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Evaluation of the Uterine Causes of Female Infertility by Ultrasound: A

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Evaluation of the Uterine Causes of Female Infertility by Ultrasound: A Evaluation of the Uterine Causes of Female Infertility by Ultrasound: A Literature Review Shohreh Irani (PhD)1, 2, Firoozeh Ahmadi (MD)3, Maryam Javam (BSc)1* 1 BSc of Midwifery, Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Iranian Academic Center for Education, Culture, and Research, Tehran, Iran 2 Assistant Professor, Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, Iranian Academic Center for Education, Culture, and Research, Tehran, Iran 3 Graduated, Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Iranian Academic Center for Education, Culture, and Research, Tehran, Iran A R T I C L E I N F O A B S T R A C T Article type: Background & aim: Various uterine disorders lead to infertility in women of Review article reproductive ages. This study was performed to describe the common uterine causes of infertility and sonographic evaluation of these causes for midwives. Article History: Methods: This literature review was conducted on the manuscripts published at such Received: 07-Nov-2015 databases as Elsevier, PubMed, Google Scholar, and SID as well as the original text books Accepted: 31-Jan-2017 between 1985 and 2015. The search was performed using the following keywords: infertility, uterus, ultrasound scan, transvaginal sonography, endometrial polyp, fibroma, Key words: leiomyoma, endometrial hyperplasia, intrauterine adhesion, Asherman’s syndrome, uterine Female infertility synechiae, adenomyosis, congenital uterine anomalies, and congenital uterine Menstrual cycle malformations. Ultrasound Results: A total of approximately 180 publications were retrieved from the Uterus respective databases out of which 44 articles were more related to our topic and studied as suitable references. In addition, 11 published books on ultrasonography and infertility were evaluated to provide more precise knowledge on the mentioned areas. According to the literature, ultrasonography has a crucial role in the investigation and differentiation of uterine disorders in females with infertility. However, the diagnosis depends on the day of menstruation, clinical prese- ntations, and the suspected uterine disorder. In this review, we provided the key notes about proper timing of the ultrasound examination. Conclusion: Ultrasonography is the first step imaging tool in the investigation of female infertility, which provides information for the diagnosis of uterine disorders. However, the accurate diagnosis depends on the “time of evaluation”. Therefore, every midwife needs to learn about the “optimum timing” for ultrasound evaluation based on each patient. Please cite this paper as: Irani Sh, Ahmadi F, Javam M. Evaluation of the Uterine Causes of Female Infertility by Ultrasound: A Literature Review. Journal of Midwifery and Reproductive Health. 2017; 5 (2): 919-926. DOI: 10.22038/jmrh.2017.8252 Introduction Infertility is a widespread phenomenon that account for about 3% of the infertile women and affects approximately 10-15% of the couples is categorized in seven classes, which will be around the world (1, 2). There are several described in details later (1-5). congenital or acquired uterine disorders, which Sonography is known as the first imaging cause infertility in the females. The acquired modality in the investigation of the female pelvis uterine abnormalities that are responsible for to detect the mentioned disorders among the female infertility include polyps, some types of infertile females. It is an “accurate, non-invasive, fibromas, adenomyosis, and some endometrial and cost-effective” modality, which provides disorders such as intrauterine adhesions. On the useful knowledge for the detection and other hand, the congenital uterine anomalies characterization of the possible female infertility * Corresponding author: Maryam Javam, Graduated, Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Iranian Academic Center for Education, Culture, and Research, Tehran, Iran. Tel: 9774066673; Email: [email protected] Irani Sh et al. JMRH Uterine Factors of Infertility factors (1, 2, 4-6). All infertile women undergo as the original text books between 1985 and 2015 an initial ultrasound pelvic exam (baseline were employed. A careful search was performed sonography) to investigate the probable causes using the following keywords: “infertility”, of infertility. A careful pelvic ultrasound, “uterus”, “ultrasound scan”, “transvaginal particularly transvaginal sonography (TVS), can sonography”, “endometrial polyp”, “fibroma”, detect the uterine abnormalities, ovarian “leiomyoma”, “endometrial hyperplasia”, “intrau- disorders, and other pathologic conditions, terine adhesions”, “Asherman’s syndrome”, which lead to female infertility (1,2,4-8). “uterine synechiae”, “adenomyosis”, “congenital Therefore, it can help the midwives, physicians, uterine anomalies”, “congenital uterine gynecologists, and infertility experts to examine malformations”, and “timing+ultrasound scan”. the infertile women and make better treatment The articles, which were written in English or choices for these patients. Persian and contained helpful data on “diagnostic Hackeloer examined the role of ultrasound in criteria of uterine disorders on transvaginal investigation and management of female ultrasound scan” and “proper timing of the infertility in a review article in 1984. He ultrasound examination” were considered as precisely described the uterine abnormalities, proper references. All manuscripts were carefully ovarian disorders, and adnexal masses, which assessed, and the proper articles were selected to cause infertility using ultrasound images (9). be studied. The irrelevant articles or those Recently, Hrehorcak and Nargund (2011) have written in other languages were excluded from published a review study on the new the study. perspective of diagnosing female infertility by Finally, a total of approximately 180 advanced ultrasound techniques (10). There are manuscripts were carefully assessed. Out of a number of reviews targeting this issue, these, 12 articles were not published in English however, all of them are written by radiologists or Persian, 16 manuscript provided diagnostic and gynecologists and provide advanced and criteria for hysteroscopy instead of TVS, 30 specific knowledge for the specialists. articles provided diagnostic accuracy of TVS To the best of our knowledge, no study has instead of diagnostic criteria, and 78 papers did been published in this area for the midwives. not discussed about the timing of the ultrasound Since many midwives work at the infertility scan. Therefore, 136 manuscripts were not treatment centers or personal offices, they thoroughly related to the topic of interest and interface with infertile females and need to excluded from the study. The remained 44 involve in the infertility assessment. Ultrasound articles met the inclusion criteria and were scan is one of the most used diagnostic tools for studied as suitable references. In addition, 11 the infertility workup. Therefore, every midwife books on ultrasonography and infertility were needs to learn about the application of the evaluated to provide more precise knowledge on ultrasound and management of the patients the investigated areas (Figure 1). based on abnormal findings. Nevertheless, there are not enough learning opportunities for Results midwives in this area. With this background in We gathered the useful findings of the mind, the present study aimed to provide useful reviewed studies on uterine causes of female practical knowledge about the ultrasonography infertility and the key points on the diagnosis assessment of female infertility and give a good of these causes by ultrasonography, which chance to midwives to further learn about this were as follows issue. Acquired abnormalities Materials and methods Polyps This literature review was conducted on the Endometrial polyps are benign localized articles investigating the diagnosis of uterine overgrowth glands, blood vessels, and stroma causes of infertility by means of ultrasound scan. within the uterine cavity (1, 3, 11, 12). They The articles published in such databases as mostly originate from the fundal region and PubMed, Elsevier, Google Scholar, and SID, as well extend to the internal os and may be seen single J Midwifery Reprod Health. 2017; 5(2): 919-926. 920 Uterine Factors of Infertility JMRH Irani Sh et al. or multiple. Their size differs from a few nevertheless, they commonly cause abnormal millimeters to centimeters and may be sessile or vaginal bleeding and infertility (11, 12, 15). The pedunculated (1, 11). There are some risk factors management of the females with endometrial recognized to cause polyps, including age, polyps depends on the symptoms, fertility issues, hypertension, obesity, and tamoxifen use; and risk of malignancy (1). Polypectomy by means however, the definite cause of polyps is unknown. of hysteroscopy is considered as an effective and The symptoms do not depend on the size, safe gold standard for both diagnosis and number, or location of the polyps (11-15). treatment of this condition, especially in case of Polyps are most often asymptomatic; infertility treatment (11, 14, 16). Figure 1. Study design TVS is identified as the best diagnosis tool in age, family
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