Complete evaluation of anatomy and morphology of the infertile patient in a single visit The modern infertility pelvic ultrasound examination

Capsule:
The concept of “one-stop shopping” for evaluating female infertility is a comprehensive ultrasound evaluating the uterus and ovaries, including the shape of the cavity, serosal surface, and tubal patency.

Authors:
Yvette Groszmann, M.D., M.P.H., Beryl R. Benacerraf, M.D.

Volume 105, Issue 6, Pages 1381-1393

Abstract:

The comprehensive “one-stop shop” ultrasound evaluation of an infertile woman, performed around cycle days 5 to 9, will reveal abundant information about the anatomy and morphology of the pelvic organs and thereby avoid costly radiation and iodinated contrast exposure. We propose a two-dimensional and three-dimensional ultrasound to examine the appearance and shape of the endometrium, endometrial cavity, myometrium, and junctional zone, to assess for müllerian duct anomalies fibroids, adenomyosis, and polyps. We then evaluate the adnexa with grayscale ultrasound and Doppler, looking for ovarian masses or cysts, and signs of tubal disease. The cul-de-sac is imaged to look for masses, endometriosis, and free fluid. We then push gently on the uterus and ovaries to assess mobility. Lack of free movement of the organs would suggest adhesions or endometriosis. The sonohysterogram then allows for more detailed evaluation of the endometrial cavity, endometrial lining, and any intracavitary lesions. Tubal patency is then assessed during the sonohysterogram in real time by introducing air and saline or contrast and imaging the tubes (HyCoSy). With this single comprehensive ultrasound examination, patients can obtain a reliable, time-efficient, minimally invasive infertility evaluation in their own clinician’s office at significantly less cost and without radiation.

  • Daniel J. Kaser, MD

    Dear Drs. Groszmann and Benacerraf,
    Interesting read, and an important update to the use of ultrasound in evaluation of the infertile patient! Do you have any additional tips or tricks you could share with the readers for performing HyCoSy?
    Thanks very much for your comments.

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