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Re: doppler in non-pregnant uterusFrom: art fougner, md (evsono@pipeline.com)Sat Sep 27 07:29:37 2003
Stuart Campbell uses doppler as part of an infertility evaluation he has presented to ISUOG. TUESDAY, 2 SEPTEMBER 2003 OC086: Doppler and 3D ultrasound in infertility - do they alter the outcome for the patient? S. Campbell * UK *Correspondence to S. Campbell, UK Conference: 13th World Congress on Ultrasound in Obstetrics and Gynecology, Paris, France, 31 August 2003 to 4 September 2003. Abstract One-stop Fertility Diagnosis and Pivotal Scan. It is surprising that fertility units have not incorporated new ultrasound techniques into their clinical practice to provide a less invasive and a more cost-effective system of infertility investigation. Certainly in the public funded health service infertility investigations are still strung out over months and sometimes years. The process is not only lengthy but frequently repetitive and with respect to older women may limit her chances of success as the woman's age is the single most important prognostic factor in infertility management. For 2 years now we have restructured our infertility investigations as a one-stop shop. Investigations are focused on a pivotal scan that is carried out between days 10 and 12 of the menstrual cycle in a woman who has a 28-day cycle. The scan should show an anteverted uterus of approx 75 mm length with normal myometrium and a triple layer endometrium of greater than 7 mm thickness. A clear layer of mucus in the cervical canal is a favourable sign. Blood flow in the uterine arteries should show good diastolic velocities with a mean PI of less than 3. Endometrial colour Doppler should demonstrate vessels (spiral arteries) extending into the triple layer. There should be a dominant follicle in one of the ovaries of about 16-18 mm in diameter with a circle of blood vessels around the follicle with a peak systolic velocity of 5-10 cm/s. The stroma of each ovary should contain four or five antral follicles and the stromal blood flow velocities should be around 6-12 cm/s. Mobility of the pelvic organs is an important feature and movement of the ovaries in relation to the uterus in response to abdominal palpation should be clearly demonstrated. Unfavourable features would be large fibroids close to the endometrium, evidence of adenomyosis, an echogenic or thin endometrium, an endometrial polyp, high resistance uterine artery blood flow, polycystic ovaries or ovaries with no dominant follicle, few antral follicles and low-velocity stromal flow. Poorly mobile uterus and ovaries is another unfavourable sign. These ultrasound results are considered together with FSH, LH and inhibin B serum levels, which are estimated on days 1-3 of the cycle by the patient's general practitioner. Following this pivotal scan, HyCoSy is performed using initially negative contrast (saline), which is followed by positive contrast (Echovist, Schering AG, Berlin, Germany) under antibiotic prophylaxis. Frequently 3D-CPI is used to evaluate fill and spill from the Fallopian tube in the surface rendered mode and if there is any suggestion of a uterine congenital defect, a 3D transverse coronal plane is obtained to confirm and classify the defect. All patients have chlamydia screening and those with irregular cycles have Prolactin and thyroid function assays. This investigation normally takes about 45 min and a full discussion of these results including semen analysis is made with the couple on the day of the pivotal scan. The advantages of one-stop fertility assessment out-lined above is that it is less invasive than the conventional work-up and does not involve the kind of delay that can affect the woman's fertility potential. I believe that the use of modern ultrasound technology in this way is not only more acceptable for the couple but it is also more cost effective. art http://www3.interscience.wiley.com/cgi-bin/fulltext/104557083/HTMLSTART
At Sat, 27 Sep 2003, Terry J. DuBose wrote:
>
-- art fougner, md ich bin ein New Yorker
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