Three-dimensional ultrasonographic ovarian measurements and in vitro fertilization outcome are related to age.

OBJECTIVE: To evaluate whether the number of ovarian antral follicles, ovarian volume, and ovarian stromal blood flow change with age and to prospectively analyze whether three-dimensional ultrasonographic measurements predict ovarian response and IVF outcome. DESIGN: Prospective analysis. SETTING: Assisted reproductive unit. PATIENT(S): Fifty-six consecutive women 22 to 43 years of age with normal basal serum FSH concentrations who were undergoing their first IVF cycle. MAIN OUTCOME MEASURE(S): Number of ovarian antral follicles, ovarian volume, and ovarian stromal flow index were determined by three-dimensional and power Doppler ultrasonography. Pretreatment measurements were compared with number of recovered oocytes, fertilization rates, and pregnancy rates. RESULT(S): As patient age increased, significant trends in ovarian volume, number of follicles, and stromal vascularity decreased. Three-dimensional ovarian measurements and fertilization rates differed significantly among age groups. For each age group, a higher number of antral follicles, greater ovarian volume, and favorable ovarian stromal vascularity was associated with higher number of retrieved oocytes and increased pregnancy rates. CONCLUSION(S): Increasing patient age is associated with poor ovarian response, as represented by smaller ovarian volume, lower antral follicle count, and poor stromal vascularity. Three-dimensional power Doppler ultrasonography can help to individualize IVF in patients regardless of age.

Screening for uterine abnormalities by three-dimensional ultrasound improves perinatal outcome.

The main goal of our study was to assess the true incidence of surgically correctable uterine abnormalities (congenital uterine anomalies, submucous leiomyoma, endometrial polyps and intrauterine synechiae) in the infertile population attending our tertiary infertility clinic. All of the infertile patients enrolled in the study were evaluated by three-dimensional ultrasound. Another objective was to assess pregnancy rates before and after operative hysteroscopy in patients affected by uterine causes of infertility. Good quality 3D images were obtained in all 3850 infertile patients, and in 23.2% of them 3D US revealed surgically correctable uterine abnormalities. The incidence of uterine septum in our general infertile population was 17.9%. Uterine septum was the most common uterine abnormality accounting for 77.1% of the intracavitary lesions. Out of 310 patients that were followed-up, 225 (72.6%) patients achieved pregnancy. The rate of term deliveries after septal incision was 57.7%, while 15.4% of patients had preterm deliveries. The rate of spontaneous abortions dropped from 41.7% before, to 11.9% after hysteroscopic resection of the septum. Three-dimensional ultrasound can be used as a screening method for detection of uterine abnormalities in patients suffering from infertility. We found significant improvement in reproductive outcome after operative hysteroscopy in secondary infertile patients with septate uterus and/or other uterine abnormalities.

Events from ovulation to implantation studied by three-dimensional ultrasound.

During the last decade transvaginal color Doppler has played an important role in increasing understanding of early human development. Although our knowledge of early pregnancy development has recently improved, little is known about the most critical period of human development: between conception and implantation. Recent advances in 3D ultrasound have made studies of follicular development, ovulation and uterine receptivity more accurate. The same method can be used for evaluation of the Fallopian tube patency and assessment of the ovarian and uterine causes of infertility which hamper processes of early human development. Storage capacities, reconstruction of the volume images and simultaneous viewing of all three orthogonal planes are the main advantages of this method. Introducing 3D ultrasound into assessment of early pregnancy has enabled visualization and volume estimation of the gestational sac, yolk sac and embryo. Switching on power Doppler superimposed to 3D gray scale can detect early vasculogenesis within the intervillous space and embryo/fetus. Here we review the potential application of this novel technique in monitoring the morphological and functional processes from ovulation towards implantation and early pregnancy.