Although endometriosis is associated with infertility, the mechanism is unclear [8]. Imaging is useful in characterizing some features of endometriosis; however, small endometrial implants are not well detected on imaging. Therefore, laparoscopy remains the standard for both diagnosis and staging of endometriosis [9,10]. Women with a history of pelvic infection or surgery may develop intrauterine synechiae, fallopian tube abnormalities that include occlusion, and peritubular adhesions [11], potentially causing infertility. Imaging evaluation in these women focuses primarily on the fallopian tubes. Reprint requests to: publications@acr.org Female Infertility adhesions cause the loss of pregnancy [17]. Although hysteroscopy is the reference standard for visualizing intrauterine adhesions [18], imaging examinations can aid in making this diagnosis with a less invasive approach. Uterine fibroids are suspected to be related to recurrent pregnancy loss; however, there is insufficient evidence to confirm a causal relationship. Uterine adenomyosis, although previously felt to be more common in multiparous women, has now been associated with increased rates of spontaneous abortion and implantation failure [19]. In approximately 18% of women, a uterine abnormality such as fibroids or MDA is identified as a causative factor for recurrent pregnancy loss [20]. Special Imaging Considerations MR hysterosalpingography (HSG) is an additional technique that can demonstrate tubal patency and may be useful in women in whom both MRI and HSG need to be performed [23]; however, it remains an investigational tool [24]. US Pelvis Transabdominal Although transabdominal US and TVUS may be performed together for evaluation of the ovaries, transabdominal US should be relied upon only if the ovaries are not adequately evaluated via a transvaginal approach. US Pelvis Transvaginal TVUS can be used to monitor follicle development [27], perform antral follicle counts [28], and measure ovarian volume.
Female Infertility. Although endometriosis is associated with infertility, the mechanism is unclear [8]. Imaging is useful in characterizing some features of endometriosis; however, small endometrial implants are not well detected on imaging. Therefore, laparoscopy remains the standard for both diagnosis and staging of endometriosis [9,10]. Women with a history of pelvic infection or surgery may develop intrauterine synechiae, fallopian tube abnormalities that include occlusion, and peritubular adhesions [11], potentially causing infertility. Imaging evaluation in these women focuses primarily on the fallopian tubes. Reprint requests to: publications@acr.org Female Infertility adhesions cause the loss of pregnancy [17]. Although hysteroscopy is the reference standard for visualizing intrauterine adhesions [18], imaging examinations can aid in making this diagnosis with a less invasive approach. Uterine fibroids are suspected to be related to recurrent pregnancy loss; however, there is insufficient evidence to confirm a causal relationship. Uterine adenomyosis, although previously felt to be more common in multiparous women, has now been associated with increased rates of spontaneous abortion and implantation failure [19]. In approximately 18% of women, a uterine abnormality such as fibroids or MDA is identified as a causative factor for recurrent pregnancy loss [20]. Special Imaging Considerations MR hysterosalpingography (HSG) is an additional technique that can demonstrate tubal patency and may be useful in women in whom both MRI and HSG need to be performed [23]; however, it remains an investigational tool [24]. US Pelvis Transabdominal Although transabdominal US and TVUS may be performed together for evaluation of the ovaries, transabdominal US should be relied upon only if the ovaries are not adequately evaluated via a transvaginal approach. US Pelvis Transvaginal TVUS can be used to monitor follicle development [27], perform antral follicle counts [28], and measure ovarian volume.