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MIDS 137 > Ch 6 (fertility, 3D/4D imaging, etc) > Flashcards

Ch 6 (fertility, 3D/4D imaging, etc) Flashcards

1
Q

What is infertility?

A

-Inability to conceive + become pregnant after 1 year of unprotected sex (after 6 months if over 35 y/o)

(relatively common - 1 in 8 couples)

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2
Q

Causes of infertility?

A

-1/3 female cause
-1/3 male cause
-1/3 unexplained or combination of male + female

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3
Q

What factors contribute to infertility?

A

-Smoking cigarettes
-Body weight disorders
-STDs
-Delay of childbearing (pregnancy over 35)

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4
Q

Why is u/s helpful in diagnosing infertility?

A

B/c we can see structural anomalies in male/female systems

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5
Q

Is u/s good at evaluating male infertility?

A

It is limited, but it does provide valuable info

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6
Q

10% of infertile males present with what when they ejaculate?

A

Azoospermia or lack of spermatozoa in sperm

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7
Q

4 possible causes of male infertility?

A

-Obstructive lesion in prostate, vas deferens or seminal vesicles (this can then block ejaculatory ducts or urethra trapping sperm from getting out)

-Endocrine disorder

-Untreatable testicular defect

-Prior reproductive system infections (as this can cause irreversible damage to cells)

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8
Q

What 2 structures is u/s most useful at evaluating in male infertility?

A

-Seminal vesicles
-Ampullae of vas deferens

(rule out any cystic structures or calculi that may be obstructing these glands - which limits amount of semen that gets ejected out)

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9
Q

What is vasography?

A

An exam for determining the reproductive tract patency (checking if it is unobstructued)

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10
Q

Is a vasography invasive?

A

Yes, can cause scarring of vas deferens

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11
Q

What is the procedure for a vasography?

A

Surgical incision into scrotum, contrast injected into vas deferens, + then x-ray images are taken to assess for blockages (radiation exposure)

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12
Q

Name a type of exam that is inexpensive + less invasive than a vasography + helps detects abnormalities associated with infertility in men?

A

Endorectal sonography

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13
Q

List causes of female infertility due to hormone imbalances?

A

-Hydrosalphinx/pyosalpinx
-Endometriosis
-PCOS

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14
Q

List causes of female infertility that would block the ova from coming out of the ovary?

A

-Fibroids
-Septate uterus
-Endometrial polyp
-Asherman disease, uterine scarring
-Pelvic adhesions

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15
Q

What is the most central role u/s plays in regards to female infertility?

A

Monitors follicular growth

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16
Q

What treatment would a pt undergo if their follicles are not growing?

A

-Treatment to induce growth + maturation of their ovarian follicles (aka COH)
-Afterwards, the pt can undergo intrauterine insemination or IVF

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17
Q

Why is u/s used during embryo transfers?

A

To visualize + guide the catheter for precise placement of embryos into the uterus

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18
Q

What couples would have the option of an intrauterine insemination (IUI) after ovarian follicle stimulation?

A

If the underlying cause of infertility is unexplained or a mild male factor

(occurs when the sperm can’t make it to the egg, but the sperm itself has no major abnormalities)

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19
Q

List 3 mild male infertility factors?

A

Borderline sperm concentration, motility or shape abnormalities

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20
Q

Explain the procedure for an IUI?

A

Prewashed sperm gets placed directly into the uterus during a routine pelvic exam at the time of ovulation (is minimally invasive)

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21
Q

What couples would have the option of IVF? List 3 reasons.

A

-If prior IUIs have been unsuccessful in pregnancy
-If sperm are poor on semen analysis
-If fallopian tubes are occluded

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22
Q

What is the procedure when retrieving an ova?

A

Performed with an aspiration needle under u/s guidance to extract dominant follicle from ovary

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23
Q

List 4 options to do once ova retrieval is done?

A

The ova may be:
-cryopreserved for future use (freeze eggs)

-inserted with sperm into fallopian tube (GIFT), with fertilization occurring in vivo (in body)

-ova may be placed with sperm in culture dish, grown to a zygote in vitro (outside body) + inserted into fallopian tube (ZIFT)

-ova may be placed with sperm in culture dish, grown to create multiple embryos (2-8 typically) + inserted transcervically into uterus, right into endo (traditional IVF)

GIFT + ZIFT are not as common

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24
Q

Difference b/w GIFT + ZIFT?

