Adnexal Masses

Fallopian tube inflammatory disease and tubal pregnancy are closely related. Inflammatory disease of the fallopian tubes leads to the inability for fertilization of the oocyte when the fallopian tube is completely closed; it also makes the path difficult for the gamete to transfer into the uterine cavity. The possibility of ectopic pregnancy is rising as a result of deformity and reduced mobility of the fallopian tubes. Most ectopic pregnancies occur in the fallopian tubes and rarely in other structures. It used to be difficult to diagnose an ectopic pregnancy, but now with two-dimensional (2D)/three-dimensional (3D) ultrasound and serum β human chorionic gonadotropin (hCG), the diagnosis is easy, and women with an ectopic pregnancy should no longer be in a situation where this pathological situation is a life-threatening diagnosis. Noninvasive transvaginal ultrasound (TVU) 2D/3D examination provides an opportunity for rapid selection of patients and candidates for direct laparoscopic (LPSC) access at the first examination in “everyday” practice. Due to the increased use of high-resolution TVU, around 80% of ectopic pregnancies are diagnosed on time, without severe abdominal hemorrhage. TVU identification of an adnexal mass, empty uterine cavity, and positive pregnancy test are the gold standard for diagnosis. Keywords: Ectopic pregnancy, Fallopian tube inflammatory disease, Positive pregnancy test, Transvaginal two-dimensional/three-dimensional ultrasound examination. Donald School Journal of Ultrasound in Obstetrics and Gynecology (2022): 10.5005/jp-journals-10009-194

Imaging of Acquired Uterine Lesions

In general, the group of acquired uterine lesions consists of enhanced myometrial vascularity (EMV)/arteriovenous malformation (AVM), the isthmocele, intrauterine adhesions (IUAs) (Asherman’s syndrome), and nabothian cysts. Uterine AVMs can be congenital or acquired. These vascular lesions can cause severe hemorrhage that can be life-threatening for a woman, so it has been recently suggested that curettage should not be performed in a patient who presents with abnormal uterine bleeding after an abortion or a delivery when there is an ultrasound-detected hypervascular area with turbulent flow within the myometrium. Color Doppler sonography is the preferred method of diagnosing uterine EMV/AVMs. The isthmocele is a myometrial defect resembling a pouch on the anterior wall of the uterine isthmus over a previous cesarean scar. Transvaginal ultrasound (TVUS) is the initial and most usual method described to assess the integrity of the uterus wall in nonpregnant patients. IUAs are also known as intrauterine synechiae or endometrial sclerosis. The most common presentation of Asherman’s syndrome is secondary infertility. Two-dimensional (2D)/three-dimensional (3D) TVUS is useful in measuring the thickness of the endometrial lining. Also, together with or without sonohysterography (injection of sterile saline into the uterine cavity) can show the adhesions that characteristically appear as “bridging bands” of tissue that distort the cavity. Nabothian cysts are a common occurrence on the cervix. These are retention cysts of the endocervical glands caused by chronic inflammation. 3D ultrasonography gives an excellent image and the possibility of detecting nabothian cysts. Keywords: Color Doppler sonography, Enhanced myometrial vascularity/arteriovenous malformation, Intrauterine adhesions (Asherman’s syndrome), Nabothian cysts, The isthmocele, Transvaginal ultrasound, Three-dimensional ultrasonography. Donald School Journal of Ultrasound in Obstetrics and Gynecology (2022): 10.5005/jp-journals-10009-194

2D/3D Ultrasound Findings of Uterine Carcinosarcoma: A Case Report and Literature Review

Uterine carcinosarcoma is an infrequent, yet an invasive malignant tumor of the uterus. We presented the case of a 76-yearold menopausal woman with the first sparse bleeding and ultrasound findings of a large polypoid formation filling the uterine cavity. Ultrasound, specially more advanced techniques as 3D ultrasound and 3D Color Doppler ultrasound provide very useful data not only in the recognition of tumor mass, but also in terms of the structure, differentiation and stage of the malignancy. Keywords: 2D ultrasound, 3D color Doppler transvaginal ultrasound, Uterine carcinosarcoma. Donald School Journal of Ultrasound in Obstetrics and Gynecology (2022): 10.5005/jp-journals-10009-192

The interaction of female age and active male smoking has negative influence on success rates of the in vitro fertilization treatments

This study monitors the effect of male smoking and age of the woman on the success of the intracytoplasmic sperm injection (ICSI) fertilization process as part of the assisted reproduction technique (ART). A total of 703 couples in the in vitro fertilization (IVF) program were included. Binary logistic regression analysis was used to study the effect of male smoking on clinical pregnancy rate and live birth rate. The results from the study showed that interaction of male smoking and women’s age (>35 years) have significant negative impact on ongoing pregnancy rate and live birth rate. Keywords: Assisted reproduction treatment (ART); Infertility; Intracytoplasmic sperm injection (ICSI); In vitro fertilization (IVF); Male smoking

