Donald School Journal of Ultrasound in Obstetrics and Gynecology

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  18 (2024)
Volume  17 (2023)
Volume  16 (2022)
Volume  15 (2021)
Volume  14 (2020)
Volume  13 (2019)
Volume  12 (2018)
Volume  11 (2017)
Volume  10 (2016)
Volume  9 (2015)
Volume  8 (2014)
Volume  7 (2013)
Volume  6 (2012)
Volume  5 (2011)
Volume  4 (2010)
Volume  3 (2009)
Volume  2 (2008)
Volume  1 (2007)
Related articles

VOLUME 13 , ISSUE 4 ( October-December, 2019 ) > List of Articles

REVIEW ARTICLE

Fibroids and Infertility: The Added Value of Three-dimensional Ultrasound

Sanja Plavsic Kupesic

Keywords : Infertility, Three-dimensional power Doppler, Three-dimensional ultrasound, Uterine fibroids.

Citation Information : Kupesic SP. Fibroids and Infertility: The Added Value of Three-dimensional Ultrasound. Donald School J Ultrasound Obstet Gynecol 2019; 13 (4):220-228.

DOI: 10.5005/jp-journals-10009-1606

License: CC BY-NC 4.0

Published Online: 01-12-2018

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Uterine fibroids, benign monoclonal tumors of the uterine smooth muscle cells and fibrous connective tissue, are the most common tumors of the female pelvis, occurring in about 20–30% of women of reproductive age. The cumulative rate of uterine fibroids increases with age, with a tendency of slower increase at older reproductive age. Fibroids may be of various sizes, single or multiple, and are described based on their relationship to the uterine cavity. Those located within the myometrium are called intramural and are considered the most common, occurring in about 58–79% of all patients, while the other locations are submucous which eventually may become intracavitary and subserous fibroids. According to the American Society for Reproductive Medicine (ASRM), uterine myomas are associated with infertility in 5–10% of cases and may be responsible for 2–3% of infertility cases. The growth of fibroids during pregnancy cannot be predicted. Majority of the fibroids’ growth occurred in the first trimester. Imaging techniques used for the diagnosis of uterine fibroids include transabdominal and transvaginal two-dimensional (2D) and three-dimensional (3D) ultrasound, saline infusion sonography (SIS), and magnetic resonance imaging (MRI). Sonographic assessment of the uterine fibroids includes determination of their number, location, echotexture, and size, by measuring the three maximum diameters (length, width, and height). Serial examinations are necessary to document the interval growth and change in morphology. Combining the advantages of multiple imaging modalities: ultrasound as a noninvasive, nonirradiation, and inexpensive method, and volume acquisition known from CT and MR imaging technologies, 3D ultrasound and 3D power Doppler angiography have become valuable diagnostic tools for the assessment of uterine fibroids. By providing multiplanar imaging, 3D ultrasound not only gives an additional dimension to the uterine scan but also provides a similar quality and less expensive alternative to MRI. Automated volume acquisition minimizes the subjectivity of the ultrasound assessment and can be used for retrospective analysis.

