Initially this book was conceived as an ultrasound imaging reference volume for nurses and clinicians working in the field of assisted reproductive technology (ART), to illustrate the use of ultrasound in fertility clinics. To reach a wider audience, more information was added, as a reference guide for trainee sonographers, medics, general gynaecologists and midwives.

Transvaginal imaging of the pelvic area begins at the perineum. With the probe positioned at the opening of the vagina, in the sagittal plane, the image demonstrates the symphysis pubis anterior towards (left of image) and the rectum posterior (right of image).

The vaginal probe is covered in a sterile plastic sheath, with an attached needle guide. The guide is used to align with each follicle at its largest diameter. A 16–17-gauge needle is used to aspirate the fluid with the oocyte.

Hydrosalpinx is a fluid accumulation in the fallopian tube which has become blocked, at the fimbrial end and the isthmus. This blockage can be caused by infection, sexually transmitted disease, previous sterilisation, endometriosis or surgery.

Endometriosis is a condition in which functional endometrial glands are located outside the uterine cavity. Common sites are the pelvic peritoneum, the ovaries, uterine ligaments and rectovaginal septum.

The ultrasound machine console varies between companies in the layout of the knobs. However, the overall panels are very similar, labeled and become familiar with use.

Sonographers are at risk of injury to the shoulders, neck and back. It is important to be aware of your posture when scanning and not to place repetitive strain on the body. Sonographers need to practice good ergonomics to prevent injury. Stretching and exercise will help reduce the risk of injury.

There are several different definitions of polycystic ovarian syndrome (PCOS). The most commonly used definition is the Rotterdam criteria, which states that the diagnosis of polycystic ovarian syndrome requires at least two of the following three criteria to be present: (1) oligo- or anovulation, (2) clinical and/or biochemical signs of hyperandrogenism, and (3) polycystic ovaries. The definition requires that all other possible causes of the aforementioned features must be excluded prior to the diagnosis of PCOS being made. Only one of the features required for the diagnosis of PCOS can be diagnosed on ultrasound, and other aetiologies for the required features cannot be excluded by ultrasound. Therefore it is not possible to diagnose a woman as having PCOS by ultrasound alone.

Elevated β-hCG in the maternal serum or urine is an indication of pregnancy. Once the hCG levels reach 1,000–2,000 mIU/ml a transvaginal ultrasound should be able to demonstrate a gestational sac.

The role of nurses conducting ultrasound in assisted conception cycle monitoring is to evaluate the endometrial thickness and document the size of each ovarian follicle present. Women should have undergone a formal diagnostic ultrasound prior to commencing a stimulation cycle; therefore any pathology present should have already been formally documented. However, if any pathology is identified on an assisted fertility cycle monitoring scan, it should be noted and brought to the attention of the treating doctor.