Laviscio, Paola (2008) L’ecografia transvaginale nella donna infertile: dalla valutazione pre-impianto alla nascita. [Tesi di dottorato] (Unpublished)

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Transvaginal ultrasound for infertile woman: from pre-implantation evaluation to the birth. Introduction Transvaginal ultrasound (USG TV) plays a fundamental role in different applications in infertile women, from the study of uterine cavity to the evaluation of follicular and endometrial blood flow in IVF (in vitro fertilization) cycles. It’s also commonly used to identify patients at high risk for spontaneous preterm birth. For all this capacity, transvaginal ultrasound represents an excellent and irreplaceable instrument for the study of infertile women. Objective The aim of this study was to evaluate the capacity of transvaginal ultrasound to improve pregnancy outcome in infertile women, from pre-implantation evaluation to the birth. Study design We conducted three lines of research: First research line: “Transvaginal ultrasonography to evaluate uterine cavity in infertile woman”. The capacity of transvaginal ultrasound as to study intracavity disease, was evaluated in this line. The role of power Doppler USG TV in differentiating septate and bicornuate uterus was investigated too. Second research line: “Transvaginal ultrasonography in IVF cycles. Improvement of implantation rate”. This research investigated the role of USG TV in IVF cycles and in particular the follicular vascularization and intrafollicular leptin levels in oocyte selection. Third research line: “Transvaginal ultrasonography in the prediction of preterm delivery in ART (assisted reproductive technique) pregnancy”, to identify the patients at the risk of preterm labour on the basis of the measure of cervical length that underwent to tocolytic treatment. Results: First research line: the results about intracavity diseases was published in “La patologia uterina benigna”, in: Ecografia transvaginale, E.L.I. Medica editor, 2008. About the second endpoint, the 3D USG TV Power Doppler, with the identification of “gamma sign” seems to be the less invasive and the most sensitive, hamless and conclusive diagnostic tool to perform the differential diagnosis between septate and bicornuate uterus. The results haven’t been published yet. Second research line: the results about the application of USG TV in IVF cycles were published in “L’ecografia transavaginale e riproduzione assistita”, in: Ecografia transvaginale, E.L.I. Medica editor, 2008. About the second endpoint significative correlations weren’t found between perifollicular vascularization and intrafollicular levels. The results are poor and so they will not be published. Third research line: the results were published in “Atosiban vs ritodrine used prophylactically with cerclage in ICSI pregnancies to prevent pre-term birth in women identified as being at risk on basis of transvaginal ultrasound scan”, J of Obstet and Gynecol, 2006; 26(5):396-401. Conclusion: Transvaginal ultrasound can improve fertility rate and pregnancy outcome in infertile women. Key words: uterine malformation, perifollicular vascularization, preterm delivery.

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