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Ultrasonography in In Vitro FertilizationRoger A. PiersonDepartment of Obstetrics, Gynecology

Imaging has become such an integral part of clinical care in the assisted reproductive technologies that it is difficult to imagine how in vitro fertilization (IVF) was done before we had the ability to visualize the ovaries and uterus easily. Recall that IVF was once done using laparoscopic retrieval of oocytes following ovarian stimulation cycles monitored only by hormonal assay of systemic estradiol levels, that embryos were transferred back into a uterus when we had no real idea about the physiologic status of the endometrium, and only a clinical touch was used to guide the placement of the embryo. | 6__ Ultrasonography in In Vitro Fertilization Roger A. Pierson Department of Obstetrics Gynecology and Reproductive Sciences College of Medicine University of Saskatchewan Royal University Hospital Saskatoon Saskatchewan Canada Imaging has become such an integral part of clinical care in the assisted reproductive technologies that it is difficult to imagine how in vitro fertilization IVF was done before we had the ability to visualize the ovaries and uterus easily. Recall that IVF was once done using laparoscopic retrieval of oocytes following ovarian stimulation cycles monitored only by hormonal assay of systemic estradiol levels that embryos were transferred back into a uterus when we had no real idea about the physiologic status of the endometrium and only a clinical touch was used to guide the placement of the embryo transfer catheter. Easily accessible and easy-to-use ultrasonographic imaging in the hands of the individuals performing the assisted reproductive technology ART procedures has delivered us from those uncertainties. The quality and quantity of the information we received from the ultrasonographic images that are now an essential part of every procedure have been a very important aspect of the incredible increases in ART success rates we have seen over the past decade. It is important to remember that the integration of enhanced understanding of anatomy physiology endocrinology and pathology we have gained with imaging in the patients undergoing IVF are as important as the fantastic increase in knowledge in the embryo laboratories. The confluence of technologies 91 92 Pierson we now used in ART care have greatly increased the probabilities of successful pregnancies for our patients. The purpose of this chapter is to describe the primary uses of ultrasound imaging in IVF and to identify some promising new areas where imaging has the potential to enhance our understanding in assisted reproduction. The .