Fertility Check Up: A concept of all-in-one ultrasound for the autonomous evaluation of female fertility potential: Analysis and evaluation of first two years of experience.

RESEARCH QUESTION: Today, women can plan for parenthood and family life, but delaying pregnancy is often associated with anxiety regarding the question of future fertility. We aim to evaluate if there is a benefit to offering fertility evaluation to all women, including those who have no immediate plans for pregnancy. DESIGN: We developed in our reproductive center a new concept of an all-in-one ultrasound open to all women of reproductive age. Fertility Check Up (FCU) is a medical and ultrasound exam followed by an interview with a fertility expert, accessible to all women of childbearing age whether or not they are planning a pregnancy. The FCU provides an anatomical and functional evaluation of the reproductive system and indicates the theoretical likelihood of conception, along with advice from fertility experts. RESULTS: In the first year, 440 women between 24 and 48 were screened, 56% of whom had never attempted to conceive. An anatomical abnormality was found in 58.5% of women, the examination concluded to a low-for-age ovarian reserve in 14% of the cases. 37.5% of the women in our study were referred either for ART treatment, fertility preservation or oocyte donation. Six months after, 50% of the women who had no immediate pregnancy plans stated that the FCU had modified their personal or professional plans regarding a possible future pregnancy. CONCLUSIONS: Fertility assessment for all women, whether infertile or not, with or without immediate pregnancy plans, allows for information, advice, and treatment if necessary.

Using low-cost 3D-printed models of prenatal ultrasonography for visually-impaired expectant persons.

BACKGROUND: For visually impaired or blind patients, the experience of pregnancy sets them apart from nondisabled people for whom viewing of the first ultrasound has become a social and emotional milestone. OBJECTIVE: We proposed the use of 3D-printed models to allow the societal inclusion of visually impaired or blind expectant parents. PATIENT INVOLVEMENT: Visually impaired expectant parents were proposed to touch a 3D printed sensory vector of their prenatal classic ultrasonography. METHODS: After a classic ultrasound assessment was performed, selected volumes were processed and 3D-printed with acrylonitrile butadiene styrene. Patient satisfaction was recorded after they manipulated the models. RESULTS: A total of 42 prenatal 3D prints were for 12 expectant parents, used during 20 ultrasonographic sessions with visually impaired or blind expectant parents. During 13 of them (65%), it was the mother who was affected by a visual loss whereas the father was the parent affected by the disability during 7 sessions (35%). The parent affected by the disability was congenitally blind and Braille-reader in 9 ultrasonography sessions (45%). All expectant visually impaired or blind parents expressed very significant satisfaction with the use of 3D models for inclusive use. DISCUSSION: We have shown that acrylonitrile butadiene styrene-printed models improve the sonographic experience of visually impaired or blind expectant parents. They can thereby perform their own mental representation process by extrapolating sensory information obtained from the 3D tactile support. PRACTICAL VALUE: These low-cost 3D-printed models improve the inclusion of visually impaired or blind expectant parents, by offering them a sensory vector of information.

Benefits of using a simulator in the initial training for transvaginal ultrasound examination in gynecologic emergency unit.

PURPOSE: Transvaginal ultrasound examination is decisive in Gynecologic emergency unit. This study's aim was to evaluate benefits of using a simulator for initial training of medical student for transvaginal ultrasound examination. METHOD: A multicenter randomized trial was conducted. Medical student were randomized in two groups: in the intervention group, students took part in a simulation session in addition to the companionship-training while in the control group, they were only trained by companionship. To evaluate their progression, the quality of ultrasound pictures performed in real conditions before (pre-test) and after (post-test) the training by the students of both groups were evaluated and compared. Evaluation was performed according to predefined quality criterias for each ultrasound examination using a score of 20 points. Mean scores of students in both groups were compared for the pre and post-test. RESULTS: Fifty six medical students were included. Mean scores of the 56 students were significantly better at the post-test than at the pre-test: 10,61/20 [9,62-11, 59] vs 6,35/20 [5,48-7,24], p < 0,001. Mean scores were significantly better at the post-test for students in the intervention group (n = 29) than in the control group (n = 27) 11,79/20 [7,72-10,94] vs 9,33/20 [7,72-10,94], p = 0,01. All the students in the intervention group were satisfied or highly satisfied to take part in this program. CONCLUSIONS: Using a simulator for medical student was beneficial in the initial training of transvaginal ultrasound examination.

