When the ovarian volume is <3 cm3 and <5 antral follicles are present, this suggests diminished ovarian reserve [29]. MRI Pelvis A recent study in obese adolescents with suspected PCOS demonstrated that MRI without IV contrast can provide reproducible and reliable ovarian volume assessment; however, ovarian follicle counts had only moderate interobserver agreement. Nonetheless, in the obese adolescent or patient in whom TVUS is unacceptable and transabdominal US limited, MRI may provide additional information on PCOM [25,26,30]. US Pelvis Color Doppler Although increased central stromal vascularity has been demonstrated in the ovaries of women with PCOS, there is limited evidence to indicate color Doppler should be performed routinely in the evaluation of PCOM [31]. Female Infertility US Pelvis Transabdominal Transabdominal US is often performed in conjunction with TVUS; however, in some settings it may be performed in isolation. The transabdominal approach is generally not suitable to record an accurate follicle count but is considered reliable to determine if the ovarian volume is >10 mL. On occasion, with a high superficial location, the ovary may be better seen for follicle counts than via the TVUS route but remains less reliable because of lower transducer frequency. Variant 3: Female infertility. History or clinical suspicion of endometriosis. Initial imaging. Fluoroscopy Hysterosalpingography HSG to assess tubal patency and the uterine cavity has been proposed as part of an infertility workup in women with endometriosis [8]. However, in one study, 21% of women undergoing infertility evaluation were found to have endometriosis at surgery despite a normal HSG [33]. Although HSG may be helpful in diagnosing tubal occlusion or patency in patients with endometriosis, other imaging modalities are more sensitive in detecting endometriosis.
Female Infertility. When the ovarian volume is <3 cm3 and <5 antral follicles are present, this suggests diminished ovarian reserve [29]. MRI Pelvis A recent study in obese adolescents with suspected PCOS demonstrated that MRI without IV contrast can provide reproducible and reliable ovarian volume assessment; however, ovarian follicle counts had only moderate interobserver agreement. Nonetheless, in the obese adolescent or patient in whom TVUS is unacceptable and transabdominal US limited, MRI may provide additional information on PCOM [25,26,30]. US Pelvis Color Doppler Although increased central stromal vascularity has been demonstrated in the ovaries of women with PCOS, there is limited evidence to indicate color Doppler should be performed routinely in the evaluation of PCOM [31]. Female Infertility US Pelvis Transabdominal Transabdominal US is often performed in conjunction with TVUS; however, in some settings it may be performed in isolation. The transabdominal approach is generally not suitable to record an accurate follicle count but is considered reliable to determine if the ovarian volume is >10 mL. On occasion, with a high superficial location, the ovary may be better seen for follicle counts than via the TVUS route but remains less reliable because of lower transducer frequency. Variant 3: Female infertility. History or clinical suspicion of endometriosis. Initial imaging. Fluoroscopy Hysterosalpingography HSG to assess tubal patency and the uterine cavity has been proposed as part of an infertility workup in women with endometriosis [8]. However, in one study, 21% of women undergoing infertility evaluation were found to have endometriosis at surgery despite a normal HSG [33]. Although HSG may be helpful in diagnosing tubal occlusion or patency in patients with endometriosis, other imaging modalities are more sensitive in detecting endometriosis.