Polycystic ovary syndrome: the controversy of diagnosis by ultrasound.

Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder. The criteria used to establish the diagnosis remain controversial. The 1990 National Institutes of Health conference guidelines required a combination of both chronic anovulation and clinical/or biochemical signs of hyperandrogenism. These criteria were revised in 2003 at the Rotterdam European Society of Human Reproduction and Embryology/American Society of Reproductive Medicine consensus workshop to include ultrasound polycystic ovarian morphology (PCOM) as one of the two of three criteria necessary for establishing the diagnosis of PCOS. The inclusion of PCOM sparked a controversy as it broadens the population of women who meet the criteria for PCOS and allows for the creation of two phenotypically different patient populations who previously would have been excluded. The ultrasound findings, which are consistent with PCOM, include an assessment of follicle number and/or ovarian volume. As technology advances with two-dimensional and three-dimensional ultrasound, our ability to discretely evaluate independent portions of the ovary may help to redefine the criteria of PCOM and thus standardize for clinical and research interests a more specific descriptor for PCOM.

Ultrasound in assisted reproductive technology.

Transvaginal ultrasound-guided oocyte retrieval is the gold standard for in vitro fertilization (IVF) treatment. Despite its relative safety, oocyte retrieval is associated with risk to the adjacent pelvic organs, bleeding, and pelvic infection. The embryo transfer (ET) procedure is considered a crucial step in an IVF cycle. The success of the ET is dependent upon multiple factors including embryo quality, proper endometrial receptivity, and the technique by which the embryos are transferred. Optimizing the technique of ET would therefore provide the best chance for pregnancy. No standard evidence-based protocol exists, but ET with ultrasound guidance has been shown to significantly increase the chance of embryo implantation, an ongoing pregnancy, and a live birth and to improve the ease of transfer. Identifying appropriate ultrasound-guided simulation training techniques in ET would ensure adequate fellowship training without affecting the outcome of assisted reproductive technology cycles.