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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
With IVF, how many cell embryos are typically transferred into a uterus?
2-8 cell embryos
26
After how many hours can the embryos be inserted into the uterus with IVF?
After 44-72 hrs
27
What is intracytoplasmic sperm injection (ICSI)?
Injection of 1 sperm directly into the cytoplasm of an egg
28
What is the purpose of ICSI?
Improves chance of fertilization + subsequent embryo development if successful
29
What couples would undergo ICSI?
If the infertility cause is a male factor (low chance that sperm can fertilize egg)
30
What option is available for couples who are infertile due to a uterine anomaly or pathology that prevents the women from carrying a pregnancy?
Using a gestational carrier, the couple can still use their own sperm + ovum this way
31
What must IVF-ET of donor sperm/ova address?
A couple's treatment needs
32
List types of pt's that may be infertile?
-Heterosexual couples -Same sex couples -Single women/men seeking parenthood
33
Can people volunteer to donate their sperm/eggs?
Yes!
34
What is a gestational carrier?
A women who offers to carry a pregnancy to term in her uterus to help an infertile couple
35
What is the fertility team made up of?
Teammates involved in interdisciplinary (several specialists) work helping couples overcome infertility together
36
Main role of the sonographer in the fertility team?
Diagnostic workup + follicular monitoring
37
What is an antral follicle count (AFC)?
Done during a pelvic u/s to assess the size + # of potential variable follicles within the ovaries
38
Protocol for an AFC?
-Cineclips of each ovary in SAG + TRV during EV scan -Count each follicle -Follicles over 10mm get measured in 3 planes
39
What does the info from an AFC help with?
Helps determine level of hormones that should be administered to the pt for fertility success, depending on treatment plan
40
Follicles over what measurement need to be measured in 3 planes during an AFC?
>10mm (1cm)
41
What is one of the m/c methods of contraception in the world?
IUCD (u/s is first line imaging for evaluation of device)
42
List reasons why an u/s would be done due to an IUCD?
-Pelvic pain, abnormal bleeding, absent retrieval strings -Uterine perforation, malposition in uterus, embedding into myometrium, incomplete removal
43
List 4 non-contraceptive uses of an IUCD?
-Menorrhagia treatment -Fibroids -Endometriosis pain -Reduction in endometrial hyperplasia
44
2 m/c types of IUCDs used for reversible contraception?
-Nonhormonal copper (paraguard) -Hormonal (mirena, kyleena)
45
Shape of IUCD?
M/c T shaped, although others do exist
46
What does an IUCD consist of?
-T shaped polyethylene frame -Copper wire on shaft -Strings to guide removal
47
How does a non-hormonal copper IUCD work + how long does it last?
-Releases copper ions from wire which interfere with sperm mobility + prevents fertilization -Lasts approx 10 years
48
How does a hormonal IUCD work + how long does it last?
-Releases synthetic progesterone (levonorgestrel) which suppresses endo growth + thickens cervix to prohibit sperm entry into uterus -Lasts approx 5 years
49
Which layer of the uterus is an IUCD implanted into?
ENDO - fundal section
50
Does a hormonal or non-hormonal copper IUCD last longer?
Non-hormonal copper
51
SF of IUCD?
-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
Measurement of IUCD in uterus?
3cm when measured from uterine fundus to superior endo cavity
53
List the 4 malpositions of an IUCD?
-Embedment (myometrium penetration) -Expulsion (completely/partially into cervix) -Displaced (in lower uterus) -Perforation (invasion into myometrium)
54
What to do if we don't see an IUCD when we should?
Tell the RAD! X-ray can be used to locate it.
55
How are 3D images of an IUCD helpful?
B/c it shows the shaft + arms in 1 image
56
What is a tubal occlusion device?
A cost-effective method for permanent birth control with a minimally invasive placement method
57
2 types of tubal occlusion devices?
-Coil -Silicone
58
SF of tubal occlusion device?
Proper: should cover the uterotubal junction Improper: malpositioned either distal to uterotubal junction, or within uterine cavity
59
Do we commonly asses tubal occlusion devices?
No
60
What is tubal ligation?
Getting tubes tied: permanent contraception where fallopian tubes are occluded with clips/bands, tied/cut or heat/cauterization
61
Procedure for tubal ligation? Which part of tube is affected?
Clips are placed across the isthmic portion of fallopian tube in order to occlude them
62
Can we see tubal ligation clips on u/s?
Nope
63
Why does a tampon cause shadowing?
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
Types of vaginal rings?
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
Are vaginal rings commonly seen on u/s?
Nope
66
Does the nuvaring or femring/estring last longer?
Femring/Estring
67
What is the newest form of contraception?
NuvaRing
68
What is a vaginal pessary?
Ring shaped device composed of rubber or silicone + placed into vagina to prevent pelvic organ prolapse
69
Where should a pessary be placed in the vag?
Posterior aspect of the vag, around the cervix
70
Can we do an EV on pt's that have a pessary inserted?
No, devices are large and often inserted by a doctor. If pt can insert + remove them themself then we can.
