Female pathologies related to infertility which can be diagnosed by ultrasonography?

Uterus is the place for embryo implantation and pregnancy continuation. The normal adult uterus is a muscular organ 6-10 cm in length and 3-5 cm in width and has a unique capacity to grow and expand to hold a full term fetus during pregnancy.

TVS (Trans vaginal sonography) can accurately assess the uterine factors. Addition of fluid (saline) by sono-hysterography the cavity can be accurately studied. By color flow imaging, color doppler studies of uterine artery, power angiography, the spiral artery and endometrial vasculature can be evaluated to score the uterus for favorability of implantation.


Conditions related to infertility, which are diagnosed by USG are

Leiomayomas or fibroids:

Leiomyomas or fibroids are one of the most common benign neoplasm in women and have been reported to occur in up to 40 percent of women over the age of 35. May be an important factor for infertility can easily be diagnosed by USG. Transvaginal ultrasound is the most useful tool for screening for fibroids. The uterus is enlarged with contour deformity (Fibroid causing contour problem) and focal masses with different echogenecities (Hypoechoic usually, hyperechoic when calcified and may be isoechoic also).

A submucosal myoma within the uterine cavity, which prevent implantation of the fertilized ovum into the uterine cavity, can be picked up by the USG study.

Endometriosis

These cysts are homogenous with a low level echo patterns with good through transmission. They have fine stippling pattern filling the whole of the cyst.

Congenital Anomalies

Congenital anomalies of the uterus occur in about 0.1-0.4% of general population of women and are due to the embryological problems in Mullerian system. Congenital anomalies are a significant cause of recurrent pregnancy loss. About 80% of women with congenitally abnormal uterus may have no problem in conceiving but anomalies are responsible for almost 20% of recurrent pregnancy loss and hence should be carefully looked for and treated whenever encoun¬tered during infertility evaluation.

Uterine congenital anomalies can be diagnosed by HSG, TVS, contrast sonohysterography, hysteroscopy and laparoscopy and by a MRI 3D HSG and TVS without saline contrast are the commonest methods. The anomalies which can be diagnosed are bicornuate uterus, unicornuate uterus, intrauterine septa (complete, incomplete or arcuate).


Endometriosis of the Uterus (Adenomyosis)

Endometriosis is a disease in which typically the endometriotic implants are scattered in various extra uterine locations. However sometimes the ectopic endometrium goes into the myometrium and causes adenomyosis. These endometrial tissue starts to proliferate inside the myometrium and tends to bleed on progesterone withdra wl during the menstrual cycle thus giving the uterus a typically speckled appearance resembling 'Salt and Pepper' (Hyperecohic areas and hypoechoic areas) appearence. Depending on the extent of lesion and the severity of disease the uterus will appear enlarged and sometimes all of the adenomyosis areas may together look like a fibroid (Adenomyoma).

This article is also published in India Study Channel