Transvaginal Ultrasonographic Assessment Research Articles

Type and Location of Adenomyosis in Women with Recurrent Pregnancy Loss: A Transvaginal Ultrasonographic Assessment.

The current knowledge on adenomyosis as a risk factor for RPL is very scant. Overall 120 women were included in this retrospective observational study. They were divided in three groups each of which consisted of 40 subjects: Group 1: women with RPL who were diagnosed to have adenomyosis on transvaginal ultrasound (TVS); Group 2: patients with RPL without ultrasonographic findings of adenomyosis; Group 3: patients with ultrasound diagnosis of adenomyosis without RPL and at least one live birth pregnancy. The copresence of endometriosis was also investigated. Among women with RPL, patients with adenomyosis (Group 1) had higher number of pregnancy losses (p = 0.03) and lower age at first pregnancy loss (p = 0.03) than women without adenomyosis (Group 2). Moreover, they had more frequently primary RPL (p = 0.008). Adenomyosis of the inner myometrium was found more frequently (p = 0.04) in patients of Group 1 than in patients of Group 3 in which adenomyosis was mainly in the outer myometrium (p= 0.02). No differences were found in the severity of adenomyosis between these two groups of women. TVS findings for endometriosis were observed more frequently in women with adenomyosis without RPL (Group 3) than in the other two groups of patients. Adenomyosis can be a factor involved in RPL. Differences in adenomyosis localization are associated with different risks for RPL. Patients with RPL should be investigated for the presence of adenomyosis and also for the type and localization of the disease in the different myometrial layers.

Transvaginal Ultrasonographic Assessment of Lower Uterine Segment Thickness and Prediction of Uterine Rupture In Cases of Vaginal Birth After Caesarean Delivery

Background: The rise in elective CSs, which make about one-third of all CSs, is primarily to blame for the rise in the Cesarean birth rate. Objective: To assess the strength of the association between transvaginal ultrasonographic measurement of the lower uterine segment in women with prior one CS undergoing a trial of vaginal birth and uterine scar defect at delivery. Patients and Methods: A retrospective observational study was conducted at Al Ahrar Zagazig Teaching Hospital during the period from June 2018 through June 2020. The lower uterine segment thickness was measured transvaginal ultrasonography in 60 gravid as (36 week – 40 week) with previous one CS undergoing VBAC, and the scar was evaluated during delivery. Results: Uterine dehiscence was found in 4 cases (6.7%). There were no cases of uterine rupture. There was significant correlation between the grade of scar and sonographic measurement of LUS thickness using trans-vaginal ultrasound (p value= 0.001).The scar thickness in the third trimester (36-40 week) had a significant relation with the mode of delivery. 2.4 mm was considered the critical cutoff value of the LUS thickness above which safe vaginal delivery can be achieved. This critical cutoff value was derived from the ROC curve with sensitivity, specificity, PPV, and NPV 75.0%, 85.7%, 27.3%, and 98.0%, respectively. Conclusion: Measurement of the lower uterine segment thickness by TVS seems to be a good screening test with its obviously high sensitivity and negative predictive value. LUS thickness of

Value of Transvaginal Ultrasonographic Assessment of Cervical Length in Predicting Duration of Second Trimester Pregnancy Termination

Value of Transvaginal Ultrasonographic Assessment of Cervical Length in Predicting Duration of Second Trimester Pregnancy Termination

Transabdominal and transvaginal ultrasonographic assessment of lower uterine segment thickness in pregnant women before repeat cesarean section

Transabdominal and transvaginal ultrasonographic assessment of lower uterine segment thickness in pregnant women before repeat cesarean section

Prediction of Admission to Delivery Time by Transvaginal Ultrasonographic Assessment of the Cervix in Cases of Preterm Prelabour Rupture of Membranes

Background: Preterm Premature Rupture of Membranes (PPROM) heralds about 30% of cases with spontaneous preterm births. Latency in PPROM is delineated as the time interval between PROM and delivery. It might be beneficial to predict this latency period as it may help to make a decision concerning in-utero transfer of fetus to better neonatal centers with advanced facilities and to administer corticosteroids in favor of fetal lung maturity. Objective: The aim of the current study was to assess the usefulness of measuring the cervical parameters by transvaginal sonography mainly cervical length and posterior cervical angle, in predicting the interval from admission to delivery in women with (PPROM). Subjects and methods: This study was conducted at Kafr El- Shiekh General Hospital and Al-Azhar University Hospitals and included 100 pregnant women with a singleton pregnancy of gestational age between 28-34 weeks and PPROM presenting within 24 hours and not in labour. Results: showed non-significant differences between the mean of PCA among different groups (P>0.05). Nevertheless, the results indicated that amniotic fluid index (AFI) increased significantly in patients with latency period >7days group (P<0.001). Furthermore, the mean Cervical length (CL) was observed to increase in PPROM patients’ group with high latency period. The latency period had significant positive correlation with AFI and cervical length (p<0.05). Also, it had significant negative correlation with birth weight, gestational age at hospitalization, CRP, and TLC, and neonatal sepsis (p<0.05). Conclusion: It could be concluded that assessment of Cervical length via transvaginal sonography is a valuable tool in the evaluating the interval between rupture of membranes and delivery in women with PPROM.

