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Three-dimensional (3D) ultrasound technologies are beneficial in some applications of obstetrics and gynecology and may aid in the evaluation of abnormal ovaries. Although the diagnostic criteria of polycystic ovary syndrome (PCOS) do not include 3D imaging, Allemand performed a study establishing the diagnostic threshold for 3D Ultrasonography of PCOS. The administration of gonadotropins for both insemination cycles as well as in-vitro fertilization cycles relies upon the use of serial real-time ultrasound examinations. In clinical practice, TV ultrasound monitoring during controlled ovarian hyperstimulation (COH) is performed to improve safety and precise monitoring of ovarian response to gonadotropin stimulation. PCOS patients have an increased number of preantral follicles; hence, close monitoring for ovarian hyperstimulation syndrome (OHSS) is essential. 3D ultrasound is a new imaging modality that improves the sensitivity and specificity of ultrasound. Recent advances in 3D ultrasound have the potential to better our understanding of follicular development, ovulation, and uterine receptivity.
This chapter presents a comprehensive review of the reproductive problems that could be associated with uterine septum. The classification of uterine anomalies divides the uterine septum into complete (septate) or partial (subseptate) groups, according to whether the septum approaches the internal os or not, respectively. Although surgery (hysteroscopy, alone or with laparoscopy) constitutes the gold standard for the diagnosis of uterine septum, various imaging tools including hysterosalpingography (HSG), ultrasonography, and magnetic resonance imaging (MRI) have great value in the diagnosis with high level of accuracy. The hysteroscopic approach for surgical resection of uterine septum is a safe and effective approach. While generally it is an operator preference whether to utilize ablative energy, for example, electrical diathermy or laser, or to utilize sharp scissors without energy, the outcome of treatment is comparable as regards complication and reproductive performance after surgery.
This chapter discusses the potential role of the new group of medications called aromatase inhibitors in assisted reproduction. When an aromatase inhibitor is applied during controlled ovarian hyperstimulation (COO), estrogen production per growing ovarian follicle has been found to be significantly lower than when aromatase inhibitors are not used. The use of aromatase inhibitors for in vitro maturation is an exciting application that can involve a brief aromatase inhibitor-induced rise in endogenous gonadotropin secretion leading to multiple ovarian follicles, followed by retrieval of immature oocytes. Both lowering supraphysiological levels of estrogen during COH and improving response to COH by enhancing endogenous gonadotropin production and increasing the ovarian follicular sensitivity to gonadotropin stimulation could be of benefit in particular groups of patients, for example, poor responders, endometriosis-associated infertility, polycystic ovarian syndrome (PCOS), and survivors of estrogen-dependant malignancies, for example, breast cancer.
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