Magnetic Resonance and Ultrasound Fusion Imaging to Characterise Ovarian Masses: A Feasibility Study.

BACKGROUND/AIM: Magnetic resonance (MR) and ultrasound (US) fusion imaging (MR-US fusion) is already used to guide prostate biopsies and has been proven accurate for diagnosing cervical cancer. In this study, we aimed to evaluate the feasibility and performance of MR-US fusion for characterizing adnexal masses. PATIENTS AND METHODS: A retrospective study was conducted between 2014 and 2018 including women referred to our Gynaecological Oncology Department for characterization of an adnexal mass (n=106). Performance of MR-US fusion was evaluated in a subgroup of patients who underwent surgery (n=26). Two readers, blinded to final histology, performed and rated US findings according to the International Ovarian Tumor Analysis simple rules score, MR according to Ovarian-Adnexal Reporting Data System Magnetic score, and MR-US fusion through a tailored score. The reference outcome was the final pathology. RESULTS: MR-US fusion had a sensitivity of 100% (95%CI=80-100), specificity of 89% (95%CI=52-99), positive likelihood ratio of 9 (95%CI=1.4-57), and accuracy of 96% (95%CI=80-99). CONCLUSION: MR-US fusion is feasible for characterizing adnexal masses to predict ovarian cancer.

Three-Dimensional Printing of Prenatal Ultrasonographic Diagnosis of Cleft Lip and Palate: Presenting the Needed "Know-How" and Discussing Its Use in Parental Education.

Parental prenatal counseling is of paramount significance since parents often experience an emotional crisis with feelings of disappointment and helplessness. Three-dimensional (3D) printed model of the unborn child's face presenting with cleft lip and palate, based on ultrasonographic information, could be used to provide visual 3D information, further enhancing the prospective parent's comprehension of their unborn child's pathology and morphology, helping them to be psychologically prepared and improving the communication with the caretaking team. Prospective parents appreciate if prenatal counseling is available with the most detailed information as well as additional resources. The technique necessary to create 3D models after ultrasonographic information is explained, and the related costs are evaluated. The use of such models in parental education is then discussed.

A novel concept for female infertility exploration: the Fertiliscan©, a dedicated all-in-one 3D ultrasound exploration.

The investigation of the probable cause of infertility is mandatory to propose an accurate therapeutic option to the infertile couple i.e. good chance of pregnancy. Usually, this investigation in woman includes at least hormonal dosages to estimate the ovarian function and reserve, a pelvic ultrasound scan and a hystero-salpingography to determine tubal patency. We introduce a unique investigation based on the realization of a high quality 3D ultrasound scan that involves the assessment of tubal patency. It is called Fertiliscan as opposed to the standard pelvic scan. The Fertiliscan assesses both the anatomy and the function of the uterus, the ovaries as well as the tubes. It includes a hystero-sonography for the analysis of the uterine cavity and with respect to tubal patency, a hysterosalpingo-foam-sonogography (Hyfosy). The investigation is woman-friendly, cheaper and shorter. It allows a fast track to a treatment if needed and shortens "time to pregnancy" for the couple.

Fetal dental panorama on three-dimensional ultrasound imaging of cleft lip and palate and other facial anomalies.

OBJECTIVES: Craniofacial deformities have a high psychosocial impact. The aim of this paper is to improve obstetric ultrasonography and prenatal detection of facial anomalies by providing a new fetal dental panorama. MATERIAL AND METHODS: The present study describes a new modality to visualize the fetal tooth germs and an easy step-by-step diagnostic approach. Image acquisition was performed between 23 and 32 weeks of gestation using a Voluson E10 GE ultrasound machine with an RM6C transducer (GE Medical Systems, Zipf, Austria). Reconstruction was performed using Omniview from the axial image. Volume contrast imaging (VCI) was used with a thickness of 20 mm, and a render mode that combined "Rx mode" and "surface texture." RESULTS: The resulting imaging allows a more precise visualization of the fetal dental arch and can be obtained between 14 and 28 weeks of gestation. The presence of dental anomalies can be a clue for the diagnosis of various congenital defects, in particular conditions with a shortage of other physical abnormalities, such as ectodermal dysplasia and Binder syndrome. CONCLUSIONS: The creation of a precise fetal dental panorama allows an improved detection of facial deformities. CLINICAL RELEVANCE: With the current paper, we want to increase prenatal diagnostics facial anomalies, and help to establish a tailored multidisciplinary treatment plan. This paper should be of interest to readers who are currently treating patients with craniofacial malformations and readers who are performing diagnostic prenatal sonography.

