ACR appropriateness Criteria® infertility

Area of Science:

• Radiology
• Women's Health
• Reproductive Medicine

Background:

• Infertility affects a significant portion of women, with various underlying causes.
• Accurate diagnosis of infertility causes is crucial for effective treatment.
• Imaging plays a pivotal role in the infertility workup.

Purpose of the Study:

• To outline appropriate imaging modalities for evaluating female infertility based on clinical suspicion.
• To provide guidance on selecting the optimal imaging technique for specific infertility-related conditions.
• To highlight the role of imaging in diagnosing causes of anovulatory infertility, endometriosis, tubal occlusion, recurrent pregnancy loss, and pituitary abnormalities.

Main Methods:

• Review of the American College of Radiology Appropriateness Criteria.
• Evidence-based guidelines developed through multidisciplinary expert panel review.
• Analysis of current medical literature and consensus methodology (modified Delphi).

Main Results:

• Transvaginal ultrasound is recommended for assessing polycystic ovary syndrome (PCOS).
• MRI and pelvic ultrasound are valuable for suspected endometriosis.
• Hysterosalpingogram (HSG) is the preferred method for evaluating suspected tubal occlusion.
• Saline infusion sonohysterography, MRI, and 3-D ultrasound are appropriate for anatomical causes of recurrent pregnancy loss (RPL).
• MRI is the imaging exam of choice for pituitary gland assessment.

Conclusions:

• The selection of imaging for infertility workup should be guided by clinical suspicion and the suspected underlying cause.
• Specific imaging modalities are most appropriate for diagnosing distinct causes of infertility, including PCOS, endometriosis, tubal factors, uterine anomalies, and pituitary issues.
• Adherence to evidence-based guidelines ensures appropriate and effective utilization of imaging in female infertility evaluation.