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Polycystic ovarian syndrome (PCOS) is one of the most prevalent endocrinopathies affecting 5 to 10 percent of women of reproductive age [1;2]. Characteristic clinical features of PCOS include menstrual irregularity such as oligomenorrhea/amenorrhea and signs of hyperandrogenemia including hirsutism, acne, and/or obesity. The syndrome was first clearly described by Stein and Leventhal in 1935 . While the primary etiology remains poorly defined , insulin resistance with compensatory hyperinsulinemia is a prominent feature of the condition and appears to be an underlying cause of hyperandrogenemia identified in both lean and obese women . Hyperinsulinemia promotes increased ovarian androgen biosynthesis in vivo and in vitro [6;7]. It also decreases sex hormone-binding globulin production in the liver , which results in the increased bioavailability of free androgens and exacerbates the signs of androgen excess.
Surgical methods of ovulation induction for women with clomiphene (clomifene) citrate-resistant polycystic ovary syndrome (PCOS) include laparoscopic ovarian drilling with diathermy. This technique has replaced the more invasive and damaging technique of ovarian wedge resection first introduced by Gjønnaess in the early 1980s . Laparoscopic ovarian surgery is free from the risks of multiple pregnancy and ovarian hyperstimulation, which makes it an attractive procedure for PCOS women, but surgery is not without risks. The techniques of laparoscopic ovarian diathermy have been described previously [2;3]. Studies suggest that four punctures per ovary with application of diathermy current via needle cautery set at 30 watts for 5 seconds per puncture (i.e., no more than 600 J per ovary) should produce an optimal response. The greater the damage to the surface of the ovary the greater the risk of peri-ovarian adhesions estimated at 60 percent (ranging from 0 to 100 percent) in treated women.
Assisted reproductive technology has moved from the cottage industry of the 1980s to a global business that treats millions of patients using advanced treatments and cutting-edge science. The landscape shifts constantly, and it is incumbent upon those who work in this area of medicine to stay up to date and provide their patients with the best possible chance of a healthy child. In my opinion it is incontrovertible that the best currently available laboratory technology for culture of optimal quality and number of blastocysts involves time-lapse imaging systems with use of artificial intelligence (AI) in image analysis. As with many rapidly moving areas of medical technology, it has taken time to develop efficient systems for time-lapse imaging of embryos in culture, but there are now several mature and stable options available for purchase. Time-lapse systems obviously allow the embryologist to assess development to blastocyst without disturbing the embryo incubation, and offer significant shortening in time to pregnancy over conventional incubation methods . This is important to patients as a shorter time to pregnancy reduces the emotional burden of treatment that leads to implantation failure and reduces the financial and psychological costs involved in repeated embryo transfers.
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.
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.
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.