ROLE OF ULTRASOUND FOR EVALUATION AND TREATMENT OF FEMALE INFERTILITY.

Abstract

Background: Ultrasound is a non-invasive, real-time modality central to the evaluation of female infertility because it assesses uterine, ovarian, and adnexal factors and can guide treatment planning.  Evidence is still limited on the measurable diagnostic and management impact of routine transvaginal sonography (TVS) with selective saline infusion sonohysterography (SIS) in resource-constrained tertiary-care settings.

Methods: This prospective observational study included 180 consecutive infertile women aged 20–40 years (primary/secondary infertility ≥1 year) evaluated in a tertiary-care teaching hospital.  All participants underwent ultrasound evaluation (TVS for all; SIS in selected cases), and ultrasound etiologies were categorized as ovarian, uterine, tubal/adnexal, endometriosis, or normal; changes in diagnosis and management were assessed by comparing pre-ultrasound versus post-ultrasound diagnosis and treatment plans.

Results: The mean age was 29.4±4.2 years (21–39), and 132 (73.3%) had primary infertility with mean duration 3.8±2.1 years; oligomenorrhea/PCOS features were present in 64 (35.6%).  TVS established a diagnosis in 146 (81.1%), and SIS (n=62) added/refined findings in 28 (45.2%) including 10 newly detected intracavitary lesions (6 polyps, 2 fibroids, 2 adhesions).  Ovarian causes predominated (51.1%), followed by uterine (35.6%) and tubal/adnexal causes (11.1%); endometriosis was seen in 13.3%, while 25.6% had normal scans.  The documented diagnostic rate increased from 43.3% pre-ultrasound to 85.6% post-ultrasound (absolute gain 42.3%), and ultrasound findings resulted in a management change in 62.2% (p<0.001), most commonly induction modification (30.0%), hysteroscopy (18.9%), laparoscopy (11.1%), and IVF escalation (15.6%).In 72 monitored cycles, 68 (94.4%) were successfully timed and 4 (5.6%) were cancelled.

Conclusion: TVS with selective SIS substantially improved diagnostic yield and frequently altered clinical management among infertile women in a tertiary-care setting. Incorporating standardized ultrasound protocols may enhance targeted treatment planning and optimize fertility care pathways, particularly where access to advanced diagnostics is limited.