HTML PDF Share
  1. Haney AF. Leiomyomata. In: Danforth's Obstetrics and Gynecology, 10th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2003.
  2. Day Baird D, Dunson DB, Hill MC. et al. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 2003;188(1):100–107. DOI: 10.1067/mob.2003.99.
  3. Laughlin SK, Schroeder JC, Baird DD. New directions in the epidemiology of uterine fibroids. Semin Reprod Med 2010;28(3): 204–217. DOI: 10.1055/s-0030-1251477.
  4. Salem S, Wilson SR. Gynecologic ultrasound. In: Diagnostic Ultrasound, 3rd ed. St. Louis, MO: Elsevier Mosby, vol. 1; 2005.
  5. Schwartz SM. Epidemiology of uterine leiomyomata. Clin Obstet Gynecol 2001;44(2):316–326. DOI: 10.1097/00003081-200106000-00018.
  6. Wise LA, Palmer JR, Harlow BL, et al. Risk of uterine leiomyomata in relation to tobacco, alcohol and caffeine consumption in the Black Women's Health Study. Hum Reprod 2004;19(8):1746–1754. DOI: 10.1093/humrep/deh309.
  7. Levine DJ, Berman JM, Harris M, et al. Sensitivity of myoma imaging using laparoscopic ultrasound compared with magnetic resonance imaging and transvaginal ultrasound. J Minim Invasive Gynecol 2013;20(6):770–774. DOI: 10.1016/j.jmig.2013.04.015.
  8. Moshesh M, Peddada SD, Cooper T, et al. Intraobserver variability in fibroid size measurements. J Ultrasound Med 2014;33(7):1217–1224. DOI: 10.7863/ultra.33.7.1217.
  9. Mavrelos D, Ben-Nagi J, Holland T, et al. The natural history of fibroids. Ultrasound Obstet Gynecol 2010;35(2):238–242. DOI: 10.1002/uog.7482.
  10. Poder L. Ultrasound evaluation of the uterus. In: Ultrasonography in Obstetrics and Gynecology, 5th ed., Philadelphia, PA: Elsevier; 2008.
  11. Parker WH. Etiology, symptomatology, and diagnosis of uterine myomas. Fertil Steril 2007;87(4):725–736. DOI: 10.1016/j.fertnstert.2007.01.093.
  12. Cloke B, Brosens J, Brosens I. Leiomyomata and reproductive function. In: Uterine Leiomyomata. Pathogenesis and Management, 1st ed., London, UK: Taylor & Francis; 2006. pp. 107–116.
  13. Pritts EA. Fibroids and infertility: a systematic review of the evidence. Obstet Gynecol Surv 2001;56(8):483–491. DOI: 10.1097/00006254-200108000-00022.
  14. Pritts EA, Parker WH, Ikuve DL. Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril 2009;91(4):1216–1223. DOI: 10.1016/j.fertnstert.2008.01.051.
  15. Yoshino O, Hayashi T, Osuga Y, et al. Decreased pregnancy rate is linked to abnormal uterine peristalsis caused by intramural fibroids. Hum Reprod 2010;25(10):2475–2479. DOI: 10.1093/humrep/deq222.
  16. Yan L, Ding L, Li C, et al. Effect of fibroids not distorting the endometrial cavity on the outcome of in vitro fertilization treatment: a retrospective cohort study. Fertil Steril 2014;101(3):716–721. DOI: 10.1016/j.fertnstert.2013.11.023.
  17. Practice Committee of the American Society for Reproductive Medicine. Myomas and reproductive function. Fertil Steril 2004;82(1):S111–S116. DOI: 10.1016/j.fertnstert.2004.05.061.
  18. Buttram VC, Reiter RC. Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril 1981;36(4):433–445. DOI: 10.1016/S0015-0282(16)45789-4.
  19. Vander Werff BJ, Hagen-Ansert S. Pathology of the uterus. In: Ultrasonography in Obstetrics and Gynecology, 5th ed., Philadelphia, PA: Elsevier; 2008.
  20. Ito F, Kawamura N, Ichimura T, et al. Ultrastructural comparison of uterine leiomyoma cells from the same myoma nodule before and after gonadotropin-releasing hormone agonist treatment. Fertil Steril 2001;75(1):125–130. DOI: 10.1016/S0015-0282(00)01660-5.
  21. Kurjak A, Kupesic S. Effetto degli analoghi del GnRH sul flusso ematico negli organi ginecologici. In: Nuovi aspetti clinici dei GnRH analoghi. Roma: CIC Edizioni Internazionali; 1994.
  22. Kupesic S, Kurjak A. Blood flow in gynecological organs treated by GnRH agonists. Book of abstracts. XIV FIGO World Congress, Montreal, Canada, September 25–30. IJGOAL 1994;46(Suppl 2):60.