Everyday Practice of 2D/3D Vaginal Ultrasound in Reproductive Gynecology

The key point of this review is to evaluate the diagnostic capability of the initial 2D/3D vaginal ultrasound (US) for the most common conditions that have negative impact on the reproductive potential in women. From our experience with 2D/3D transvaginal US as the initial examination in more than 10,000 patients in the last couple of years, we choose specific cases of different pathologies such as fibroids, endometrial polyps, endometrial synechiae, uterine congenital anomalies, polycystic ovaries (PCOs), ovarian follicular monitoring, and endometrial receptivity assessment. Vaginal US is the method of choice for initial examination in evaluation of the reproductive potential in female patients. The 2D vaginal US examination gives only preliminary data, while the 3D vaginal US increases the efficiency and predictive value of the examination. Some pathologies detected on 2D vaginal US such as uterine anomalies, in general, indicate the presence of the anomaly, while 3D vaginal US fully detects the type of uterine anomalies. Doppler techniques bring detection of neovascularization in specific pathologies and give a view of the vascularization in general, which is essential in this field. Combination of 2D and 3D US is a powerful tool in the hands of a gynecologist in everyday practice. Improvement in 3D, 3D Doppler, and power Doppler vaginal US supplemented with new software tools rises the predictive value of US in the diagnosis of female reproductive system pathology and makes it equal with other diagnostic tools such as magnetic resonance imaging. On the contrary, 2D and 3D US examination are less traumatic for the patients and are less expensive. Keywords: 2D/3D ultrasonography, 3D Doppler, Reproductive gynecology. Donald School Journal of Ultrasound in Obstetrics and Gynecology (2020): 10.5005/jp-journals-10009-164

Immature Ovarian Teratoma

We present our experience of diagnosing immature ovarian teratoma with 2D and 3D vaginal ultrasound. A 29-year-old female patient with no symptoms was examined for routine gynecology examination before the start of an in vitro fertilization program. The patient had two previous surgeries both for ovarian cystectomy and histopathology finding of mature cystic ovarian teratoma. Left oophorectomy was performed for complex ovarian mass that demonstrated immature ovarian teratoma on final pathology. The neoplasm was well-differentiating (low-grade), according to two-tiered (low- and high-grade) system, and in IA stage, according to the Union for International Cancer Control (UICC) and American Joint Committee on Cancer (AJCC). The oncologist's council proposed that no treatment is needed. Keywords: 2D/3D ultrasonography, Immature teratoma, Ovarian teratoma. Donald School Journal of Ultrasound in Obstetrics and Gynecology (2020): 10.5005/jp-journals-10009-167

Impact of active female smoking on controlled ovarian stimulation in intracitoplasmic sperm insemination cycles

Aim To examine the impact of smoking among females on controlled ovarian stimulation (COS), at intra-cytoplasmatic sperm injection (ICSI) outcome. Methods A prospective analysis of outcomes of 876 women (fresh, non donor cycles) of which 559 (63.8%) were non-smokers, 317 (36.2%) were smokers, underwent standard COS/ICSI treatment. Results Among smokers, the average time of COS, expressed in days, was significantly longer compared with non-smokers (10.5±2.10 vs. 10±1.90 p<0, 05). There were no registered significant differences in the number of retrieved oocytes, (10.4±6.8 vs10.3±6.9), mature oocytes (8.6±5.8 vs. 8.4±5.9), in the group of non-smokers versus smokers. However, smoking and age have a significant impact of the number of high-quality embryos, i.e. older smokers had a lower number of high-quality transferred embryos (non-smokers ≥ 35 years : smokers ≥ 35 years; 1.9±1.1 vs. 1.6±1). On multiple logistic regresion analysis, factor that had a significantly negative impact of clinical pregnancy was maternal age. Conclusion Smoking among patients entering the COS and ICSI fertilization process had insignificant negative impact on the final outcome of the process resulting in reduced pregnancy rate. The chance for the pregnancy declines with age, but smoking did not significantly influence the outcome. Key words: in vitro fertilisation, high - quality embryos, clinical pregnancy rat

Different Timing of Adjuvant Low Dose hCG and GnRH Agonist Trigger Protocol, in OHSS High-Risk Patient with Peak E2 Level <4000 pg/mL

Objective: The aim of the study is to compare the live birth rates between 1,500 I.U. of Human chorionic gonadotropin at the time of Gonadotropin-releasing hormone agonist trigger day or 35-36 h later on the oocyte pick-up day, without affecting the risk of significant ovarian hyperstimulation syndrome development in high-risk patients with peak E2 level <4,000 pg/m

Novel method of treating ovarian infertility: is Platelet-Rich Plasma a new promising therapy in the future?

Introduction. In today's modern society, the treatment of patients with poor ovarian reserve presents a medical challenge of increased clinical importance. The use of platelet-rich plasma (PRP) is a new hope that improves pregnancy chances. Increased use of the PRP in a number of in vitro centers around the world as well as publication of the first experience in in vitro fertilization entailed the need for this systematic review. Methods. PubMed, Cochrane and Ovid Medline were searched between 2000 and 2019 under the following strategy: [ and and ]. Fourteen original articles published in medical scientific journals were analyzed in this study. The evidence level and quality assessment were made based on the most up-to-date, reliable, scientific evidence as well as from the number of additional relevant citations. Results. Taking the current available proof and evidence into consideration, we can conclude that the PRP method improves the ovarian function and increases the chances of clinical pregnancy. In addition, we assume that, over time, the PRP method objectively improves the ovarian reserves. Recent studies support the theory of increasing the number of preantral follicles, followed by appropriate growth and reduction of follicular atresia. Conclusion. The improvement of the quantity and quality of oocytes with the intra-ovarian application of PRP potentially suggests a new concept of ovarian aging, where the ovarian microenvironment plays a crucial role