You require to know the indication for the gynecological scan and it is essential to take a relevant clinical history beforehand.

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Address the patient by her preferred name and avoid terms of endearment such as love dear or lass. Your examination should be skillful and gentle. You should be alert to any discomfort or pain experienced by the patient. Explain to the patient what you are doing and what is being seen on the screen. If the woman becomes distressed ask if she wishes you to pause or stop the examination.

Always maintain professionalism and avoid personal remarks relating to body appearance such as suntans, tattoos or piercing.

It is important to be aware of certain practicalities when undertaking a gynecological ultrasound examination because a transvaginal scan will normally be required. Explain to the patient what the examination entails. Obtain verbal consent by asking the patient if she is happy with the explanation and willing for you to proceed. A chaperone is a witness to what is happened is also a source of support. Facilities should be available for the woman to change in privacy and comfort. She may need some guidance and help, particularly if elderly. A gown or sheet should be available to maintain dignity and the patient should not be left undressed for long. The procedure should be undertaken in a private setting, preferably in a room which can be locked to avoid unexpected intrusion.

GYNECOLOGY IN ULTRASOUND

Acsites is a collection of abdominal fluid within the peritoneal cavity.

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Uterine assessment by hysteroscopy.

Serum hormonal evaluation of FSH, LH, prolactin and thyroid hormones.

A physical examination for thyroid abnormalities and pelvic examination for the condition of the external Instruments and reproductive organs.

DIAGNOSIS OF INFERTILITY
A thorough and detailed history is essential for an accurate diagnosis. The assessment should include age, body mass index, occupation, menstrual cycle pattern, use of contraceptives, previous infections, coital frequency, history of infertility in the family, surgeries undergone and previous infertility treatment.

¤ Unexplained causes.

¤ Psychological dysfunction.

¤ Mechanical trauma to external Instruments.

¤ Immunologic factors like presence of antisperm antibodies.

¤ Ejaculatory dysfunction like retrograde ejaculation, Ejaculatory failure and neurologic impairment

¤ Infections like gonorrhea/chlamydia, prostatitis and epididymitis.

¤ Anatomic factors like varicocele, cryptorchidism and congenital anomalies like hypospadias. Endocrine factors like Cushing's disease, acromegaly and pituitary tumour.

MALE
¤ Semen containing no sperm (azoospermia), or few sperm (oligospermia), poor quality sperm (asthenospermia) or a high percentage of abnormal sperm (teratospermia) or a combination of these conditions.

Unexplained causes: Other causes are obesity, hormonal imbalances like hyperprolactinemia, hypothyroidism, immunological causes like presence of antisperm antibodies, vaginal infections and some unknown causes.

Cervical factors: Cervical causes may be related to poor quality or quantity of cervical mucus, cervical stenosis and varicosities of the cervical canal, all of which inhibit the migration of sperm through the cervical mucus. Endocervical polyps and cervical fibroids can obstruct os.

Luteal phase defect: LPD occurs when the corpus luteum secretes an inadequate amount of progesterone. There are many causes for LPD but the end result is that the endometrium is not adequately prepared for implantation and nourishment of the fertilized embryo leading to infertility.

Ashermans Syndrome is also known as Uterine Synechiae.

Uterine factors: The uterine factors could be anatomical abnormalities like the presence of septum and polyps or fibroids which distort the uterine cavity and affects implantation. Also Asherman's Syndrome which is intrauterine adhesions and tubercular endometritis also affects fertility.

Advanced age: The fertility potential is maximum around 24years of age. The fertility potential begins to decline by age 30 and accelerates by age 35. With advancing age there is a decline in ovarian reserve and quality of the oocytes. It is also thought that diminished endometrial receptivity with advancing age may play a role.

Endometriosis: This is a condition in which the endometrium proliferates and spreads outside the uterus. The fertility is affected depending on the severity of the condition.

Tubal failure: The tubes may become blocked as a result of scarring due to pelvic infection, appendicitis peritonitis or previous abdominal surgery or due to fibroids.

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