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70 Cards in this Set
- Front
- Back
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What is infertility? |
The inability to conceive after 12 months of unprotected, regular intercourse. (6 months for those 35 years old or older) |
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What percent of infertility is attributed to women? |
40% |
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What percent of infertility is attributed to men? |
40% |
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What percent of infertility is combined or unexplained? |
20% |
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Infertility affects __ in __ couples in the US. |
1 in 7 |
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Infertility casuses include what... |
-Cervical -Endometrial/Uterine -Male Factor -Ovulatory -Peritoneal -Tubal |
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What is the role of the cervix in fertility? |
The role of the cervix in fertility is to provide a non-hostile environment to harbor sperm. The glands secrete mucus and crypts that hold sperm. |
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Ultrasound is used to evaluate cervical length during pregnancy to assess for _______ _______. |
Cervical Incompetence |
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The length and opening in the cervix are difficult to assess in a _______ uterus. |
Non-gravid |
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What is the definition of "non-gravid" uterus? |
A uterus that is NOT pregnant
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-Also known as Uterosalpingography -Tubal Occlusion is the most common cause -Used to evaluate the fallopian tube patency and uterus. -Can be used to evaluate the internal os diameter. - Diameter less than 1 mm by _____ may indicate cervical stenosis. |
Hysterosalpingography (HSG) |
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When evaluating the uterus, the 2 main objective are? |
1. Assess structural anatomy 2. Assess endometrium |
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When assessing the uterus for structural anatomy, we are checking for what 3 things? |
1. Uterine shape (bicornuate, didephys, septate) 2. Congenital malformations 3. Evaluating echogenicity |
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Is this uterus uniform in echogenicity? Are there masses suggestive of fibroids that may impede implantation of fertilized eggs? |
No, the echogenicity is not uniform. Yes, there are masses that will impede implantation of any fertilized eggs. |
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When assessing the endometrium, evaluate ______ and ______ characteristics and include evaluations for any intracavitary lesions. |
Thickness and echogenicity |
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A endometrium thickness of at least _____ mm appears to present the central threshold for achieving pregnancy. |
6 mm |
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Endometrial appearance is important in planning for infertility treatment with embryo transfer. The endometrial thickness can be evaluated throughout the ______ ______. |
Menstrual Cycle |
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If not enough _______ is produced in the luteal phase, the endometrial lining may be thinner than expected on ultrasound evaluations. |
Progesterone |
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The lack of progesterone production is known as "_____ ______ ______" and may be associated with infertility and early pregnancy loss. |
Luteal Phase Deficiency |
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The failure of the corpus luteum is associated with a lack of _____. |
Progesterone |
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What are the other things that can make endometrium appear irregular or more echogenic than normal are: |
1. Submucosal fibroids 2. Polyps 3. Fibroids 4. Adhesions |
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____ _____ _____ can be used in situations where the endometrium appears irregular to further delineate (describe) anatomic structure of endometrium. |
Saline Infusion Sonography (SIS) |
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____ & ____ can potentially impede implantation and if found, will be removed to enhance fertility. |
Fibroids & Polyps |
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What are ... 1. Broad Base 2. More isoechoic to the uterine myometrium 3. Circumferential Flow |
Fibroids |
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Where are ... 1. Narrow base attachment to the endometrium 2. Uniform hyperechoic appearance 3. Vascular pedicle feeding them |
Polyps |
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Saline Infusion Sonography (SIS) can also be used to evaluate the uterine cavity for ______, scars from uterine trauma. |
Synechiae |
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_____ are typically seen on ultrasound as linear strands of tissue extending from one wall of uterine cavity to other. |
Synechiae |
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Tubes can be examined by ultrasound for ______ and to assess patency. |
Hydrosalpinx |
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Hydrosalpinx is associated with what percent in reduction in pregnancy rate and doubling of spontaneous miscarriage rate. |
50% |
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If removed, what fallopian tube abnormality can dramatically improve in vitro fertilization success? |
Hydrosalpinx |
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What is the definition of "Patency"? |
- Plural patencies - The degree of openness of a tube, such as a fallopian tube. - The absence or presence of a blockage within the tubes. |
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____ ____ is assessed by injecting saline/air/contrast agent into the tube and lookingfor spillage of fluid into cul-de-sac or by using contrast to evaluate forspillage. |
Tubal Patency |
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Do we want to see spillage when a contrast agent is inserted into uterine cavity? |
Yes, we want to see spillage. When spillage is seen, we know the tubes are not blocked. |
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If spillage is not seen when contrast is injected into the uterine cavity, what does that infer? |
A blockage within the fallopian tubes |
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True or False: Tubal Patency and Hysterosalpingography are the same procedure. The only difference is Hysterosalpingography is checking for uterine anomalies and Tubal Patency is checking for anomalies within the fallopian tubes. |
TRUE |
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A follicle is selected to develop into a dominant follicle in response to _____ _____ _____. |
