During the past three decades, major improvements have been made in the treatment and cure of certain hematological malignancies, as well as solid tumors in young patients. As a result of improved survival, attention has been turned to the long-term physical and psychological sequelae of treatment. The loss of fertility in males and premature menopause in females are important and common long-term side effects of curative radio- and chemotherapy. The frequency of fertility failure varies with the type, dose, duration of radio- and chemotherapy, and age of patient. Currently, there are no good estimates of the magnitude of the risk involved in relation to these factors. However, the combination of hormonal values, pubertal staging and the ultrasonography and Doppler analyses of the gonads may noninvasively study the subtle modification following anticancer therapies. This could help to find new insights on potential preventive acts before initiation of the anticancer therapy, and hopefully, the restoration of fertility after treatment.

The usefulness of the vascular ultrasound in the filed of gynecology is now well recognized. The intima-media thickness (IMT) and the elastic property of the common carotid artery are reported to be associated with the risk of cardiovascular diseases and are thought to be influenced by menopause. The assessment of the flow-mediated vasodilation (FMD) of the brachial artery is a noninvasive method for the evaluation of vascular endothelial function and is reported to be associated with menopause or hormone replacement therapy. Certain gynecological situations such as contraceptive use or hormone replacement therapy are reported to increase the risk of thrombosis. For the screening of deep vein thrombosis of the lower extremities in the gynecological diseases, compression ultrasonography (CUS) is useful.

Ultrasonography is a well-established imaging modality for evaluation of gynecologic tumors. In recent years, more sophisticated technologies like the use of intravascular contrast agents led to an improvement in the ability of the practitioner to differentiate benign from malignant masses. When we consider the safety of contrast-enhanced ultrasonography in obstetrics and gynecology, we must discuss about the effect of ultrasound contrast media on embryo and fetus. The use of ultrasound contrast media in pregnant women always concerns in the obstetricians because of the principle of not exposing a fetus to any drug. Therefore, the literature was reviewed for information about those safety and efficacy because of the uncertainty about the use of contrast media during pregnancy. Based on the limited information available, mutagenic and teratogenic effects have not been described after administration of ultrasound contrast media. No effect on the fetus has been seen after contrast media. The small potential risk associated with the nonthermal bioeffects via acoustic cavitation may be considered to prohibit the use in first trimester pregnant women. In previous studies including human trials, no evidence of adverse effect was reported. Contrast-enhanced ultrasonography could prove a useful adjunct in multiple gestations and in evaluation of uteroplacental circulation. It appears to be very promising potential in obstetrics.

Transabdominal ultrasonography was initially used for the investigation of overt abdominal swellings and much later for the detection of early ovarian cancer in asymptomatic women. The technique was undoubtedly of value for detecting transient, persistent and overt ovarian cysts. Subsequently, the resolving power of pelvic ultrasonography was increased substantially by the advent of transvaginal probes. This revolutionary development was first applied to systemic studies of overt ovarian masses in patients awaiting surgery. Over the past decade, several ultrasound-based morphological scoring systems, color Doppler parameters, logistic regression models have been proposed and tested in order to try to predict the histology of ovarian tumors. On prospective testing, no standard criterion has been published. Therefore, it is important for each operator to establish their own criteria based on individual recognition potential.

Ultrasonographic changes of endometrium, ovaries and salpinges detected by realtime B-mode and 3D ultrasound indicate effective treatment of infertility not only in the Assisted Reproduction Technology (ART) but also in the conventional management where essential plan for the therapy is indicated. The articles concerning ultrasonographic assessments of fecundity and infertility are reviewed. Although the ART has become ordinary treatment of infertility, the pregnancy rate is yet unsatisfactory and it is important to select cycles where favorable conception is predicted in order to increase pregnancy rate in ART. Although antral follicle count (AFC) is the index for predicting ovarian response to human menopausal gonadotropin (hMG) stimulation, it is able to select stimulation options for a poor responder of low AFC value. Since three-dimensional (3D) ultrasonography with power Doppler angiography (PDA) indicates an organ blood flow as a whole, they are important tools for the evaluation of perfusion. The assessment of perifollicular blood flow in preovulatory follicles may be useful for predicting conception and cancelling in vitro fertilization (IVF) in poor vascularity cycle. Since rich endometrial vascularity assessed by 2D and 3D flow signs and the low impedance to flow suggests well perfused endometrium and the high receptivity in the embryo transfer (ET), and vice versa, it would be recommended to limit the number of embryos for the ET in the high receptivity, while to cryopreserve the embryo in case of bad flow signs and wait the cycle of favorable perfusion in order to successfully transfer the embryo.

Our aim was to describe the corpus luteum morphology by two-dimensional ultrasound correlated by its vascularization and volume by 3D ultrasound and study the possible relationship between serum progesterone levels and the corpus luteum morphology.

Thirty-eight women were included in an intrauterine insemination program (IUI) in Santa Cristina University's Hospital. All the patients were evaluated in mesoluteal phase, the day +7 after hCG administration, by two-dimensional and three-dimensional ultrasound. The volume and vascular indices of the corpus luteum were calculated off-line using virtual organ computer-aided analysis (VOCAL^TM) software.

Four different morphologies were described in the corpus luteum: echo-positive, echo-negative or sonoluscent, mixed echogenicity or nonvisible. Corpus luteum with mixed echogenicity was the most frequent one with 37.5% (12 cases). The corpus luteum vascular indices change in each morphology type, but there was statistically significant association just in vascularization index between echo-negative and mixed echogenicity corpus luteum morphologies, with p = 0.034. The rest of vascular indices do not change in each morphology corpus luteum types. There was statistically significant difference in mean gray value between echo-negative and mixed echogenicity morphologies, with p = 0.007. There were no statistically significant correlations between the corpus luteum morphology and the corpus luteum volume of any of the different types. There either was no statistically significant correlation between the corpus luteum morphology and progesterone serum levels on day +7 postovulation.

The mixed echogenicity corpus luteum morphology has more vessels and more cell mass than echo-negative ones. Progesterone serum levels in mid-luteal phase has no influence in corpus luteum morphology and vascularization.

Monitoring of individual follicles during the menstrual cycle demonstrates in a noninvasive way the changes in their number and position during the early and the late follicular phase and the luteal phase. The differences in relations between the follicles near the dominant follicle can be demonstrated with the same technique using 3D reconstruction of the ovary.

An increased perifollicular blood flow can be measured in the perifollicular period using color and pulsed Doppler. Automated estimation of blood volume around the ovarian follicles brought a new concept to this area. Results confirm the observation that vascularity around the follicle is intense in the periovulatory period. The blood volume does not differ between follicles containing an oocyte and those with no oocyte in the aspirate, or a nonfertilizable oocyte. From our results we can hypothesize that those follicles containing oocytes able to produce pregnancy have a more uniform perifollicular vascular network .

Recognition of the follicle growth pattern has a prognostic value for the outcome of assisted reproduction methods. Follicular diameter and changes in growth patterns are more important than follicular wall thickness as parameters having an impact on clinical success.

Using autoradiography, transmission and raster electron microscopy, this review shows how oocytes disappear in human ovaries.

Clinical, hormonal and ultrasound (using 3D, vocal and inverse mode) parameters used in the diagnosis of early ovarian aging are described on the light of the most recent knowledge.