When Are Trainees Ready to Perform Transvaginal Ultrasound? An Observational Study.

PURPOSE: The purpose of this study was two-fold: (1) To determine how the number of ultrasound scans a trainee has completed predicts the trainee's diagnostic accuracy when performing transvaginal ultrasound examinations, and (2) to examine the utility of simulation-based assessment of ultrasound competence for determining readiness for independently performing examinations. MATERIALS AND METHODS: 101 OB/GYN trainees were surveyed regarding their clinical experience and the number of scans they had completed. All participants completed five different cases on a transvaginal virtual-reality ultrasound simulator (Scantrainer, Medaphor). The participants' diagnostic accuracy was recorded and expert raters evaluated their performance using the Objective Structured Assessment of Ultrasound Skills (OSAUS) scale. The utility of simulation-based assessments was assessed with respect to reliability, validity, acceptability, and costs. The main outcome was diagnostic accuracy for five different ultrasound cases. RESULTS: Although the number of scans was associated with diagnostic accuracy (p = 0.006), it was a poor predictor (AUC 0.69) of diagnostic accuracy. Only 56.6 % (n = 34) of participants who had more than 100 transvaginal scans demonstrated a diagnostic accuracy of 0.80 or above. The reliability of the OSAUS assessments was high (ICC 0.82) and the majority of participants supported the use of simulation-based assessments for future licensing exams (70.3 %). The running costs of simulation-based assessments (154 EUR per participant) were lower than for practical examinations using real patients. CONCLUSION: The number of completed ultrasound scans was a poor predictor of the trainees' diagnostic accuracy. Instead, simulation-based assessments can be used to ensure that trainees are ready for independently performing future scans.

MRI and Ultrasound Fusion Imaging for Cervical Cancer.

BACKGROUND: Evaluating locoregional extension of cervical cancer is a key step in patient management. This study evaluated the feasibility of fusion imaging - a combination of magnetic resonance imaging (MRI) with real-time high-resolution ultrasound (US) - to diagnose cervical cancer and its extension. PATIENTS AND METHODS: This prospective bi-center study included 13 women who underwent a 1.5-T MRI protocol including at least one T2-weighted plane. The results of imaging fusion were then compared with US and MRI results alone. RESULTS: Cervical cancer was detected as a hyperechogenic hypervascularized lesion. Parametrial extension was detected by exploration of the stromal ring and the use of color Doppler mode in fusion imaging, and characterized by visualization of a vascular bridge. CONCLUSION: Fusion imaging could be used as a complementary technique for MRI to enhance diagnostic performance for cervical cancer lesions. While MRI remains the reference, real-time fusion imaging could improve its characterization and detect parametrial infiltration.

Anti-Müllerian Hormone and Ovarian Morphology in Women With Isolated Hypogonadotropic Hypogonadism/Kallmann Syndrome: Effects of Recombinant Human FSH.

CONTEXT: Isolated hypogonadotropic hypogonadism (IHH), characterized by gonadotropin deficiency and absent puberty, is very rare in women. IHH prevents pubertal ovarian stimulation, but anti-Müllerian hormone (AMH) and antral follicle count (AFC) have not been studied. OBJECTIVES: (1) To compare, in IHH vs controls, AMH, ovarian volume (OV), and AFC. (2) To compare, in IHH, ovarian responses to recombinant human follicle-stimulating hormone (rhFSH) and rhFSH plus recombinant human luteinizing hormone (rhLH). SUBJECTS: Sixty-eight IHH women; 51 matched healthy women. METHODS: Serum LH, FSH, sex steroids, inhibin B (InhB), AMH, and OV and AFC (sonography) were compared. Ovarian response during rhFSH administration was assessed in 12 IHH women with low AMH levels and low AFC and compared with hormonal changes observed in six additional IHH women receiving rhFSH plus rhLH. RESULTS: InhB was lower in IHH than in controls. AMH levels were also significantly lower in the patients, but two-thirds had normal values. Mean OV and total, larger, and smaller AFCs were lower in IHH than in controls. Ovarian stimulation by rhFSH led to a significant increase in serum estradiol and InhB levels and in the number of larger antral follicles. AMH and smaller AFC increased early during rhFSH stimulation but then declined despite continued stimulation. rhFSH plus rhLH stimulation led to a significantly higher increase in estradiol levels but to similar changes in circulating InhB and AMH than with rhFSH alone. CONCLUSIONS: IHH women have both low AMH levels and low AFC. However, their decrease can be reversed by follicle-stimulating hormone. Serum AMH and AFC should not serve as prognostic markers of fertility in this population.