Prediction of Admission to Delivery Time by Transvaginal Ultrasonographic Assessment of the Cervix in Cases of Preterm Prelabour Rupture of Membranes

Background: Preterm Premature Rupture of Membranes (PPROM) heralds about 30% of cases with spontaneous preterm births. Latency in PPROM is delineated as the time interval between PROM and delivery. It might be beneficial to predict this latency period as it may help to make a decision concerning in-utero transfer of fetus to better neonatal centers with advanced facilities and to administer corticosteroids in favor of fetal lung maturity. Objective: The aim of the current study was to assess the usefulness of measuring the cervical parameters by transvaginal sonography mainly cervical length and posterior cervical angle, in predicting the interval from admission to delivery in women with (PPROM). Subjects and methods: This study was conducted at Kafr El- Shiekh General Hospital and Al-Azhar University Hospitals and included 100 pregnant women with a singleton pregnancy of gestational age between 28-34 weeks and PPROM presenting within 24 hours and not in labour. Results: showed non-significant differences between the mean of PCA among different groups (P>0.05). Nevertheless, the results indicated that amniotic fluid index (AFI) increased significantly in patients with latency period >7days group (P<0.001). Furthermore, the mean Cervical length (CL) was observed to increase in PPROM patients’ group with high latency period. The latency period had significant positive correlation with AFI and cervical length (p<0.05). Also, it had significant negative correlation with birth weight, gestational age at hospitalization, CRP, and TLC, and neonatal sepsis (p<0.05). Conclusion: It could be concluded that assessment of Cervical length via transvaginal sonography is a valuable tool in the evaluating the interval between rupture of membranes and delivery in women with PPROM.

Non-Invasive Prediction of Histologic Chorioamnionitis in Women with Preterm Premature Rupture of Membranes.

PurposeTo develop a model based on non-invasive clinical and ultrasonographic parameters for predicting the likelihood of subsequent histologic chorioamnionitis in women with preterm premature rupture of membranes (PPROM) and to determine whether the inclusion of invasive test results improves the predictive value of the model.Materials and MethodsThis retrospective cohort study included 146 consecutive women presenting with PPROM (20–33 weeks). Transvaginal ultrasonographic assessment of cervical length was performed. Maternal serum C-reactive protein (CRP) levels and white blood cell (WBC) counts were measured after amniocentesis. Amniotic fluid (AF) obtained by amniocentesis was cultured, and interleukin-6 (IL-6) levels and WBC counts were determined. The primary outcome measure was histologic chorioamnionitis.ResultsRisk scores based on serum CRP concentrations and gestational age (model 1) were calculated for each patient. The model was shown to have adequate goodness of fit and an area under the receiver operating characteristic curve (AUC) of 0.742. When including AF test results (e.g., AF IL-6 levels) in model 1, serum CRP concentrations were found to be insignificant, and thus, were excluded from model 2, comprising AF IL-6 levels and gestational age. No significant difference in AUC was found between models 1 and 2.ConclusionFor women with PPROM, the newly developed model incorporating non-invasive parameters (serum CRP and gestational age) was moderately predictive of histologic chorioamnionitis. The inclusion of invasive test results added no predictive information to the model in this setting.