  23. Garcia Velasco JA, Kupesic S, Mrazek M, et al. Synchronization of the follicle cohort with the GnRH antagonist Degarelix: a randomized assessor blind, placebo controlled trial. Fertil Steril 2008;90:234. DOI: 10.1016/j.fertnstert.2008.07.569.
  24. Bourlev V, Pavlovitch S, Stygar D, et al. Different proliferative and apoptotic activity in peripheral versus central parts of human uterine leiomyomas. Gynecol Obstet Invest 2003;55(4):199–204. DOI: 10.1159/000072074.
  25. Wei JJ, Zhang XM, Chiriboga L, et al. Spatial differences in biologic activity of large uterine leiomyomata. Fertil Steril 2006;85(1):179–187. DOI: 10.1016/j.fertnstert.2005.07.1294.
  26. Dapunt O. Studies on the structure of the myoma capsule. Arch Gynecol 1965;202(1):492–494. DOI: 10.1007/bf00672205.
  27. Lindner V, Reidy MA. Proliferation of smooth muscle cells after vascular injury is inhibited by an antibody against basic fibroblast growth factor. Proc Natl Acad Sci U S A 1991;88(36):3739–3743. DOI: 10.1073/pnas.88.9.3739.
  28. Stewart EA, Nowak RA. Leiomyoma-related bleeding: a classic hypothesis updated for the molecular era. Hum Reprod Update 1996;2(4):295–306. DOI: 10.1093/humupd/2.4.295.
  29. Olmos Gring AO, Lora V, Ferreira GD, et al. Protein expression of estrogen receptors α and β and aromatase in myometrium and uterine leiomyoma. Gynecol Obstet Invest 2012;73(3):113–117. DOI: 10.1159/000330700.
  30. Ishikawa H, Ishi V, AnnSerna V, et al. Progesterone is essential for maintenance and growth of uterine leiomyoma. Endocrinology 2010;151(6):2433–2442. DOI: 10.1210/en.2009-1225.
  31. Barbarisi A, Petillo O, Di Lieto A, et al. 17-beta estradiol elicits an autocrine leiomyoma cell proliferation: evidence for a stimulation of protein kinase-dependent pathway. J Cell Physiol 2001;186(3): 414–424. DOI: 10.1002/1097-4652(2000)9999:999<000::AID-JCP1040>3.0.CO;2-E.
  32. Park S, Ramachandran S, Kwon S, et al. Upregulation of ATP-sensitive potassium channels for estrogen-mediated cell proliferation in human uterine leiomyoma cells. Gynecol Endocrinol 2008;24(5): 250–256. DOI: 10.1080/09513590801893315.
  33. Rein MS, Barbieri RL, Friedman AJ. Progesterone: a critical role in the pathogenesis of uterine myomas. Am J Obstet Gynecol 1995;172(1):14–18. DOI: 10.1016/0002-9378(95)90077-2.
  34. Andersen J. Growth factors and cytokines in uterine leiomyomas. Semin Reprod Endocrinol 1996;14(3):269–282. DOI: 10.1055/s-2007-1016336.
  35. Kurjak A, Kupesic S, Miric D. Transvaginal color Doppler in the assessment of uterine blood flow changes during the pregnancy in patients with fibroids. J Perinat Med 1991;19(Suppl 2):81.
  36. Kurjak A, Predanic M, Kupesic S, et al. Transvaginal color Doppler in the study of early pregnancies associated with fibroids. J Matern Fetal Invest 1992;2:81–83.
  37. Rosati P, Exacoustòs C, Mancuso S. Longitudinal evaluation of uterine myoma growth during pregnancy. A sonographic study. J Ultrasound Med 1992;11(10):511. DOI: 10.7863/jum.1992.11.10.511.
  38. Strobelt N, Ghidini A, Cavallone M, et al. Natural history of uterine leiomyomas in pregnancy. J Ultrasound Med 1994;13(5):399. DOI: 10.7863/jum.1994.13.5.399.
  39. Aharoni A, Reiter A, Golan D, et al. Patterns of growth of uterine leiomyomas during pregnancy. A prospective longitudinal study. Br J Obstet Gynaecol 1988;95(5):510. DOI: 10.1111/j.1471-0528.1988.tb12807.x.
  40. Klatsky PC, Tran ND, Caughey AB, et al. Fibroids and reproductive outcomes: a systematic literature review from conception to delivery. Am J Obstet Gynecol 2008;198(4):357. DOI: 10.1016/j.ajog.2007.12. 039.
  41. Chen YH, Lin HC, Chen SF, et al. Increased risk of preterm births among women with uterine leiomyoma: a nationwide population-based study. Hum Reprod 2009;24(12):3049–3056. DOI: 10.1093/humrep/dep320.