Prenatal diagnosis of cleft lip/palate: The surface rendered oro-palatal (SROP) view of the fetal lips and palate, a tool to improve information-sharing within the orofacial team and with the parents.

The ultrasonographic surface rendered oro-palatal (SROP) view is a 3D reconstructed view of the fetal perioral region, which combines ultrasound insonation in a trans oral, upward directed axial direction and the surface rendered mode. It allows the simultaneous visualization on a single scan of the superior lip, alveolar ridge and secondary palate. It corresponds prenatally to the submental intra oral photography of the palate of neonates. The aim of the study was to demonstrate the benefice of using the SROP view in the management of cleft lip with or without cleft palate, uni- or bi-lateral, diagnosed prenatally (22-28 gestational weeks). The SROP view allowed the representation on a single view of the characteristics of the defect useful to the different members of the orofacial team to exactly evaluate the difformity and to plan the ulterior therapeutic steps (e.g. side, extension of the cleft to the secondary palate, tooth organization). Also, being easier to read by lay people thanks to the use of a surface rendered representation rather than the usual multiplanar reconstructions in the three traditional orthogonal planes, the SROP view makes it easier to bring exact information to the parents about the malformation and its consequences.

Assessment of Abdominal Ultrasound Guidance in Hysteroscopic Metroplasty.

STUDY OBJECTIVES: To compare the rates of re-intervention, and immediate and later complications associated with abdominal ultrasound-guided versus unguided hysteroscopic metroplasty in the surgical repair of European Society of Human Reproduction and Embryology/European Society for Gynecological Endoscopy class II intrauterine septa. DESIGN: We performed a large observational retrospective study (Canadian Task Force Classification II-2) in a selection of patients who underwent metroplasty in a tertiary university center between 2009 and 2013. PATIENTS: A total of 108 patients were included in the study. INTERVENTIONS: Patients were categorized as having abdominal ultrasound-guided metroplasty (n = 46) or unguided metroplasty (n = 62). MEASUREMENTS AND MAIN RESULTS: Data were collected with regard to medical and reproductive histories, diagnosis of septate uterus, surgical procedures, and complications. Using these data, the need for re-intervention and complication rates were compared between groups. Statistical analysis was performed using Fisher's exact test and Student's t-test. The characteristics of the 2 groups were comparable. A persistent septum of >10 mm, defined by 3-dimensional ultrasound hysterosonography, with a need for re-intervention, was found in 16 patients (39.0 %) in the unguided group versus 7 patients (18.4 %) in the ultrasound guidance group (p = .04). Risk of a persistent septum after resection (>10 mm) was reduced with ultrasound guidance (odds ratio = 0.35; 95% confidence interval 0.13-0.99). Two uterine perforations occurred in our series; both were in the unguided group. CONCLUSIONS: A systematic abdominal ultrasound-guided metroplasty by hysteroscopy seems to reduce the rates of re-intervention.

Accuracy of three-dimensional ultrasonography in differential diagnosis of septate and bicornuate uterus compared with office hysteroscopy and pelvic magnetic resonance imaging.