A

GIFT: -in vivo (fertilization inside body)
-gamete
ZIFT: -in vitro (fertilization outside body in dish)
-zygote

(both get inserted into fallopian tube)

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25
Q

With IVF, how many cell embryos are typically transferred into a uterus?

A

2-8 cell embryos

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26
Q

After how many hours can the embryos be inserted into the uterus with IVF?

A

After 44-72 hrs

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27
Q

What is intracytoplasmic sperm injection (ICSI)?

A

Injection of 1 sperm directly into the cytoplasm of an egg

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28
Q

What is the purpose of ICSI?

A

Improves chance of fertilization + subsequent embryo development if successful

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29
Q

What couples would undergo ICSI?

A

If the infertility cause is a male factor (low chance that sperm can fertilize egg)

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30
Q

What option is available for couples who are infertile due to a uterine anomaly or pathology that prevents the women from carrying a pregnancy?

A

Using a gestational carrier, the couple can still use their own sperm + ovum this way

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31
Q

What must IVF-ET of donor sperm/ova address?

A

A couple’s treatment needs

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32
Q

List types of pt’s that may be infertile?

A

-Heterosexual couples
-Same sex couples
-Single women/men seeking parenthood

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33
Q

Can people volunteer to donate their sperm/eggs?

A

Yes!

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34
Q

What is a gestational carrier?

A

A women who offers to carry a pregnancy to term in her uterus to help an infertile couple

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35
Q

What is the fertility team made up of?

A

Teammates involved in interdisciplinary (several specialists) work helping couples overcome infertility together

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36
Q

Main role of the sonographer in the fertility team?

A

Diagnostic workup + follicular monitoring

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37
Q

What is an antral follicle count (AFC)?

A

Done during a pelvic u/s to assess the size + # of potential variable follicles within the ovaries

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38
Q

Protocol for an AFC?

A

-Cineclips of each ovary in SAG + TRV during EV scan
-Count each follicle
-Follicles over 10mm get measured in 3 planes

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39
Q

What does the info from an AFC help with?

A

Helps determine level of hormones that should be administered to the pt for fertility success, depending on treatment plan

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40
Q

Follicles over what measurement need to be measured in 3 planes during an AFC?

A

> 10mm (1cm)

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41
Q

What is one of the m/c methods of contraception in the world?

A

IUCD

(u/s is first line imaging for evaluation of device)

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42
Q

List reasons why an u/s would be done due to an IUCD?

A

-Pelvic pain, abnormal bleeding, absent retrieval strings

-Uterine perforation, malposition in uterus, embedding into myometrium, incomplete removal

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43
Q

List 4 non-contraceptive uses of an IUCD?

A

-Menorrhagia treatment
-Fibroids
-Endometriosis pain
-Reduction in endometrial hyperplasia

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44
Q

2 m/c types of IUCDs used for reversible contraception?

A

-Nonhormonal copper (paraguard)
-Hormonal (mirena, kyleena)

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45
Q

Shape of IUCD?

A

M/c T shaped, although others do exist

46
Q

What does an IUCD consist of?

A

-T shaped polyethylene frame
-Copper wire on shaft
-Strings to guide removal

47
Q

How does a non-hormonal copper IUCD work + how long does it last?

A

-Releases copper ions from wire which interfere with sperm mobility + prevents fertilization
-Lasts approx 10 years

48
Q

How does a hormonal IUCD work + how long does it last?

A

-Releases synthetic progesterone (levonorgestrel) which suppresses endo growth + thickens cervix to prohibit sperm entry into uterus
-Lasts approx 5 years

49
Q

Which layer of the uterus is an IUCD implanted into?

A

ENDO - fundal section

50
Q

Does a hormonal or non-hormonal copper IUCD last longer?

A

Non-hormonal copper

51
Q

SF of IUCD?

A

-Echogenic structure in central uterus, specifically in upper fundal portion of endo with wings that extend into uterine cornua
-SAG shows shaft
-TRV shows arms
-Produces posterior shadowing

52
Q

Measurement of IUCD in uterus?

A

3cm when measured from uterine fundus to superior endo cavity

53
Q

List the 4 malpositions of an IUCD?

A

-Embedment (myometrium penetration)
-Expulsion (completely/partially into cervix)
-Displaced (in lower uterus)
-Perforation (invasion into myometrium)

54
Q

What to do if we don’t see an IUCD when we should?

A

Tell the RAD! X-ray can be used to locate it.

