RD7.1 | Imaging in Infertility Evaluation — Summary & Reflection

KEY TAKEAWAYS

Imaging in Infertility Evaluation — Key Points

• The female workup answers three questions — ovulation/ovarian reserve, tubal patency, and uterine-cavity normality — and imaging is matched to each.
• Ovarian reserve and ovulation — transvaginal ultrasound (TVS): antral follicle count (AFC) for reserve; serial follicular tracking for ovulation and to monitor ovulation induction.
• Tubal patency — HSG, HyCoSy or laparoscopy: HSG (fluoroscopy, iodinated contrast) is the conventional standard, done in the follicular phase (days 6-10) after excluding pregnancy and active infection; HyCoSy is the radiation-free ultrasound alternative; laparoscopy with chromopertubation is the definitive gold standard.
• Uterine cavity — saline infusion sonohysterography (SIS) for polyps, submucous fibroids, adhesions and septum; 3D ultrasound or MRI for Mullerian anomalies (distinguished by external fundal contour). CT has no role.
• Findings: patent tubes = free bilateral peritoneal spill; block = no spill; distal block with a dilated tube = hydrosalpinx; beware false-positive cornual spasm mimicking proximal block.
• Management integration: ovulatory dysfunction → ovulation induction with follicular tracking; bilateral tubal block → IVF (with salpingectomy/occlusion of a hydrosalpinx first, as its fluid lowers IVF success); cavity lesion → hysteroscopic correction; diminished reserve → earlier assisted reproduction.
• Radiation stewardship: prefer ultrasound-based tests where they answer the question; time any pelvic radiographic study to the follicular phase to avoid irradiating an early pregnancy.

REFLECT

When you next sit in an infertility clinic, notice how the clinician sequences the investigations: is each test clearly tied to one of the three questions — ovulation/reserve, tubes, cavity — or are tests ordered indiscriminately? Watch the timing: is the HSG or HyCoSy booked for the follicular phase, and is pregnancy excluded first? Notice whether a radiation-free alternative is offered where it answers the same question, and whether an incidental finding such as a hydrosalpinx is acted upon before IVF. Building the habit of choosing the right test, at the right time, and reading it into the couple's plan — with radiation safety always in mind — is what turns the imaging menu into competent, compassionate fertility care.