Ultrasound technology has made dramatic advances in recent years, and  now tests have been described which allow the doctor to  use ultrasound  to  assess tubal patency.  Basically,  these  involve passing  a  fluid  into your tubes through the  uterus;  and  the gynecologist  can see the passage of the bubbles into  the  tubes and  out into the abdomen. Since this test (  sonosalpingography) can  be done in the doctor's clinic itself, and does not  involve X-ray  radiation, it has advantages - especially for  documenting that  the tubes are normal. However, the gold standard for  tubal testing remains HSG and laparoscopy today.

Doppler:  The newer ultrasound machines have Doppler  attachments which  allow the doctor to judge the flow of blood in  the  blood vessels.  The  most exciting advance is that of  Colour  Doppler, where the blood flow can be mapped in color on the monitor. While still  a research tool, it may provide important information  for assessing the infertile patient in the coming years.

Three – dimensional ultrasound. Using sophisticated microprocessors, the newest ultrasound machines allow the doctor to reconstruct the image, so that he gets a three dimensional view. While this provides excellent pictures, the true value of this technique for infertility still has to be evaluated.

Ultrasound  now  also offers infertile patients  newer  treatment options  not available before. Modern surgical techniques  have progressively  become  less and less invasive - all  to  the patient's benefit ! From laparotomy to laparoscopy , and  now to ultrasound guided procedures, we are witnessing a change in the  gynecologist's  armamentarium  from  the  knife to the endoscope to the guided needle !

The benefits to the patient are many and include : reduced costs; reduced  hospitalisation  ; reduced risk  of  complications;  and better  preservation  of  fertility,  with  increased  chance  of conception for the future.

Ultrasound-guided procedures can be used to treat a variety of problems seen in the infertile woman.

1.  Egg pickup for IVF - The use of vaginal ultrasound for  egg pickup  has  made egg retrieval a short, simple  and  inexpensive procedure, which can be performed in a day-care unit, under sedation and local anesthesia . The ovaries are normally  present in the pouch of Douglas, and are very accessible  transvaginally. Moreover,  the presence of adhesions does not interfere with  egg collection.

2.  Ovarian  cyst aspiration. An ovarian cyst is  a  very  common condition  in which fluid collects in the ovary.  However,  cysts which are more than 5 cm in size need to be treated, as they  can cause problems ( eg twisting and rupture). Normally, surgery  had to  be  done to remove these cysts - and often this  damaged  the surrounding  normal ovary as well. With  ultrasound-guidance,  we can  stick a needle from the vagina into the cyst, and empty  the contents ( usually clear fluid ) by sucking it out. This  empties the cyst, which often does not recur.

3. Treatment of ectopic pregnancy . With technological advances ( ultrasound  and  beta-HCG  blood tests) the  diagnosis  of  tubal pregnancy can be made very early, usually before rupture. It  can be treated by injecting a toxic chemical, methotrexate, into  the sac,  which  causes the tissue to die and  then  get  reabsorbed, without   any   surgery  whatsoever.  In  more   advanced   tubal pregnancies,  potassium chloride can be injected direct into  the heart of the baby in the ectopic gestational sac, thus killing it and preventing it from growing.

4. Ultrasound-guided tubal embryo and gamete transfer for IVF and GIFT  techniques. Techniques have been devised to pass a  special tube  -  the Jansen-Anderson catheter set -  into  the  fallopian tubes  through  the vagina under ultrasound guidance,  so  as  to place  the  embryos and /or the gametes in the  fallopian  tube. Since  the tube offers a better environment for the  gametes  and embryos  than the uterine cavity, it is believed that  this  will improve pregnancy rates.

5.  Tubal  recanalisation  for cornual blocks  (  proximal  tubal obstruction)  . Often cornual blocks are due to the  presence  of mucus  plugs and amorphous debris in the tubal lumen.  Ultrasound guided  tubal catheterization can effectively treat  the  blocked tubes in some of these patients.

The   scope  of  ultrasound  guided  procedures   has   increased dramatically in the last few years; and with further improvements in technology, we can expect this list to become even longer, and doctors become more versatile with using this technology.