55
Q

How are 3D images of an IUCD helpful?

A

B/c it shows the shaft + arms in 1 image

56
Q

What is a tubal occlusion device?

A

A cost-effective method for permanent birth control with a minimally invasive placement method

57
Q

2 types of tubal occlusion devices?

A

-Coil
-Silicone

58
Q

SF of tubal occlusion device?

A

Proper: should cover the uterotubal junction
Improper: malpositioned either distal to uterotubal junction, or within uterine cavity

59
Q

Do we commonly asses tubal occlusion devices?

A

No

60
Q

What is tubal ligation?

A

Getting tubes tied: permanent contraception where fallopian tubes are occluded with clips/bands, tied/cut or heat/cauterization

61
Q

Procedure for tubal ligation? Which part of tube is affected?

A

Clips are placed across the isthmic portion of fallopian tube in order to occlude them

62
Q

Can we see tubal ligation clips on u/s?

A

Nope

63
Q

Why does a tampon cause shadowing?

A

Space occupied by tampon has an attenuation similar to air b/c of the gas held b/w the fibers of the tampon

(basically shadow is due to air)

64
Q

Types of vaginal rings?

A

NuvaRing: inserted in vag for 21 days + releases low doses of hormones to prevent ovulation

Femring + Estring: inserted into vag for 3 months + releases constant dose of hormones. Low dose estrogen rings for relief of menopausal symptoms (hot flashes, vaginal atrophy)

65
Q

Are vaginal rings commonly seen on u/s?

A

Nope

66
Q

Does the nuvaring or femring/estring last longer?

A

Femring/Estring

67
Q

What is the newest form of contraception?

A

NuvaRing

68
Q

What is a vaginal pessary?

A

Ring shaped device composed of rubber or silicone + placed into vagina to prevent pelvic organ prolapse

69
Q

Where should a pessary be placed in the vag?

A

Posterior aspect of the vag, around the cervix

70
Q

Can we do an EV on pt’s that have a pessary inserted?

A

No, devices are large and often inserted by a doctor. If pt can insert + remove them themself then we can.

71
Q

SF of vaginal pessary?

A

Looks similar to a tampon but much wider, echogenic walls + hypoechoic center

72
Q

What year was 3D u/s introduced?

A

1980s

73
Q

Is 3D/4D becoming more available in imaging centers now?

A

Yes, although many techs are unfamiliar with how to use it

74
Q

What does a 3D image provide?

A

-Anatomic (coronal) views that we can not get with 2D u/s
-Increases diagnostic confidence by providing an infinite # of images, rather than multiple still images in a typical exam

75
Q

What is volume u/s?

A

Term used to describe 3D + 4D imaging

76
Q

What is the smallest unit of a 3D data set/volume?

A

Voxel / volume element

77
Q

2 methods for acquiring a volume data set?

A

Freehand: we do manual sweep

Automated Acquisition: AI performs sweep while we hold probe in 1 plane

78
Q

First step in performing a 3D u/s?

A

Acquiring volume data set

79
Q

What type of transducer do we use for obtaining a 3D volume acquisition?

A

A mechanical 3D/4D probe

(this probe can also do 2D scanning + obtain volumes)

80
Q

How does a 3D/4D probe do automated sweeps?

A

Contains a motor inside probe

81
Q

Are 3D/4D probes bigger or smaller than 2D probes?

A

3D/4D are slightly bigger + heavier

82
Q

If our 2D image has poor quality, will the 3D image good quality?

A

No, poor 2D image results in poor quality volume data set

83
Q

Explain how we would get a 3D/4D image?

A

-Optimize 2D image
-Acquire volume data set (by doing sweeps)
-Manipulate each axis plane on the machine to optimize the 3D/4D image

84
Q

M/c use of 3D/4D imaging?

A

IUCD location

85
Q

List clinical applications of 3D/4D in gynecology?

A

-Congenital uterine anomalies
-IUCD location
-Endometrial lesions
-Fibroid # + location
-Origin of adnexal masses
-Saline-infused sonohysterography
-Infertility
-Evaluating pelvic floor

86
Q

List advantages to doing an EV opposed to surgery?

A

-Accurate needle placement
-Rare injury to adjacent organs
-Low cost
-Shorter time
-Portability
-Pt comfort

87
Q

List 3 rare complications of an EV?

A

-Bleeding
-Infection
-Puncture of neighboring organs

88
Q

EV procedures are divided into what 2 groups?

