Ultrasound technology has made dramatic advances in recent years. Ultrasound now offers infertile patients newer treatment options not available before. Modern surgical techniques have progressively become less and less invasive – all to the patient’s benefit! From laparotomy to laparoscopy, and now to ultrasound guided procedures, we are witnessing a change in the gynecologist’s armamentarium from the knife to the endoscope to the guided needle!
The benefits to the patient are many and include: reduced costs, reduced hospitalization, reduced risk of complications and better preservation of fertility, with increased chance of conception for the future.
Ultrasound-guided procedures can be used to treat a variety of problems seen in the infertile woman.
The use of vaginal ultrasound for egg pickup has made egg retrieval a short, simple and inexpensive procedure, which can be performed in a day-care unit, under sedation and local anesthesia. The ovaries are normally present in the Pouch of Douglas, and are very accessible transvaginally. Moreover, the presence of adhesions does not interfere with egg collection.
An ovarian cyst is a very common condition in which fluid collects in the ovary. However, cysts that are more than 5 cm in size need to be treated as they can cause problems (eg twisting and rupture). Normally, surgery had to be done to remove these cysts – and often this damaged the surrounding normal ovary as well. With ultrasound-guidance, we can stick a needle from the vagina into the cyst, and empty the contents (usually clear fluid) by sucking it out. This empties the cyst, which often does not recur.
With technological advances (ultrasound and beta-HCG blood tests) the diagnosis of tubal pregnancy can be made very early, usually before rupture. It can be treated by injecting a toxic chemical, Methotrexate, into the sac, which causes the tissue to die and then get reabsorbed, without any surgery whatsoever. In more advanced tubal pregnancies, potassium chloride can be injected directly into the heart of the baby in the ectopic gestational sac, thus killing it and preventing it from growing.
Techniques have been devised to pass a special tube into the fallopian tubes through the vagina under ultrasound guidance, so as to place the embryos and /or the gametes in the fallopian tube. Since the tube offers a better environment for the gametes and embryos than the uterine cavity, it is believed that this will improve pregnancy rates.