500: Non-invasive prediction of chorioamnionitis in women with preterm premature rupture of membranes

with preterm premature rupture of membranes Kyo Hoon Park, Shi Nae Kim, Eun Ha Jeong, Sung Youn Lee, Aeli Ryu, Kyung Joon Oh Seoul National University College of Medicine, Seoul National University Bundang Hospital, Department of Obstetrics and Gynecology, Seongnam-si, South Korea OBJECTIVE: To develop a model based on non-invasive clinical and ultrasonographic parameters to predict the probability of subsequent chorioamnionitis in women with preterm premature rupture of membranes (PPROM), and to determine if additional invasive test results improve the prediction of subsequent chorioamnionitis based on the non-invasive model. STUDY DESIGN: Transvaginal ultrasonographic assessment of cervical length was performed and maternal serum C-reactive protein (CRP) and white blood cell (WBC) count were determined immediately after amniocentesis in 106 consecutive women with PPROM at 23 0/7-33 6/7 weeks of gestation. Amniotic fluid (AF) obtained by amniocentesis was cultured and interleukin-6 (IL-6) levels and WBC counts were determined. Outcome measures were histologic and clinical chorioamnionitis. The placentas were examined histologically for presence of chorioamnionitis and women were evaluated for evidence of clinical chorioamnionitis. RESULTS: The non-invasive model (model 1) for prediction of histologic chorioamnionitis included serum C-reactive protein (CRP), gestational age, and parity. The model was shown to have an adequate goodness of fit, and the area under the receiver operating characteristic curve (AUC) was 0.756. When adding AF IL-6, AF culture, and AF WBC as invasive markers to the non-invasive model, serum CRP and parity were excluded from the final model (model 2) as not significant, whereas AF IL-6 and gestational age remained in model 2. No significant difference in AUC was found between models 1 and 2. For the outcome of clinical chorioamnionitis, no parameters studied could be identified to predict women at high risk for its development, although the association with AF culture results was borderline statistically significant (P 0.055). CONCLUSION: In women with PPROM, the non-invasive model based on serum CRP, gestational age, and parity was shown to be moderately predictive of developing histologic chorioamnionitis. However, invasive test results did not add predictive information to the non-invasive model in this setting.

Transvaginal ultrasonographic assessment of cervical length following mid-trimester loss of one twin

A 33-year-old woman, G3P0+2, dichorionic, diamniotic twin pregnancy who conceived following IVF treatment presented to the antenatal day assessment unit at 19+1 weeks' gestation with contractions, ...

Transvaginal ultrasonographic measurement of cervical length in predicting intra-amniotic infection and impending preterm delivery in preterm labor: a comparison with amniotic fluid white blood cell count

To determine whether sonographic measurement of cervical length predicts intra-amniotic infection and impending preterm delivery (within 7 days of amniocentesis) in women with preterm labor and intact membranes, and to compare the predictability with that of amniotic fluid (AF) white blood cell (WBC) count. Transvaginal ultrasonographic assessment of cervical length was performed immediately after amniocentesis in 67 consecutive women with preterm labor. AF obtained by amniocentesis was cultured for aerobic and anaerobic bacteria and for Mycoplasmas, and WBC count was determined. Patients with a positive AF culture had a significantly shorter median cervical length, higher median AF WBC count, and lower median gestational age at delivery than did those with a negative AF culture. Multivariate analysis indicated that only the AF WBC count bears a significant relationship with the presence of intra-amniotic infection, whereas only cervical length correlates with impending preterm delivery. Transvaginal sonographic measurements of cervical length are a valuable method for predicting intra-amniotic infection as well as impending preterm delivery in women with preterm labor. However, in comparison with AF WBC, cervical length is less predictive for intra-amniotic infection, whereas cervical length demonstrates better predictability of impending preterm delivery.

Transvaginal ultrasonographic assessment of the expulsion rate of intrauterine devices inserted in the immediate postpartum period: a pilot study

Objective To compare the expulsion rates of intrauterine devices (IUDs) inserted in the immediate postpartum after vaginal birth and cesarean section. Methods Nineteen patients who had a vaginal birth and 19 patients who had a cesarean section at Hospital de Clínicas de Porto Alegre, Brazil, were selected for copper T 380A IUD insertion. With the aim of detecting clinically unnoticed dislodged devices, ultrasound examinations were performed at 1 month and between 3 and 12 months after delivery. The IUDs were considered completely expelled when found outside the endometrial cavity (e.g., in the cervical canal) or outside the uterus (in the vagina). Results Expulsion rates were statistically different between the two groups: after a vaginal birth, 50% (ultrasound only) + 27.8% (clinical examination); and post-cesarean section, 0% (p<.001; OR 5.75, 95% CI 2.36–14.01). Conclusion Considering that the contraceptive efficacy of IUDs is associated with their intrauterine location, the high expulsion rates seen when they are inserted immediately after vaginal delivery contraindicate their use in this setting. The use of IUDs immediately after a cesarean section is still a reasonable alternative because its expulsion rate was zero. Ultrasound assessment of IUD positioning performed better than clinical examination, which failed to detect expulsion after postpartum insertion in 75% of the cases (9 from 12 cases).