A

Puncturing: think injury, a treatment from a pathology that has developed

Non-Puncturing: think non-injury, to do with fertility treatment, contraceptive devices, etc

89
Q

List procedures that would fall under puncturing EV?

A

-Oocyte retrieval
-Ovarian cyst aspiration
-Biopsy of pelvic mass
-Drainage of pelvic abscess
-Culdocentesis
-Treatment for ectopic pregnancy

90
Q

List procedures that would fall under non-puncturing EV?

A

-Embryo transfer + tubal catheterization
-Hysterosonography
-IUCD positioning
-Radiotherapy planning + monitoring

91
Q

How does an EV u/s guided procedure work?

A

-Use 5-7.5 MHz probe with needle attached to probe shaft
-Examine the pelvic structures + cul-de-sac twice afterwards to check for internal bleeding + complications (10 mins after + 2-3 hrs after)

92
Q

How does an oocyte retrieval work?

A

-U/s probe inserted into vag to identify follicles
-Needle goes through vag + into the follicles
-Eggs get removed from follicles through needle (which is connected to suction device)

93
Q

What does a needle look like on u/s?

A

Echogenic dot

94
Q

When aspirating an ovarian cyst, which spot of the cyst should be targeted?

A

The center

95
Q

With intraabdominal masses, can both u/s guided needle aspiration + needle core biopsy be used?

A

Yes! Both efficiently used for early confirmation and/or exclusion of malignancy

96
Q

How is tissue obtained with a needle aspiration biopsy (FNA)?

A

Obtained by suction through a thin needle attached to a syringe

(m/c for cystic tissue)

97
Q

How is a needle core biopsy (CNB) performed?

A

Using a large hollow + thicker needle to extract a core of tissue

(m/c for solid tissue)

98
Q

What technique is an alternative to an open laparoscopy procedure for treating a tubo-ovarian abscess?

A

Drainage - this makes recovery faster + improves efficacy of antibiotic therapy (b/c the body heals quicker if the pus gets drained out)

99
Q

What are 2 options to do when performing an abscess drainage?

A

-Aspirate out as much as possible
-Place a drainage catheter in

100
Q

What is a culdocentesis?

A

Drainage of fluid in posterior cul-de-sac, done by inserting a needle using EV guidance

101
Q

Can a culdocentesis help differentiate b/w different kinds of fluid?

A

Yes! Clear fluid, blood or pus.

102
Q

What is a hysteroscopy?

A

-Thin flexible tube inserted into vagina to examine the cervix + endo
-Minimally invasive + does not need u/s guidance

103
Q

What 3 structures can get removed during a hysteroscopy?

A

Polyps, fibroids + adhesions

104
Q

Is a hysteroscopy or laparoscopy better at seeing inside the uterus?

A

Hysteroscopy b/c it sees inside of pelvis (laparoscopy views outside)

105
Q

What is a laparoscopy?

A

-Views + accesses exterior of uterus, ovaries, fallopian tubes + other pelvic structures
-More invasive than a hysteroscopy
-Only uses local anesthesia

106
Q

What is a laparoscope?

A

-Slender lightened telescope that gets inserted into pelvis through small incisions
-Pt’s heal faster from this exam compared to open surgery, however they both require general anesthesia

107
Q

Name 3 reasons why a laparoscopy may be done?

A

-Remove ovarian cysts
-Perform tubal ligation
-Hysterectomy

108
Q

What is a hysterosonography / saline infusion sonohysterography (SIS)?

A

Small amount of sterile saline injected into uterine cavity while using u/s to image the endo

109
Q

What does the saline do during a SIS?

A

Helps differentiate focal abnormalities, that may have been missed during routine imaging

(the fluid illuminates pathologies in the endo)

110
Q

What is a hysterosonosalpingography (HSSG)?

A

-Entire tubal path (endo + fallopian tubes) is assessed for patency, meaning looking for obstructions
-Saline injection + u/s are used

111
Q

What is a hysterosalpingography (HSG)?

A

-Similar to HSSG, except instead of saline + u/s used, contrast dye + x-ray is used
-Contrast dye injected into endo using a catheter
-Fluroscopy (x-ray) used while the dye passes through the uterus + fallopian tubes

112
Q

Difference b/w HSG + HSSG?

A

HSG: contrast dye + x-ray
HSSG: saline + u/s

MIDS 137 (14 decks)

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