Ultrasound - Seeing with Sound
from
the book How to Have a Baby: Overcoming Infertility
by Dr. Aniruddha Malpani, MD
and Dr. Anjali Malpani, MD.
table
of contents ·
previous page · next page
Recent
Advances in Ultrasound
Ultrasound
technology has made dramatic advances in recent years, and now tests
have been described which allow the doctor to use ultrasound to assess
tubal patency. Basically, these involve passing a fluid into your
tubes through the uterus; and the gynecologist can see the passage
of the bubbles into the tubes and out into the abdomen. Since this
test ( sonosalpingography) can be done in the doctor's clinic itself,
and does not involve X-ray radiation, it has advantages - especially
for documenting that the tubes are normal. However, the gold standard
for tubal testing remains HSG and laparoscopy today.
Doppler:
The newer ultrasound machines have Doppler attachments which allow
the doctor to judge the flow of blood in the blood vessels. The most
exciting advance is that of Colour Doppler, where the blood flow can
be mapped in color on the monitor. While still a research tool, it
may provide important information for assessing the infertile patient
in the coming years.
Three
– dimensional ultrasound. Using sophisticated microprocessors, the
newest ultrasound machines allow the doctor to reconstruct the image,
so that he gets a three dimensional view. While this provides excellent
pictures, the true value of this technique for infertility still has
to be evaluated.
Ultrasound
now also 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 hospitalisation
; 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:
- Egg
pickup for IVF - 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.
- Ovarian
cyst aspiration. An ovarian cyst is a very common condition in which
fluid collects in the ovary. However, cysts which 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.
- Treatment
of ectopic pregnancy . 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
direct into the heart of the baby in the ectopic gestational sac,
thus killing it and preventing it from growing.
- Ultrasound-guided
tubal embryo and gamete transfer for IVF and GIFT techniques. Techniques
have been devised to pass a special tube - the Jansen-Anderson catheter
set - 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.
- Tubal
recanalisation for cornual blocks (proximal tubal obstruction).
Often cornual blocks are due to the presence of mucus plugs and
amorphous debris in the tubal lumen. Ultrasound guided tubal catheterization
can effectively treat the blocked tubes in some of these patients.
The scope
of ultrasound guided procedures has increased dramatically in the
last few years; and with further improvements in technology, we can
expect this list to become even longer, and doctors become more versatile
with using this technology.
previous
page · next
page
|