Funneling to the stitch: an informative ultrasonographic finding after cervical cerclage.

The purpose of this study was to evaluate the utility of ultrasound surveillance after cerclage placement and to propose a rationale for cervical sonography in this setting. This was a retrospective analysis of 53 women undergoing cervical cerclage by a maternal-fetal medicine specialist, regardless of indication, and delivering between January 1999 and April 2001. Transvaginal ultrasonographic assessment of cervical length and the degree of cervical funneling after cerclage were compared to preoperative values and to outcomes including gestational age at delivery. Funneling to the cerclage was defined as membranes prolapsing down the endocervical canal until they reached the plane of the cerclage. Cervical cerclage resulted in a significant increase in cervical length from 2.1 +/- 1.2 cm to 2.9 +/- 0.8 cm after the procedure, P < 0.001; however, this measure was not correlated with gestational age at delivery. Funneling to the level of the cerclage was associated with an earlier gestational age at delivery 31.3 +/- 5.6 weeks vs. 36.8 +/- 2.8 weeks for those cases without this finding, P < 0.001. A statistically significant association between funneling to the cerclage and preterm delivery was identified irrespective of the indication (prophylactic or emergency) for the procedure. When descent of the membranes to the level of the cerclage was noted, it occurred by 28 weeks' gestation in all patients studied. The incidence of premature rupture of the membranes was also significantly greater postcerclage in women with descent of the membranes to the cerclage (52%) compared to those without this finding (9%) P= 0.002. Funneling to the cerclage is significantly associated with earlier preterm delivery in patients who have undergone cervical cerclage. Serial sonography up to 28 weeks' gestation is useful in identifying patients at higher risk for premature rupture of the membranes and preterm delivery.

Ultrasound-indicated cervical cerclage: Outcome depends on preoperative cervical length and presence of visible membranes at time of cerclage

Objective: The purpose of this study was to assess cases of ultrasound-indicated cervical cerclage and to relate preoperative cervical length, operative findings, postoperative cervical length, and pregnancy outcome to establish the appropriate criteria to offer cervical cerclage. Study Design: A prospective observational study comprised 380 women at high risk of preterm labor who underwent serial transvaginal ultrasonographic assessment of cervical length. Seventy-three women had criteria for and underwent cervical cerclage. Data concerning preoperative cervical length, operative findings, postoperative cervical length, and pregnancy outcome were collected. Statistical analysis was performed with Mann-Whitney and Fisher exact tests. Results: There was a significant increase in median cervical length after cerclage, 15.0 versus 25.0 mm (P <.0001). Preoperative cervical length and postoperative upper cervical length were independently better predictors of outcome than postoperative entire cervical length. Fetal membranes were visible in 18% of cases at the time of suture insertion, which was associated with a significantly worse outcome, regardless of preoperative cervical length. Of those 41 women with a very short preoperative cervical length (≤15 mm), outcome was significantly worse in those women with visible fetal membranes at the time of cerclage compared with those women with no visible fetal membranes at the time of cerclage: median gestational age at delivery, 23 weeks versus 37 weeks 4 days (P =.002); suture insertion to delivery interval, 19 days versus 108 days (P =.0004); and fetal survival rates, 50% versus 86% (P =.03). Conclusion: In a high-risk population that undergoes serial transvaginal ultrasound surveillance of cervical length, the presence of visible fetal membranes at the time of suture insertion, regardless of preoperative cervical length, is associated with a poor outcome. Fetal membranes were not visible in any cases with a preoperative cervical length of >15 mm. These findings lend support to a practice of offering cerclage at or above a cervical length of 15 mm. (Am J Obstet Gynecol 2002;187:445-9.)

The role of sonographic assessment of cervical length in the prediction of preterm birth in primigravidae with twin gestation conceived after infertility treatment.