Follicle Stimulating Hormone |
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A dominant follicle in the ovaries with grow at a rate of approximately 1 to 3 mm per day until it reaches an average diameter of _____ mm. |
22 mm |
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Once reaching a mean diameter of 22 mm squared, the dominant follicle will ______. |
Rupture |
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What is the sonographer measuring on this image? What is the size in millimeters? |
1. A dominant follicle 2. 22 mm |
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PCOS often occurs with the diagnostic triad. What is the 3 parts of the diagnostic triad?? |
1. Oligoovulation 2. Hyperandrogenism 3. Polycystic Ovaries |
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What is the condition called that can inhabit the release of FSH and LH? |
Polycystic Ovarian Syndrome |
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With PCOS, follicles begin to grow but do not ______ normally. |
develop |
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What am I describing? - Adhesion and endometriosis - May be the cause for as many as 25% of infertility cases - Adhesions are bands of scar tissue that can obstruct the fimbriated end of the fallopian tube. - Sometimes fluid will collect in between adhesions, resulting in peritoneal inclusion cyst. |
Peritoneal Factors |
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What am I describing? - Refers to treatment in which ovarian stimulation is achieved in controlled settings. - Obtain baseline transvaginal ultrasound to rule out ovarian cyst and assess for presence of dominant follicle. - Measure cyst greater than 15 mm and respond with medication. |
Ovarian Induction Therapy |
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Which infertility drug comes in the form of a tablet and is used for women who have infrequent periods or long menstrual cycles? |
Clomiphene Citrate (Clomid, Serphene) |
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Which infertility drug is injectable and is used to induce the release of the egg once the follicles are developed and the eggs are mature? |
Gonadotrophins (Perganol) |
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Which infertility drug is used to lower prolactin levels and will also help reduce pituitary tumor size (if one is present)? This drug has few side effects and it is relatively inexpensive. |
Parlodel |
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Which infertility drug is give to patients as an insulin lower medication? This drug is most commonly used in PCOS, and has been shown to reverse the endocrine abnormalities seen with PCOS within 2-3 months. |
Glucophage (Metformin) |
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If a large ovarian cyst is present, _____ ______ have been known to suppress follicular activity before beginning therapy. |
Oral Contraceptives |
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Once ovarian induction therapy has started, ultrasound is used to monitor the number and size of follicles in days ____ to ____ of menstrual cycle. |
8 to 14 |
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The Sonographer needs to count and measure all follicles greater than ___ cm in longitudinal and transverse planes. |
1 cm |
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What is the optimal mean measurement of mature follicles? |
Between 16-20 mm |
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The normal response associated with ovarian stimulation is an increasing thickness of ___ to ___ mm to ___ to ____ mm. |
2 to 3 mm & 12 to 14 mm |
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A thin endometrium (< 6 mm) and an abnormal echogenicity usually indicates _____. |
Infertility |
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Which method is known for fertilizing human oocytes outside of the body? |
In Vitro Fertilization (IVF) |
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What am I describing? - Fertilizing human oocytes outside the body - Mature oocytes are collected and mixed in a dish with sample sperm. - Resulting embryos are placed back into the uterus |
In Vitro Fertilization (IVF) |
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What is this image demonstrating? |
Oocyte Retrieval |
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What is the trace function used for in embryo transfer? |
The trace function is used to trace from the cervix to apex of the fundus to determine the length. |
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What is the optimal placement for embryo transfer? |
2 cm of the apex of the fundus |
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What am I describing? - TA guidance, a catheter is inserted through the cervix and placed within 2 cm of the fundus. - Embryos are slowly released and a transfer air bubble is visible on ultrasound - Once complete, the catheter is checked to ensure all embryos were transferred. |
In Vitro Fertilization and Embryo Transfer |
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What am I describing? - Technique used to treat male factor infertility - A catheter containing sperm is placed into the uterine fundus |
Intrauterine Insemination |
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What does GIFT stand for? |
Gamete Intra-Fallopian Transfer |
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What am I describing? - Founded in the 1980's - Accepted by the Roman Catholic Church - Success rate is somewhat higher than standard In Vitro Fertilization - Can only be performed on patients with normal fallopian tubes and adequate sperm. |
Gamete Intra-Fallopian Transfer |
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What are the 3 complications associated with assisted reproductive technology? |
1. Ovarian Hyperstimulation Syndrome (OHSS) 2. Multiple gestations 3. Ectopic pregnancy |
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What are these symptoms describing? - Leg edema - Ascites - Pleural Effusion - Hypotension - Polycythemia |
Severe Cases of Assisted Reproductive Technology |
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What are the sonographic findings in severe OHSS cases? |
- Enlarged ovaries with multiple cysts - Ascites -Pleural Effusions |
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Is severe OHSS a unilateral or bilateral condition? |
Bilateral condition |
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What percent of patients who undergo in vitro fertilization are at risk for having multiple gestations? |
30% |
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What is this an image of? |
Intrauterine twin pregnancy
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What is this an image of? |
A live heterotopic pregnancy in patient |
