Pelvic Ultrasonography: Its Role in IVF

For patients dealing with infertility, there are several diagnostic procedures available. Many of these procedures may be invasive, time-consuming, or expensive. Fortunately, there are a few procedures that have none of these traits. Pelvic ultrasound, sometimes referred to as transvaginal ultrasound, is one of them, and in the Philippines, causes of infertility can be established using this important technique.

Pelvic ultrasound is a diagnostic imaging examination that is used to visualize a woman’s reproductive organs, including the cervix, ovaries, and uterus. To perform the simple procedure, the patient lies down on an examination table with her feet in stirrups. A transducer (or probe) is covered with a condom and lubricating gel, and inserted into the vagina. The probe emits ultrasonic waves that reflect off structures within the body to varying degrees depending on the density of the tissue visualized. Sound information is encoded into a map of the various structures, and a picture is created. This is what appears on a real-time video monitor.

Patients who have experienced infertility can undergo a pelvic ultrasound as a first-line, initial evaluation. This examination can detect structural pathologies such as ovarian cysts, anomalies in the endometrial tissue such as endometrioma, as well as hydrosalpinx. Uterine pathologies can also be determined, such as the presence of polyps, fibroids, as well as the presence of other lesions or masses. Combined with other examinations, pelvic ultrasonography can be used to determine the nature of certain anomalies, whether they are benign or malignant, and the most appropriate treatment course can be approached with confidence.

Pelvic ultrasonography has several key advantages. It is well tolerated by the patients under examination, carries little to no risk for infection, and is radiation-free. The disadvantages of TVS would include limited sensitivity and specificity in the diagnosis of certain endometrial cavity abnormalities as well as tubal pathologies such as hydrosalpinx, (tubal blockage).

For assistive reproductive therapies, pelvic ultrasound can be used to determine the size and position of the uterus, which is important for in-vitro fertilization. Aside from detecting structural lesions, uterine size and position are important anatomical details for IVF success because implantation of an embryo must occur at a very specific distance from the fundus. During embryo transfer, placement of the embryo 1-2 cm below the fundus has a higher success rate than if it were lower on the body of the uterus. This level of accuracy can be achieved with the aid of pelvic ultrasound.