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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.
An ovarian cyst is a very common condition in which fluid collects in the ovary. However, cysts that are more than 5 cm in size need to be treated, as they can cause problems (e.g., 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 through 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.
With technological advances (ultrasound and beta-HCG blood tests), the diagnosis of tubal pregnancy can be made very early, usually before the pregnancy ruptures. Injecting a toxic chemical, methotrexate, into the sac, which causes the tissue to die and then get reabsorbed, without any surgery whatsoever, can treat it. 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.
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.
Often cornual blocks are due to the presence of mucus plugs and amorphous debris in the tubal lumen. Ultrasound = guided tubal catheterization can effectively open 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, as doctors become more versatile with using this technology.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
