Preimplantation 3D ultrasound: current uses and challenges

What is it about?

The preimplantation ultrasound refers to targeted imaging of the uterus and adnexa prior to assisted reproductive techniques to optimize the infertility treatment outcomes. A systematic approach for ultrasound examination consists of a detailed examination of the uterine shape, size and contour, evaluation of the endometrial thickness, volume, pattern and vascularity, and assessment of the junctional zone regularity, echogenicity and thickness. 3D ultrasound enables assessment of the uterine anatomy by simultaneous visualization of the uterine cavity, the external surface of the fundus and cervix in a coronal plane. Saline infusion sonogram is recommended for patients with increased endometrial volume, abnormal endometrial pattern and irregular uterine cavity shape suggestive of the Müllerian duct anomalies or acquired intracavitary abnormalities. Myometrial lesions should be recognized and proper dimensions and locations should be ascertained. Ovarian dimensions and volume are measured and the antral follicle count is recorded. Adnexa are carefully assessed for masses, endometriosis and dilated tubes. Color power Doppler US may be applied to evaluate vascularity of the ovaries and pelvic lesions. Hysterosalpingo-contrast-sonography should be optimally utilized for assessment of tubal patency. Accessibility and mobility of the ovaries should be checked in real time for better planning of the ultrasound-guided oocyte retrieval. The cul-de-sac is assessed for the presence of free fluid or masses.

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Why is it important?

Early and non-invasive detection of the uterine, ovarian and tubal causes of infertility by ultrasound enables better planning of the assisted reproductive techniques to optimize infertility treatment outcomes.

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