| Article ID | Journal | Published Year | Pages | File Type |
|---|---|---|---|---|
| 4233397 | Journal of Medical Ultrasound | 2007 | 8 Pages |
Transvaginal probes have enhanced sonographic depiction of the uterus and ovaries over that obtained with conventional transabdominal scans. Cyclic variations of female pelvic hemodynamics and angiogenesis can be studied with Doppler ultrasound. The power Doppler has a threefold increase in sensitivity compared with conventional color Doppler imaging at detecting low velocity flow. There have been numerous investigations on the applications of the assessment of uterine and perifollicular vascularity and their possible relation with the treatment of infertility. However, the main applications in infertility so far are follicular monitoring and endometrium measurement by traditional two-dimensional (2-D) ultrasound. Nowadays, sonography plays a vital role in tracking follicular development and endometrial assessment in patients receiving ovulation-induction medication. The sonographic information can be coupled with estradiol values to provide an accurate assessment of the presence or absence and number of mature follicles. The maximal follicle size is the main point to consider giving human chorionic gonadotropin and ovum pick-up. Three-dimensional (3-D) ultrasound is a new imaging modality which is being introduced into clinical practice. It has been proved that 3-D ultrasound is a very highly reproducible technique. With 3-D ultrasound, a volume of a region of interest can be acquired and stored. This volume can be further analyzed in several ways, such as navigation, multiplanar display and surface rendering or volume calculation. Power Doppler ultrasound, in combination with 3-D ultrasound, allows for a whole assessment of relevant vessels and quantitative assessment of vessel density and perfusion within a specified area. A whole evaluation is then possible for endometrial and subendometrial vascularization and also for ovarian stromal vascularity. Further, structure anomaly, such as septate uterus, can be understood more clearly with 3-D ultrasound. However, data in the literature on 3-D ultrasound assessment of endometrial receptivity to predict in vitro fertilization (IVF) outcome are controversial. Ovarian volume and antral follicle numbers have been shown to be an indicator of ovarian reserve and reproductive potential. A recent comparative meta-analysis has demonstrated that the predictive performance of ovarian volume toward poor response is clearly inferior compared with that of antral follicle count (AFC). AFC may be considered the test of first choice when estimating quantitative ovarian reserve before IVF. In combination with 3-D ultrasound, the use of power Doppler in examining ovarian stromal blood supply still fails to prove its role in predicting ovarian response and pregnancy in the IVF treatment and in the intrauterine insemination treatment. Although 3-D ultrasound has probably not replaced 2-D ultrasound, it is being increasingly used in the clinical setting. 3-D ultrasound has become an indispensable and auxiliary tool, alongside with 2-D ultrasound.
