Roger A Pierson

Pregnancy Miracle

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Department of Obstetrics, Gynecology and Reproductive Sciences, College of Medicine, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan, Canada

Imaging has become such an integral part of clinical care in the assisted reproductive technologies that it is difficult to imagine how in vitro fertilization (IVF) was done before we had the ability to visualize the ovaries and uterus easily. Recall that IVF was once done using laparoscopic retrieval of oocytes following ovarian stimulation cycles monitored only by hormonal assay of systemic estradiol levels, that embryos were transferred back into a uterus when we had no real idea about the physiologic status of the endo-metrium, and only a clinical touch was used to guide the placement of the embryo transfer catheter. Easily accessible, and easy-to-use, ultrasonographic imaging in the hands of the individuals performing the assisted reproductive technology (ART) procedures has delivered us from those uncertainties. The quality and quantity of the information we received from the ultrasonographic images that are now an essential part of every procedure have been a very important aspect of the incredible increases in ART success rates we have seen over the past decade. It is important to remember that the integration of enhanced understanding of anatomy, physiology, endocrinology, and pathology we have gained with imaging in the patients undergoing IVF are as important as the fantastic increase in knowledge in the embryo laboratories. The confluence of technologies we now used in ART care have greatly increased the probabilities of successful pregnancies for our patients.

The purpose of this chapter is to describe the primary uses of ultrasound imaging in IVF and to identify some promising new areas where imaging has the potential to enhance our understanding in assisted reproduction. The essentials of ultrasonography in IVF are in monitoring the course of ovarian stimulation protocols, visually guided retrieval of oocytes, assessment of the endometrium, and visually guided embryo transfer. Each of these areas also provides a springboard for new research areas which may be incorporated into clinical care. Awareness of new frontiers is essential to progress in ART and in understanding the changes that will surely come. We rely so heavily on imaging in general gynecology, infertility workup, and early obstetrical care that it becomes challenging to narrow our focus to only IVF; however, with the general caveat that ultrasonography has forever changed our understanding of female reproduction, my goal is to provide a synopsis of imaging in IVF integrated into a framework within which we provide the highest quality of care for the patients who require ART to complete their families.

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