Interesting cases of the three-dimensional (3D) uterus/endometrium
Interesting cases of the three-dimensional (3D) uterus/endometrium in patients with suspected infertility, Farrah Elsaghir, Pamela Norbury, Royal United Hospital, Bath
Background
NICE (2014) identifies 1 in 7 heterosexual couples are affected by infertility, furthermore, WHO (2020) estimates that globally, between 48 million couples and 186 million individuals live with infertility. It is imperative that infertility is addressed, as individuals and couples have the right to a family. Although sometimes unexplained, multiple factors can affect fertility including uterine disorders and endometrial pathology. Two-dimensional (2D) ultrasound is one of the first diagnostic tests to be requested in suspected infertility. Assessing the uterus/ endometrium with the addition of 3D ultrasound gives further detail and accuracy, aiding the ultrasound practitioner to make a diagnosis.
Case Report
A pictorial review identifies multiple pathologies including an endometrial polyp, submucosal fibroid, septate uterus, arcuate uterus and adhesions. All patients included in the review attended the ultrasound department for a pelvic ultrasound examination (transabdominal and transvaginal) due to primary/secondary infertility. After initially suspecting pathology by 2D ultrasound, the uterus and endometrium were further assessed using 3D ultrasound. The review makes a comparison of the 2D and 3D images, technique of obtaining the optimal image including settings and knobology is also discussed.
Discussion
Ultrasound is one of the first tests requested in patients with suspected primary/secondary infertility. Its role in assessing the uterus and endometrium is crucial. The addition of 3D ultrasound provides further detail and accuracy when an initial anomaly or pathology is suspected by 2D ultrasound. An ultrasound practitioner must recognise the appearances of pathology/anomalies on 3D assessment to give further information to the referring clinician. Appropriate training should be given by application specialists or from senior staff who are proficient in this technique.