Role of ultrasound evaluation of ovarian causes of infertility

D. Diculescu, D. Pop, D. Mihu, C. Todea, C. Iuhas, R. Nicula

Rezumat: Infertility is usually defined as “failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse”, but in couples with advanced female age (>35 years), most practitioners initiate diagnostic evaluation after failure to conceive within 6 months. The ovarian factor is a key element in the evaluation of infertile patients. Ovulatory defects are present in 40% of infertile women and in approximately 15% of couples with infertility. The World Health Organization (WHO) classifies ovulation disorders into three groups: Group I - hypothalamic pituitary failure (hypothalamic amenorrhea or hypogonadotrophic hypogonadism), Group II - hypothalamic-pituitary-ovarian dysfunction (predominately polycystic ovarian syndrome) and Group III - ovarian failure. At ovarian level, within the process of ovulation, there is a micro folicullar stage of development (the anomalies of this stage are divided into two groups - micropolycystic ovaries and multifolicullar ovaries) and a macro follicular stage (with three different types of anomalies: macropolicystic ovaries, functional ovarian cysts and LUF syndrome). All of these anomalies can be assessed today using ultrasound techniques, especially transvaginal ultrasound. The term “ovarian reserve” has been used to describe the capacity of ovaries to respond to stimulation with gonadotropins and therefore to predict the fertility potential. There are 4 morphological markers used to appreciate the ovarian reserve: ultrasound evaluation of antral follicles, measurements of ovarian volume, average ovarian diameter and the evaluation of blood flow al the level of the ovarian stroma. Ultrasound examination plays a key role within the evaluation of the ovarian structure by being able to asses the ovulation/dysovulation processes and other causes of ovarian infertility (endometrioma, tumors).
Cuvinte cheie: folliculogenesis, corpus luteum, ovulation failure, ovarian reserve.