Static and cine imaging offers clues to female infertility

Female infertility accounts for two-thirds of all infertility problems, and it can be due to tubal, ovarian, and/or uterine factors. Tuboperitoneal disease is thought to be a contributing factor to infertility for up to 40% of infertile couples. Imaging-led evaluations of infertility focus primarily on the uterine cavity and fallopian tubes. Transvaginal ultrasound plays a vital role. Hysterosalpingography provides information on the uterine cavity and fallopian tubes, including whether the fallopian tubes are patent. MRI is used as a problem-solving modality when ultrasound findings are inconclusive.1 Its excellent tissue contrast allows several conditions to be diagnosed precisely. Known disadvantages include the higher cost, longer scanning time, and restrictions on its use in women during the early stages of pregnancy. MRI is, however, noninvasive, and its findings can influence the treatment of infertile patients. Practitioners seeking to evaluate the cause of infertility on MRI should be familiar with female genital development as well as normal uterine MRI findings. Female genital organs originate from the paired mullerian ducts. The lower portions of the ducts fuse to form the uterus and upper third of the vagina at around nine to 12 weeks of fetal development. The lowest portion of the upper vagina then fuses with the lower vagina, which develops from the vaginal plate of the urogenital sinus. The upper portions of the mullerian ducts remain separate and form the fallopian tubes. The wollfian ducts will have regressed during this period. The normal uterus is seen as three zones on T2-weighted MRI. These are the endometrium (bright), the junctional zone (distinct low intensity), and the myometrium (higher intensity). The internal and external os, the cervical canal, and the anterior and posterior vaginal fornices all show clearly just behind the urinary bladder and the urethra.