  42. Lam SJ, Best S, Kumar S. The impact of fibroid characteristics on pregnancy outcome. Am J Obstet Gynecol 2014;211(4):395. DOI: 10.1016/j.ajog.2014.03.066.
  43. Shavell VI, Thakur M, Sawant A, et al. Adverse obstetric outcomes associated with sonographically identified large uterine fibroids. Fertil Steril 2012;97(1):107. DOI: 10.1016/j.fertnstert.2011. 10.009.
  44. Roberts WE, Fulp KS, Morrison JC, et al. The impact of leiomyomas on pregnancy. Aust N Z J Obstet Gynaecol 1999;39(1):43–47. DOI: 10.1111/j.1479-828X.1999.tb03442.x.
  45. Davis JL, Ray-Mazumder S, Hobel CJ, et al. Uterine leiomyomas in pregnancy: a prospective study. Obstet Gynecol 1990;75(1): 41–44.
  46. Vergani P, Ghidini A, Strobelt N, et al. Do uterine leiomyomas influence pregnancy outcome? Am J Perinatol 1994;11(5):356–568. DOI: 10.1055/s-2007-994554.
  47. Coronado GD, Marshall LM, Schwartz SM. Complications in pregnancy, labor, and delivery with uterine leiomyomas: a population-based study. Obstet Gynecol 2000;95(5):764–769. DOI: 10.1097/00006250-200005000-00025.
  48. Winer-Muram HT, Muram D, Gillieson MS. Uterine myomas in pregnancy. J Can Assoc Radiol 1984;35(2):168–170. DOI: 10.1097/00006254-198402000-00007.
  49. Forssman L. Distribution of blood flow in myomatous uteri as measured by locally injected 133Xenon. Acta Obstet Gynecol Scand 1976;55(2):101–104. DOI: 10.3109/00016347609156794.
  50. Heinonen PK, Saarikoski S, Pystynen P. Reproductive performance of women with uterine anomalies. An evaluation of 182 cases. Acta Obstet Gynecol Scand 1982;61(2):157–162. DOI: 10.3109/00016348209156548.
  51. Worthen NJ, Gonzalez F. Septate uterus: sonographic diagnosis and obstetric complications. Obstet Gynecol 1984;64(3 Suppl):34S–38S. DOI: 10.1097/00006250-198409001-00009.
  52. Phelan JP. Myomas and pregnancy. Obstet Gynecol Clin North Am 1995;22(4):801–805.
  53. Szamatowicz J, Laudanski T, Bulkszas B, et al. Fibromyomas and uterine contractions. Acta Obstet Gynecol Scand 1997;76(10):973–976. DOI: 10.3109/00016349709034912.
  54. Hasan F, Arumugam K, Sivanesaratnam V. Uterine leiomyomata in pregnancy. Int J Gynaecol Obstet 1991;34(1):45–48. DOI: 10.1016/0020-7292(91)90537-F.
  55. Sheiner E, Biderman-Madar T, Katz M, et al. Higher rates of tachysystole among patients with clinically apparent uterine leiomyomas. Am J Obstet Gynecol 2004;191(3):945–948. DOI: 10.1016/j.ajog.2004.05.060.
  56. Koike T, Minakami H, Kosuge S, et al. Uterine leiomyoma in pregnancy: its influence on obstetric performance. J Obstet Gynaecol Res 1999;25(5):309–313. DOI: 10.1111/j.1447-0756.1999.tb01168.x.
  57. Vergani P, Locatelli A, Ghidini A, et al. Large uterine leiomyomata and risk of cesarean delivery. Obstet Gynecol 2007;109(2 Pt 1):410–414. DOI: 10.1097/01.AOG.0000250470.78700.f0.
  58. Michels KA, Velez Edwards DR, Baird DD, et al. Uterine leiomyomata and cesarean birth risk: a prospective cohort with standardized imaging. Ann Epidemiol 2014;24(2):122–126. DOI: 10.1016/j.annepidem.2013.10.017.
  59. Kupesic S, Plavsic BM. Sonography of uterine leiomyomata. In: Uterine Leiomyomata. Pathogenesis and Management, 1st ed., London, UK: Taylor & Francis; 2006. pp. 139–151.
  60. Stephenson SR. Benign diseases of female pelvis. In: Diagnostic Medical Sonography: Obstetrics and Gynecology, 3rd ed., Baltimore, MD; Philadelphia, PA: Wolters Kluwer, Lippincott Williams and Wilkins; 2012. pp. 175–211.
  61. Stewart EA, Nowak RA. New concepts in the treatment of uterine leiomyomas. Obstet Gynecol 1998;92(4 Pt 1):624–627. DOI: 10.1016/S0029-7844(98)00243-9.
  62. Vizza E, Motta PM. The skeleton fibrous and muscolar of the uterus. In: CIC Edizioni Internazionali ed. Atti LXXVII Congresso SIGO. S.r.l. Rome: CIC Edit Int.; 2001. pp. 47–49.
  63. Kupesic Plavsic S, Montgomery L, Tullius TG, et al. Uterine fibroids. In: Kupesic Plavsic S, ed. Step by Step through OB GYN Case Studies, 1st ed., London, New Delhi, Panama City, St. Louis: Jaypee; 2014. pp. 183–199.