STUDY OBJECTIVE: To estimate the accuracy of 3-dimensional (3-D) ultrasonography in the differential diagnosis of septate and bicornuate uterus compared with office hysteroscopy and pelvic magnetic resonance imaging (MRI). DESIGN: Prospective cohort study (Canadian Task Force Classification II-2). SETTING: University hospital. PATIENTS: Thirty-one patients referred with a suspected diagnosis of septate (n = 20) or bicornuate (n = 11) uterus. INTERVENTIONS: All patients underwent 3-D ultrasonography displaying the rebuilt coronal view of the uterus, office hysteroscopy, and pelvic MRI. Operative hysteroscopic assessment and treatment was performed in case of sonographically diagnosed septate uterus. Bicornuate uterus was confirmed by laparoscopy. MAIN OUTCOMES MEASURES: Concordance between suspected diagnosis with 3-D ultrasonography, hysteroscopy, and pelvic MRI and final diagnosis. RESULTS: A septate uterus was diagnosed with 3-D ultrasonography in 29 patients and bicornuate uterus in 2 patients. Hysteroscopic transcervical section of the uterine septum was achieved in the 29 patients. Bicornuate uterus was laparoscopically confirmed in the 2 patients. Concordance between ultrasonography and operative hysteroscopy or laparoscopy was verified in all 31 cases. Twenty-five uterine septa and 5 bicornuate uteri were diagnosed by hysteroscopy (3 false-positive diagnoses of bicornuate uterus, 1 unfeasible hysteroscopy). Hysteroscopic diagnosis was correct in 27/30 patients. Twenty-four septate uteri and 7 bicornuate uteri were diagnosed by MRI (5 false-positive diagnoses of bicornuate uterus). Two complete septate uteri diagnosed by MRI were finally confirmed as incomplete septate uteri after 3-D ultrasonography and operative hysteroscopy. MRI diagnosis was correct in 24/31 patients. CONCLUSION: Transvaginal 3-D ultrasonography appears to be extremely accurate for the diagnosis and classification of congenital uterine anomalies, more than office hysteroscopy and MRI. It may conveniently become the only mandatory step in the assessment of the uterine cavity in patients with a suspected septate or bicornuate uterus.

3D ultrasound to assess the position of tubal sterilization microinserts.

BACKGROUND: The aim of this study was to assess the diagnostic accuracy of three-dimensional ultrasound (3D-US) for determining the position of Essure microinserts and the success of sterilization by the Essure method. METHODS: This retrospective observational study examined the case records of 311 women who underwent hysteroscopic sterilization from October 2002 through October 2008. Imaging with 3D-US or pelvic X-radiography or both was performed 3 months after the procedure to verify device position. Hysterosalpingography (HSG) was performed when a bilateral procedure was not completed because of a history of salpingectomy or blocked tube, when doubt persisted after 3D-US or pelvic radiography, or for comparative purposes in a prospective study. The positions seen on 3D-US were classified in four categories according to a specific scale we devised. RESULTS: The insertion procedure was completed in 94.2% patients. Only 90.5% underwent imaging verification of the device 3 months afterwards. In all, 227 3D-US, 175 pelvic radiography and 64 HSG imaging procedures were performed. Visualization of the device was possible in 99.6% of the 3D-US images. According to our classification, 3D-US was appropriate for assessing device position for 195 (85.9%) patients. The need for HSG confirmation was significantly lower with 3D-US than radiographic imaging (14.1 versus 26.8%, P = 0.001). 3D-US examinations, compared with the results of HSG as the reference test, had a sensitivity of 100% and a specificity of 76.6%. Neither pregnancy nor early expulsion occurred when 3D-US found that the devices were correctly placed. CONCLUSIONS: 3D-US is a simple technique for assessing the position of Essure(®) microinserts, even after concomitant endometrial surgery. The 3D-US classification presented here appears to make it possible to use HSG for back-up confirmation only when the microinsert is found in a very distal position on 3D-US and thus to protect the majority of women from the negative effects of pelvic radiography and HSG.

Surgical approach to and reproductive outcome after surgical correction of a T-shaped uterus.

BACKGROUND: The aim of this study was to describe the surgical approach to, and evaluate the reproductive outcome of, a T-shaped uterus. METHODS: The study included 97 women who were eligible for hysteroscopic surgery, by either monopolar or bipolar electrosurgical instruments. All had diagnostic hysteroscopy 2 months afterwards to assess the success of the procedure and determine whether any synechiae were present. RESULTS: Forty-eight women (49.5%) became pregnant after metroplasty. The overall live birth rate per pregnancy before surgery was 0%; for these patients, it increased to 73%, and their miscarriage rate fell from 78 to 27% (P < 0.05). For all 57 pregnancies in 48 women, the ectopic pregnancy rate was 9% (n = 5), the miscarriage rate 28% (n = 16), the preterm delivery rate 14% (n = 8), the term delivery rate 49% (n = 28) and the live birth rate was 63% (n = 36). CONCLUSIONS: Hysteroscopic metroplasty improves the live birth rate for women with a T-shaped uterus and a history of primary infertility, recurrent abortion or preterm delivery, although it is not a treatment of infertility.