Is 3D ultrasound of value for infertile couples? can it improve pregnancy rates. This talk may answer these questions

1. {
4D Ultrasound
& Infertility
Hesham Al-Inany, PhD

2. What is 4D Ultrasound?
4D fetal ultrasounds are similar to 3D scans, with
the difference associated with time: 4D allows a 3-
dimensional picture in real time, rather than
delayed, due to the lag associated with the
computer constructed image, as in classic 3-
dimensional ultrasound

3. Uterine cavity assessment
 The main advantage of pre cycle assessment using 3D is the
coronal view of the uterine cavity to exclude;
 Mullerian anomalies
 Uterine cavity lesions such as submucous fibroids , endometrial
polyps & IU Synechiae

6. Do We have to manage
Mullerian anomalies before the
IVF cycle
 All studies available on excision of septum prior to IVF are
retrospective no RCS are available ( Bendifallah 2013)
 Cochrane review 2013 on;Hysteroscopy for treating subfertility
associated with suspected major uterine cavity abnormalities;
insufficient evidence.

7. Mainly for the Obstetric
Outcome
High incidence of Preterm Birth in Unicornuate, Septate and
Bicornuate uterus

8. General consensus that fibroids do
affect IVF outcome, submucous,
intramural & subserous in decreasing
order of importance ( decreases live
birth rate, and myomectomy
increases pregnancy rate by 50%.(
somilgliana 2007)

14. Comparing 3D
sonohysterography to
Office hysteroscopy found
substantial concordance
between both techniques
with less time of exam and
less pain(Negm 2012)

15. Basal Ovarian Volume and
AFC

16. Ovarian volume
calculation
 Three D ultrasound is more accurate in
determining ovarian volume using the Virtual
Organ computer-aided Analysis (VOCAL, GE Kretz)
technique .
 This technique employs a rotational method
which involves the manual delineation of the
ovarian volume throughout several planes as
the data set is rotated through 180 degrees in a
consecutive series of rotations ( angle
dependant on number of planes chosen could
range from 6 ◦ to 30◦ ) , until a calculated
volume is generated

18.  Basal antral follicle count shows 5-11
small follicles < 10mm in diameter .
 Number of follicles at the early follicular
phase has been reported to be a good test
for prediction of ovarian response (Kwee
2007, Jayaprakasan 2008) . All follicles <
10mm are measured using 2D ultrasound
in the longitudinal and transverse planes,
however 3D techniques are now available
for automatic calculation (SonoAVC) (Raine-Fenning
2008).

19. SonoAVC
 A new automated ultrasound software
technique has recently been developed which
relies on volume calculation using 3-
dimensional VOCAL technique and on colour
coding of each follicle (SonoAVC, GE ) (Raine Fenning
2008).
 A 3D volume is obtained of the stimulated ovary,
and using the software will give mean diameter
and volume of the hypo echoic areas within the
ovary representing the follicles, it will then
colour code each follicle differently allowing
studying each one separately .

21.  Greater accuracy
 Quick
 Reproducible
 Correlates well with aspirated fluid volume

22. The main possible implantation
markers that stuided by real time
ultrasonography
• Endometrial thickness,
• Endometrial volume
• Endometrial morphological patterns.
• Endometrial Vascularity :
1. Uterine Artery PI
2. Endometrial and
Subendometrial Vasculature

23. {
Ultrasound Parameters in
Favour of Implantation

24. > 7 mm
TRILAMINAR > 2ml
PI < 3
FI > 20%
VFI > 20 %
Endometrial
&subendometrial
flow

25. Using ultrasound imaging in
implantation
Optimal conditions of implantation could be:-
 Endometrium > 7 mm,
 Endometrial volume > 2 ml
 Hypoechogenic endometrium with 3 well
delinated layers,
 Uterine PI < 3,
 Presence of sub-endometrial vascular flow.
 High VI,FI&VFI in endometrial & sub-
endometrial zone.

26. THANK YOU