71
SF of vaginal pessary?
Looks similar to a tampon but much wider, echogenic walls + hypoechoic center
72
What year was 3D u/s introduced?
1980s
73
Is 3D/4D becoming more available in imaging centers now?
Yes, although many techs are unfamiliar with how to use it
74
What does a 3D image provide?
-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
What is volume u/s?
Term used to describe 3D + 4D imaging
76
What is the smallest unit of a 3D data set/volume?
Voxel / volume element
77
2 methods for acquiring a volume data set?
Freehand: we do manual sweep Automated Acquisition: AI performs sweep while we hold probe in 1 plane
78
First step in performing a 3D u/s?
Acquiring volume data set
79
What type of transducer do we use for obtaining a 3D volume acquisition?
A mechanical 3D/4D probe (this probe can also do 2D scanning + obtain volumes)
80
How does a 3D/4D probe do automated sweeps?
Contains a motor inside probe
81
Are 3D/4D probes bigger or smaller than 2D probes?
3D/4D are slightly bigger + heavier
82
If our 2D image has poor quality, will the 3D image good quality?
No, poor 2D image results in poor quality volume data set
83
Explain how we would get a 3D/4D image?
-Optimize 2D image -Acquire volume data set (by doing sweeps) -Manipulate each axis plane on the machine to optimize the 3D/4D image
84
M/c use of 3D/4D imaging?
IUCD location
85
List clinical applications of 3D/4D in gynecology?
-Congenital uterine anomalies -IUCD location -Endometrial lesions -Fibroid # + location -Origin of adnexal masses -Saline-infused sonohysterography -Infertility -Evaluating pelvic floor
86
List advantages to doing an EV opposed to surgery?
-Accurate needle placement -Rare injury to adjacent organs -Low cost -Shorter time -Portability -Pt comfort
87
List 3 rare complications of an EV?
-Bleeding -Infection -Puncture of neighboring organs
88
EV procedures are divided into what 2 groups?
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
List procedures that would fall under puncturing EV?
-Oocyte retrieval -Ovarian cyst aspiration -Biopsy of pelvic mass -Drainage of pelvic abscess -Culdocentesis -Treatment for ectopic pregnancy
90
List procedures that would fall under non-puncturing EV?
-Embryo transfer + tubal catheterization -Hysterosonography -IUCD positioning -Radiotherapy planning + monitoring
91
How does an EV u/s guided procedure work?
-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
How does an oocyte retrieval work?
-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
What does a needle look like on u/s?
Echogenic dot
94
When aspirating an ovarian cyst, which spot of the cyst should be targeted?
The center
95
With intraabdominal masses, can both u/s guided needle aspiration + needle core biopsy be used?
Yes! Both efficiently used for early confirmation and/or exclusion of malignancy
96
How is tissue obtained with a needle aspiration biopsy (FNA)?
Obtained by suction through a thin needle attached to a syringe (m/c for cystic tissue)
97
How is a needle core biopsy (CNB) performed?
Using a large hollow + thicker needle to extract a core of tissue (m/c for solid tissue)
98
What technique is an alternative to an open laparoscopy procedure for treating a tubo-ovarian abscess?
Drainage - this makes recovery faster + improves efficacy of antibiotic therapy (b/c the body heals quicker if the pus gets drained out)
99
What are 2 options to do when performing an abscess drainage?
-Aspirate out as much as possible -Place a drainage catheter in
100
What is a culdocentesis?
Drainage of fluid in posterior cul-de-sac, done by inserting a needle using EV guidance
101
Can a culdocentesis help differentiate b/w different kinds of fluid?
Yes! Clear fluid, blood or pus.
102
What is a hysteroscopy?
-Thin flexible tube inserted into vagina to examine the cervix + endo -Minimally invasive + does not need u/s guidance
103
What 3 structures can get removed during a hysteroscopy?
Polyps, fibroids + adhesions
104
Is a hysteroscopy or laparoscopy better at seeing inside the uterus?
Hysteroscopy b/c it sees inside of pelvis (laparoscopy views outside)
105
What is a laparoscopy?
-Views + accesses exterior of uterus, ovaries, fallopian tubes + other pelvic structures -More invasive than a hysteroscopy -Only uses local anesthesia
106
What is a laparoscope?
-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
Name 3 reasons why a laparoscopy may be done?
-Remove ovarian cysts -Perform tubal ligation -Hysterectomy
108
What is a hysterosonography / saline infusion sonohysterography (SIS)?
Small amount of sterile saline injected into uterine cavity while using u/s to image the endo
109
What does the saline do during a SIS?
Helps differentiate focal abnormalities, that may have been missed during routine imaging (the fluid illuminates pathologies in the endo)
110
What is a hysterosonosalpingography (HSSG)?
-Entire tubal path (endo + fallopian tubes) is assessed for patency, meaning looking for obstructions -Saline injection + u/s are used
111
What is a hysterosalpingography (HSG)?
-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
Difference b/w HSG + HSSG?
HSG: contrast dye + x-ray HSSG: saline + u/s

MIDS 137 (14 decks)

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