Ultrasonic Assessment of Infertility

Ultrasonographic changes of endometrium, ovaries and salpinges detected by realtime B-mode and 3D ultrasound indicate effective treatment of infertility not only in the Assisted Reproduction Technology (ART) but also in the conventional management where essential plan for the therapy is indicated. The articles concerning ultrasonographic assessments of fecundity and infertility are reviewed. Although the ART has become ordinary treatment of infertility, the pregnancy rate is yet unsatisfactory and it is important to select cycles where favorable conception is predicted in order to increase pregnancy rate in ART. Although antral follicle count (AFC) is the index for predicting ovarian response to human menopausal gonadotropin (hMG) stimulation, it is able to select stimulation options for a poor responder of low AFC value. Since three-dimensional (3D) ultrasonography with power Doppler angiography (PDA) indicates an organ blood flow as a whole, they are important tools for the evaluation of perfusion. The assessment of perifollicular blood flow in preovulatory follicles may be useful for predicting conception and cancelling in vitro fertilization (IVF) in poor vascularity cycle. Since rich endometrial vascularity assessed by 2D and 3D flow signs and the low impedance to flow suggests well perfused endometrium and the high receptivity in the embryo transfer (ET), and vice versa, it would be recommended to limit the number of embryos for the ET in the high receptivity, while to cryopreserve the embryo in case of bad flow signs and wait the cycle of favorable perfusion in order to successfully transfer the embryo.