Ultrasonography in controlled ovarian stimulation

The field of infertility and reproductive endocrinology relies heavily on imaging. Of all imaging modalities, ultrasonography has emerged as the key modality in artificial reproductive technologies. Its role begins with assisting in the diagnosis of the cause of infertility, through deciding on the optimal treatment strategy, execution of personalized fertility treatments and diagnosis and treatment of potential complications arising during treatment. This chapter provides an evidence-based review of the role of ultrasound in COS. Prior to the initiation of treatment, ultrasound assists in pelvic evaluation (predicting treatment success, assuring a dominant follicle has not emerged and diagnosing ovarian abnormalities that should be addressed). After designing the personalized treatment protocol, ultrasound is fundamental in monitoring the response to treatment (endometrial and ovarian follicular response). In in vitro fertilizations it has a key role in guiding embryo transfer. Lastly, its role does not end with achieving pregnancy but is also essential in the diagnosis and treatment of COS complications (abdominal haemorrhage, pelvic infections, adnexal torsion, ectopic pregnancy and ovarian hyperstimulation syndrome). In fact, so indispensible is its use that it would be almost impossible to imagine COS achieved successfully and safely without pelvic ultrasonography.