Santoro N, Isaac B, Neal-Perry G et al.. Impaired folliculogenesis and ovulation in older reproductive aged women. J Clin Endocrinol Metab. 2003; 88 5502-5509 - 18 Wittmaack F M, Tureck R W, Kreger D O, Mastrioanni L, Blasco L, Lessey B A. Effect of follicular size on oocyte retrieval, fertilization, cleavage, and embryo quality in in vitro fertilization cycles: a 6-year data collection. Fertil Steril. 1994; 62 1205-1210 - 19 Andersen C Y. Characteristics of human follicular fluid associated with successful conception after in vitro fertilization. J Clin Endocrinol Metab. 1993; 77 1227-1234 - 20 Bergh C, Broden H, Lundin K, Hamberger L. Comparison of fertilization, cleavage and pregnancy rates of oocytes from large and small follicles. Hum Reprod. 1998; 13 1912-1915 - 21 Lewis V, Queenan J, Hoeger K, Stevens J, Guzick D S. Clomiphene citrate monitoring for intrauterine insemination timing: a randomized trial. Fertil Steril. 2006; 85 401-406 - 22 Jokubkiene L, Sladkevicius P, Rovas L, Valentin L. Assessment of changes in volume and vascularity of the ovaries during the normal menstrual cycle using three-dimensional power Doppler ultrasound. Hum Reprod. 2006; 21 2661-2668 - 23 Bhal P S, Pugh N D, Chui D K, Gregory L, Walker S M, Shaw R W. The use of transvaginal power Doppler ultrasonography to evaluate the relationship between perifollicular vascularity and outcome in in-vitro fertilization treatment cycles. Hum Reprod. 1999; 14 939-945 - 24 Campbell S, Bourse T, Waterstone J et al.. Transvaginal color blood flow imaging of the peri ovulatory follicle. Fertil Steril. 1993; 60 433-438 - 25 Costello M F, Shrestha S M, Sjoblom P et al.. Power Doppler ultrasound assessment of the relationship between age and ovarian perifollicular blood flow in women undergoing in-vitro fertilization treatment. J Assist Reprod Genet. 2006; 23 359-365 - 26 Palomba S, Russo T, Falbo A et al.. Clinical use of the perifollicular vascularity assessment in IVF cycles: a pilot study. Hum Reprod. 2006; 21 1055-1061 Bradley J Van VoorhisM.D. Department of Obstetrics & Gynecology, University of Iowa Hospitals 200 Hawkins Drive, Iowa City, IA 52242 Email: [email protected]

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Condition tags

endometriosis

MeSH descriptors

Infertility, Female Ovary Endometriosis Endometriosis Female Humans Infertility, Female Ovarian Follicle Ovarian Follicle Ovarian Follicle Ovarian Follicle Ovarian Neoplasms Ovarian Neoplasms Ovary Ovary Polycystic Ovary Syndrome Polycystic Ovary Syndrome Ultrasonography

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