3D ultrasound is an emerging technology with great promise to further this role. This overview describes and illustrates the applications of three-dimensional Transvaginal ultrasound in female infertility.
The obvious advantages are that 3D ultrasound offers more rapid and reproducible image acquisition as well as enhanced visualization and post-processing capabilities. Ongoing research will likely continue to define the clinical role of 3D ultrasound and it is possible in the near future to regard to 3D ultrasound as the Golden Standard for pelvic imaging.
Uterine cavity assessment
The main advantage of pre cycle assessment using 3D is the coronal view of the uterine cavity to exclude Mullerian anomalies
Uterine cavity lesions such as fibroids (submucous, Intramural and subserous) , endometrial polyps & IU Synechiae
Ovarian volume calculation
3D ultrasound is more accurate in determining ovarian volume using the Virtual Organ computer-aided Analysis (VOCAL, GE Kretz) technique.
This technique employs a rotational method which involves the manual delineation of the ovarian volume throughout several planes as the data set is rotated through 180 degrees in a consecutive series of rotations
Number of follicles at the early follicular phase has been reported to be a good test for prediction of ovarian response All follicles < 10mm are measured using 2D ultrasound in the longitudinal and transverse planes, however 3D techniques are now available for automatic calculation
The uterine abnormality most commonly associated with miscarriages is a uterine septum
Normal uterine lining does not grow over a septum, so if the embryo implants in the septum, it will not have an adequate blood supply for growth.
The traditional way to correct a septum was performing an abdominal surgery called a "metroplasty", where the septum was removed, and the uterine walls sewn together.
This surgery was not very successful, and nowadays we can remove a septum by hysteroscopy (``HYSTEROSCOPY GUIDED RESECTION``), which provides a much more successful outcome.
Understanding the type of uterine defect one has is critical, because this will determine if surgical intervention is needed to optimize one's chances of a successful pregnancy.
A 2D ultrasound can suggest that an abnormality is present, but does not necessarily differentiate among subtle abnormalities. The advantage of 3D/4D ultrasound is that it will better define the specific defect present. Based on this improved image, the best recommendation can be made
Using ultrasound imaging in implantation Optimal conditions of implantation could be:- Endometrium > 7 mm, Endometrial volume > 2 ml , Dominant follicle >18mm, Hypo-echogenic endometrium with 3 well delineated layers, Uterine PI < 3 and the Presence of sub-endometrial vascular flow.
We use a LOGIQ C5 Premium Ultrasound machine for our Oocyte retrievals and Embryo transfers.
Hysteroscopy is a procedure which involves examining the internal or the interior part of the uterus using a telescope which is injected into the cervical canal, it does not involve any surgical procedure. The procedure is done as a day procedure under the guidance of a general anesthetic at the clinic.The individual experiences minimal discomfort and doesn’t require any anesthesia. The procedure is done to figure out the cause of the problem in the uterus.
LOGIQ C5 Professional Ultrasound – at our Banjara hills OPD
Hysteroscopy enables to visually see the openings of the fallopian tubes, but it doesn’t permit to directly investigate the fallopian tubes. Hysteroscopy is a procedure which is opted by the doctor to examine and treat several different conditions arising in the uterus area. Some of the most frequently occurring conditions of the uterine cavity which can cured through hysteroscopy include:
- Examining the cause of abnormal uterine bleeding
- Investigating the tumors present inside the uterus.
- Treatment of scarring due to the previous surgeries present in the uterus (Asherman syndrome)
- Treatment to remove the fibroids or polyps
- Endometrial ablation (operation done to remove the uterine lining as a result of heavy periods)
- Treatment of uterine abnormalities.
Complications of hysteroscopy
There are no serious or major complications associated with hysteroscopic surgery, there are chances of complications which has a probability of occurrence 1 out of 2500 cases. Some of the complications explicit to the hysteroscopic surgery consist of uterine perforation, an opening or hole is made in the uterus. Its recommended to stay overnight in the hospital for observation.
If the hole or opening has been made using an instrument, to get rid of the abnormalities such as fibroid or polyp from the uterus which results in the other organs getting affected like bladder swelling which could be a serious threat of complication. To rule out the chances of any problem arising, laparoscopy is done to examine the damage than to opt for a surgery after prolonged time.
Some of the other complications that result due to hysteroscopy is the threat of fluid being absorbed into the main bloodstream. Also if abnormalities such as fibroid or polyps are removed during surgery, if excess amounts of fluid are absorbed it disturbs the salt levels in the bloodstream and results in brain swelling or wet lungs. The complications can be reduced by checking the fluid levels lost during the hysteroscopic procedure.
Also pregnant women cannot opt for hysteroscopy, as there is a threat of miscarriage. Talk to the doctor if you have plans to conceive to postpone the procedure. Your doctor shall suggest some alternatives.