Skip to main content Accessibility help
  • Print publication year: 2010
  • Online publication date: September 2011

Chapter 19 - Ultrasonography and incidental ovarian pathology

from Section 2: - Ultrasonography in infertility


A transvaginal scan (TVS) is performed with an empty bladder using a curvilinear, multifrequency, endocavity transducer with a typical central frequency of 6.5MHz. A fibroid outline is usually well visualized by TVS, even in the very small lesion, because of the pseudocapsule. The mixed tissue make-up of the fibroid produces a heterogeneous echo pattern on an ultrasound scan and can be highly attenuating of the ultrasound beam in some lesions. The most common gynecological symptoms of fibroids are menorrhagia and dysmenorrhea and, when significantly enlarged, they can also cause compression of adjacent pelvic structures. Most studies that have examined the relationship between fibroids and miscarriage rates have looked predominantly at intramural fibroids, with few data available on impact of submucosal fibroids. Myolysis is ablation of a fibroid mass by use of radiofrequency (RF) electricity, cryoprobes or focused ultrasound.


1. National Institute for Clinical Excellence. Assessment and Treatment for People with Fertility Problems. London: RCOG Press, 2004.
2. JenkinsJM, AnthonyFW, WoodP, RushenD, MassonGM, ThomasE.The development of functional ovarian cysts during pituitary down-regulation. Hum Reprod 1993; 8(10): 1623–7.
3. KupferMC, RallsPW, FuYS.Transvaginal sonographic evaluation of multiple peripherally distributed echogenic foci of the ovary: prevalence and histologic correlation. Am J Roentgenol 1998; 171(2): 483–6.
4. NardoLG, KroonND, ReginaldPW.Persistent unilocular ovarian cysts in a general population of postmenopausal women: is there a place for expectant management?Obstet Gynecol 2003; 102(3): 589–93.
5. KurjakA, KupesicS.Ultrasonic assessment of ovarian endometriosis. In: KupesicS, KurjakA, de ZieglerD, eds. Ultrasound and Infertility. London: Informa Health Care, 1999.
6. Royal College of Obstetricians and Gynaecologists. The Investigation and Management of Endometriosis. Green-top Guideline No. 24. RCOG, London, 2006 [].
7. TsoumpouI, KyrgiouM, GelbayaTA, NardoLG.The effect of surgical treatment for endometrioma on in vitro fertilization outcomes: a systematic review and meta-analysis. Fertil Steril 2009; 92(1): 75–87.
8. JermyK, LuiseC, BourneT.The characterization of common ovarian cysts in premenopausal women. Ultrasound Obstet Gynecol 2001; 17(2): 140–4
9. SerafiniG, QuadriPG, GandolfoNG, GandolfoN, MartinoliC, DerchiLE.Sonographic features of incidentally detected, small, nonpalpable ovarian dermoids. J Clin Ultrasound 1999; 27(7): 369–73.
10. Van HolsbekeC, DomaliE, HollandTK, et al. Imaging of gynecological disease (3): clinical and ultrasound characteristics of granulosa cell tumors of the ovary. Ultrasound Obstet Gynecol 2008; 31(4): 450–6.
11. TinelliFG, TinelliR, La GrottaF, TinelliA, CicinelliE, SchonauerMM.Pregnancy outcome and recurrence after conservative laparoscopic surgery for borderline ovarian tumors. Acta Obstet Gynecol Scand 2007 86(1): 81–7.
12. BoranN, CilAP, TulunayG, et al. Fertility and recurrence results of conservative surgery for borderline ovarian tumors. Gynecol Oncol 2005; 97(3): 845–51.
13. PalombaS, ZupiE, RussoT, et al. Comparison of two fertility-sparing approaches for bilateral borderline ovarian tumours: a randomized controlled study. Hum Reprod 2007; 22(2): 578–85.
14. SiassakosD, SyedA, WardleP.Tubal disease and assisted reproduction. Obstet Gynecol 2008; 10: 80–7.
15. SowterMC, AkandeVA, WilliamsJA, HullMG.Is the outcome of in-vitro fertilization and embryo transfer treatment improved by spontaneous or surgical drainage of a hydrosalpinx?Hum Reprod 1997; 12(10): 2147–50.
16. GelbayaTA, KyrgiouM, TsoumpouI, NardoLG.The use of estradiol for luteal phase support in in vitro fertilization/intracytoplasmic sperm injection cycles: A systematic review and meta-analysis. Fertil Steril 2008; 90(6): 2116–25.
17. BenacerrafBR, ShippTD, BromleyB.Improving the efficiency of gynecologic sonography with 3-dimensional volumes: a pilot study. J Ultrasound Med 2006; 25(2): 165–71.
18. HagelJ, BicknellSG.Impact of 3D sonography on workroom time efficiency. Am J Roentgenol 2007; 188(4): 966–9.