With endometriosis, it’s impossible to know your patient’s odds of getting pregnant until she tries. But this common condition is considered a negative influencing factor—and the likelihood of fertility issues increases with the severity of the disease. That’s why early diagnosis and management are critical for women who want to start a family, and experts insist that ultrasound leads to more information and better understanding.

“The most important thing is to diagnose the early disease, but it’s not easy because mild endometriosis is difficult to recognize. So, we have to be on alert if a patient has any symptoms—and learn to detect endometriosis from small signs that can be seen on ultrasound,” said expert gynecologist, Caterina Exacoustos, M.D. from the University of Rome.

Dr. Exacoustos favors high-quality ultrasound as a first-line modality in detection of endometriosis because she says laparoscopy can’t always be the gold standard for diagnosing the condition. She’s backed by a growing body of evidence that supports the use of ultrasound in the diagnosis and surgical planning for endometriosis.² Studies show endometriomas can easily be detected through transvaginal ultrasound—and imaging can provide a comprehensive depiction of deep infiltrating endometriosis lesions in the pelvic and subperitoneal areas, not easily accessible laparoscopically.³

“It’s the first tool that we can see inside the uterus, pelvis, bladder and rectum. You can see more with ultrasound than with laparoscopy, and it’s much more accurate. 3D is much better in the diagnosis of adenomyosis, which is a very important factor affecting fertility,” Dr. Exacoustos stressed.

To help find answers, Dr. Exacoustos utilizes specialized tools available on Voluson™ technology. The ultrasound, by GE Healthcare, features Advanced VCI with OmniView—which can improve contrast resolution and visualization in any image plane, even irregularly shaped structures—making it easier to confirm a presumptive diagnosis. The Voluson systems also enable you to confidently evaluate the uterine cavity and determine tubal patency by performing detailed hysterosalpingo-contrast-sonography (HyCoSy).

When it comes to endometriosis, the power of ultrasound is also demonstrated in the real-time dynamic technique known as ‘sliding sign.’ By moving your probe, you can determine if the posterior cervix-uterus glides freely across the bowel. It indicates pouch of Douglas involvement and obliteration—which suggests DIE of the rectum. In fact, a systematic review and meta-analysis determined ultrasound was effective in the preoperative diagnosis of bowel endometriosis with pooled estimates of 91% sensitivity and 98% specificity.⁵

That research was led by respected endometriosis and infertility surgeon, Gernot Hudelist M.D. P.D., M.Sc, of St. John of God Hospital in Vienna. He believes ultrasound offers valuable predictors that help ensure patients are treated in the right place, by surgeons with the right skills—for the best care.

“You have to triage patients with pelvic pain into extensive disease patients who have to go to tertiary centers versus patients with a minor disease who can be treated in other places. Transvaginal ultrasound allows a noninvasive picture that gives us a very quick and accurate idea of the possibility of extensive disease. It gives us a much better idea of the extent of the problem,” Dr. Hudelist said.

Ultrasound enables you to map out the disease and coordinate interdisciplinary procedures to optimize results. Imaging can also influence patient consent and help you predict possible outcomes.

“You will be able to tell the patient how high the chances will be to achieve a pregnancy if you do this or that. And if the surgery goes right—you can talk about what the main outcome will be regarding pain issues, what the outcome will be regarding spontaneous conception rates, what the outcome will be in case she will undergo IVF.”

Even with all the benefits, Dr. Hudelist says it’s rare for surgeons to perform ultrasound. He calls it ‘the missing link,’ and believes too many of his colleagues go into the operating room blind.

“I think there are a lot of surgeons who don’t know at the beginning what they’re going to get. Some of them are able and capable to solve it. Some of them are not. The approach should be to verify the possibility of disease non-surgically with ultrasound, to triage patients adequately, and to take them to theaters with a concept—with a plan.”

For Dr. Hudelist and Dr. Exacoustous, it’s simple. The more you know, the more you can prepare. And when a woman’s fertility is at stake—that information could change everything.