Endometrial Cavity
Successful implantation largely depends on the embryo’s quality and on hormonally primed uterine receptivity [1]. In fact, the uterus and endometrial cavity are fundamental components for reproduction, and their normal structure and function positively in
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Endometrial Cavity Francesco Paolo Giuseppe Leone
4.1
Introduction
Successful implantation largely depends on the embryo’s quality and on hormonally primed uterine receptivity [1]. In fact, the uterus and the endometrial cavity are fundamental components for reproduction, and their normal structure and function positively influence conception and pregnancy outcomes. However, it is still a matter of debate whether congenital or acquired structural uterine abnormalities, such as Mullerian anomalies, adenomyosis, myomas, endometrial polyps, and intrauterine adhesions, may play a role in female infertility, probably leading to subfertility, to defective endometrial receptivity, and to consequently decreased embryo implantation or miscarriage rate [2]. This chapter will focus on the sonographic diagnosis of submucous myomas, endometrial polyps, endometrial hyperplasia, and intrauterine adhesions by transvaginal sonography (TVS) with color and power Doppler (CD and PD) assessment, combined with sonohysterography (SHG), both by saline contrast sonohysterography (SCSH) and gel infusion sonohysterography (GIS), and with three-dimensional transvaginal sonography (3D TVS) and sonohysterography (3D SHG, 3D SCSH, and 3D GIS). The International Endometrial Tumor Analysis (IETA) statement on endometrial terms and definitions will be applied to define the different sonographic findings [3].
F.P.G. Leone Department of Obstetrics and Gynaecology, Clinical Sciences Institute L. Sacco, University of Milan, Milan, Italy e-mail: [email protected] © Springer International Publishing Switzerland 2017 S. Guerriero et al. (eds.), Managing Ultrasonography in Human Reproduction, DOI 10.1007/978-3-319-41037-1_4
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4.2
F.P.G. Leone
Submucous Myomas
Myomas are the most common benign tumors of the female tract and are associated with numerous clinical problems, including heavy menstrual bleeding and infertility. They originate from smooth muscle cells of myometrium or its blood vessels and occur in about 20–50 % of women of reproductive age [4]. The mechanisms by which myomas can induce infertility are still debated. Myomas can create anatomical distortion of the uterine cavity, causing mechanical pressure or by the occurrence of abnormal uterine contractility [5]. The evidence regarding the effect of myomas on fertility mainly depends on the type (submucous, intramural, or subserous) [6]. Recently, the FIGO classification system proposed a new subclassification system including submucous (types 0–2) and other (types 3–8) myomas [7]. In particular, the traditional classification for submucous myomas by hysteroscopy (HYS) was adopted: type 0, myoma with intracavitary development only; type 1, myoma with primarily intracavitary development, intramural portion below 50 %; and type 2, myoma with primarily intramural development, intracavitary portion below 50 % [8]. Submucous myomas have a detrimental impact on fertility, while subserous seem to have little effect; the evidence regarding intramural, on the other hand, is less co
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