concept of IVF initially involved oocyte retrieval in a hospital operating room with the patient under general anesthesia. 182, 190, 191 The basal layer of endometrium may be damaged by infection or removed by instrumentation. Leiomyomata may be examined serially to evaluate changes in diameter and echotexture facilitating a conservative watch and see management approach with medications or surgery. 349 Faulty oocyte retrieval technique has been suggested as a cause for intraperitoneal or intraovarian loss of oocytes. However, a healthy embryo physiologically capable of implantation with appropriate hormonal support is necessary for conception even when endometrial receptivity is present. Assessment of ovarian follicular development, our perceptions of human follicle growth and ovulation have changed dramatically since high resolution ultrasonography has been available. 14, 15, 176, 177, 297, 298 The rate of follicle growth may prove to be the most accurate predictor for the maturity of ova.
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They are generally painless and asymptomatic structures that are seen en passant as single or multiple hypoechoic spherical structures along the lateral margins of the cervix or uterus. Vascular and three-dimensional imaging studies also have been initiated to find markers for endometrial receptivity that may increase conception rates during ART therapies. There are many theories that attribute infertility and recurrent pregnancy loss to leiomyomas. 61, 62, 65, 70 Detection of fluid within the cavity of a corpus luteum has been interpreted as a normal physiologic event related to either leakage of blood from the vascular follicle wall into the corpus luteum lumen following follicle rupture or extravasation of blood. 35, 50 There is a gradual decrease in impedance to blood flow in the vasculature surrounding the follicle up to the onset of ovulation. Consequently, ultrasonography is used to monitor the follicle response to these agents. In the IVF laboratory, the embryo is placed in a transfer catheter within a small fluid droplet and moved from the laboratory to the patient for insertion into the uterine cavity.
104, 105, 106, 109, 110, 111, 112, 113, 114 Counts done between day 3 and 7 after menstruation have been used to predict how many follicles will develop with ovarian stimulation. Uterine leiomyomatosis, a condition that often results in infertility and abnormal uterine bleeding, is recognized when numerous small leiomyomata are seen and little or no nonmyomatous tissue can be demonstrated between the myomas. 389 Color flow and power Doppler have been explored for their potential to predict the likelihood of conception following IVF. Therefore, it has been suggested that it is inappropriate to anticipate that imaging of the uterine tissues can predict all etiologies of implantation failure.