  64. Kupesic S, Kurjak A, Baston K. Color Doppler and three-dimensional ultrasound of the uterine lesions. In: Kupesic S, ed. Color Doppler and Three-Dimensional Ultrasound in Gynecology, Infertility and Obstetrics. New Delhi: Jaypee Brothers; 2011. pp. 22–33.
  65. Kupesic Plavsic S, Honemeyer U, Kurjak A. Uterine lesions: advances in ultrasound diagnosis. In: Donald School Textbook of Ultrasound in Obstetrics and Gynecology Kurjak A, Chervenak F, ed. London, New Delhi, Panama City, St. Louis: Jaypee Brothers Medical Publishers Ltd; 2017. pp. 838–859.
  66. Kupesic Plavsic S, Sparac V. Submucosal uterine fibroid. In: Reddy SY, Mendez M, Kupesic Plavsic S., ed. Illustrated OB GYN Problems, 1st ed., New Delhi, London, Philadelphia, Panama: Jaypee Brothers Medical Publishers Ltd; 2018. in press.
  67. Padilla O, Arya S, Noble LS, et al. Saline infusion sonography: tips and tricks for improved visualization of the uterine cavity. Donald School J Ultrasound Obstet Gynecol 2018;12(1):1–20. DOI: 10.5005/jp-journals-10009-1545.
  68. Kurjak A, Kupesic S, Jukic S. Successful differentiation between fibroid and uterine sarcoma by TVCD. Fifth World Congress of Ultrasound in Obstetrics and Gynecology. Book of abstracts. Ultrasound Obstet Gynecol 1995;6(Suppl 2):112.
  69. Kupesic S, Kurjak A. Color Doppler assessment of uterine leiomyoma and sarcoma. In: Kurjak A, Kupesic S, ed. An Atlas of transvaginal color Doppler. London-New York: Parthenon Publishing; 2000. p. 179.
  70. Honemeyer U, Ross RJ, Barnard J, et al. Recurrent leiomyomatosis disseminata: sonographic and laparoscopic correlation. Donald School J Ultrasound Obstet Gynecol 2012;6(3):327–332. DOI: 10.5005/jp-journals-10009-1256.
  71. Kidron D, Berheim J, Aviram I, et al. Resistance to blood flow in ovarian tumors: correlation between resistance index and histological pattern of vascularization. Ultrasound Obstet Gynecol 1999;13(6):425–430. DOI: 10.1046/j.1469-0705.1999.13060425.x.
  72. Prompuntagorn C, Saldivar JS, Kupesic Plavsic S. Ultrasound assessment of ovarian function following radiation therapy. Donald School J Ultrasound Obstet Gynecol 2014;8(3):288–292. DOI: 10.5005/jp-journals-10009-1367.
  73. Kupesic S, Kurjak A, Bjelos D. The assessment of uterine lesions. In: Kurjak A, Kupesic S, ed. Clinical Application of 3D Sonography. London-New York: Parthenon Publishing; 2000. pp. 55–67.
  74. Kurjak A, Kupesic S, Shalan H, et al. Uterine sarcoma: a report of 10 cases studied by transvaginal color and pulsed Doppler sonography. Gynecol Oncol 1995;59(3):342–346. DOI: 10.1006/gyno. 1995.9965.
  75. Kupesic S, Kurjak A. Uterine sarcoma. In: Kurjak A, Fleischer A, ed. Doppler Ultrasound in Gynecology. New York: Parthenon Publishing; 1998. pp. 125–132.
  76. Ortiz C, Mendez MD, Padilla O, et al. Leiomyosarcoma. In: Reddy SY, Mendez M, Kupesic Plavsic S, ed. Illustrated OB GYN Problems, 1st ed., New Delhi, London, Philadelphia, Panama: Jaypee Brothers Medical Publishers Ltd; 2018, in press.
  77. Ljubic A, Bozanovic T. Uterine fibroid. In: Donald School Textbook of Ultrasound in Obstetrics and Gynecology Kurjak A, Chervenak F, ed. London, New Delhi, Panama City, St. Louis: Jaypee Brothers Medical Publishers Ltd; 2017. pp. 859–874.
  78. Exacoustos C, Romanini ME, Amadio A, et al. Can gray-scale and color Doppler sonography differentiate between uterine leiomyosarcoma and leiomyoma? J Clin Ultrasound 2007;35(8):449–457. DOI: 10.1002/jcu.20386.
  79. Aragon L, Terreros D, Ho H, et al. Ultrasound imaging of ovarian angiosarcoma. J Clin Ultrasound 2011;39(6):351–355. DOI: 10.1002/jcu.20821.
  80. Rackow BW, Taylor HS. Submucous uterine leiomyomas have a global effect on molecular determinants of endometrial receptivity. Fertil Steril 2010;93(6):2027–2034. DOI: 10.1016/j.fertnstert.2008.03.029.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.