To identify the risk factors for preterm birth in primigravidae with twin gestation and the role of transvaginal ultrasonographic assessment of the cervix. Between January 1996 and December 1996, 54 twin pregnancies were prospectively enrolled. All women were at their first pregnancy. All women conceived following infertility treatments and all had a normal uterine cavity proven by hysterosalpingography (HSG) or hysteroscopy. Multiple logistic regression analysis was used to evaluate the association between the length of the cervix at 18-24 weeks of gestation and outcome variables, controlling for possible confounding factors. The mean +/- SD maternal age was 30.9 +/- 5.3 years (range 22-46), and five of them were aged 40 or more. Nine patients (20.5%) delivered prematurely, defined as spontaneous delivery at or before 34 weeks of gestation. There was no statistically significant difference between women who delivered before or after 34 weeks of gestation in regard to maternal age, body mass index (BMI), weight gain in pregnancy, smoking and work during pregnancy. The mean cervical length of patients who delivered before 34 weeks of gestation (30.1 +/- 6.1 mm) was significantly shorter than that of women who delivered after 34 weeks of gestation (42.2 +/- 6.2 mm; P < 0.001). Cervical length longer than 35 mm predicted delivery after 34 weeks of gestation with sensitivity and specificity of 88.5% and 88.9%, respectively. The positive and negative predictive values were 96.9% and 66.7%. A transvaginal ultrasonographic measurement of the cervix > 35 mm at 18-24 weeks in twin gestation can identify patients at low risk for delivery before 34 weeks. Maternal age, BMI, weights gain, smoking and work during the pregnancy did not influence the duration of the pregnancy.

Ultrasound‐indicated cervical cerclage: operative findings and preoperative cervical length predict outcome

Objectives:  To relate preoperative cervical length, operative findings, postoperative cervical length and pregnancy outcome in high risk women treated with ultrasound indicated cervical cerclage to establish if it was possible to determine the most appropriate criteria to offer cervical cerclage.Study design:  A prospective observational study of 305 high risk women undergoing serial transvaginal ultrasonographic assessment of cervical length during the second trimester. Fifty‐four women met criteria for cerclage (cervical length &lt;15 mm, significant progressive shortening to &lt;25 mm or funneling &gt;50%). Data concerning preoperative cervical length, operative findings, postoperative cervical length and pregnancy outcome was collected, and analyzed data is expressed as median values. Statistical analysis was performed using Fisher's exact and Mann–Whitney U‐tests.Results:  Gestation at delivery was 37 ± 5 weeks, suture insertion to delivery interval was 115 days and overall fetal survival rate was 85.2%. Median preoperative cervical length was 15.0 mm. Median gestation at suture insertion was 19 ± 5 weeks. There was a significant increase in postoperative cervical length 15.0 vs. 25.0 mm (P &lt; 0.0001). Fetal membranes were visible in 19% of cases at the time of surgery, this occurred in 75, 5, and 0% cases with a cervical length &lt;10, 11–15 and &gt;15 mm, respectively. Overall outcome was considerably worse for those cases with visible membranes at the time of surgery than for those with no visible membranes (gestation at delivery 23 ± 0 vs. 38 ± 2 weeks (P = 0.002), suture insertion to delivery interval 17 vs. 122 days (P &lt; 0.0001), fetal survival rates 50 vs. 93% (P = 0.0005)). This finding was regardless of preoperative cervical length (of all women with preoperative cervical length &lt;15 mm (n = 31) gestation at delivery 25 ± 1 vs. 35 ± 5 (P = 0.008), suture insertion to delivery interval 17 vs. 119 days (P = 0.0005), fetal survival rate 50 vs. 90%).Conclusions:  In a high risk population undergoing serial transvaginal ultrasound surveillance of cervical length, regardless of preoperative cervical length, the presence of visible membranes at the time of suture insertion is associated with a poor outcome. Fetal membranes were not visible in any case with a preoperative cervical length &gt;15 mm. These findings support a concept of cervical cerclage at a cervical length of 15 mm.

Follow up of women with simple ovarian cysts detected by transvaginal sonography in the Tokyo metropolitan area.

To investigate the management of women with asymptomatic ovarian masses, to determine the appropriate duration of follow up, and to identify diagnostic indicators of growing cysts. Review of women's hospital records. Tokyo Metropolitan Cancer Detection Center, Japan. Two hundred and twenty-five pre- and postmenopausal women with a diagnosis of ovarian cyst < 6 cm in diameter and normal serum level of CA125, diagnosed between 1 October 1990 and 25 December 1991. Change in size of cyst as shown by ultrasound. Seventy-five months after initial diagnosis, 29 (13%) of the masses had progressed, 31 (14%) had persisted, and 165 (73%) had regressed. One hundred and nine masses (48%) had regressed within six months of the initial diagnosis. In univariate analysis transvaginal ultrasonographic assessment of morphology findings, cyst diameter, carcinoembyronic antigen (CEA) and CA19-9 were associated with the prognosis of the cyst. Multivariate regression analysis demonstrated that only the initial serum CA19-9 level and serum CEA level were significant predictors of ovarian masses that regressed (P for trend = 0.004 and 0.02, respectively). Simple ovarian cysts in patients with a normal level of CA125 have a low risk for ovarian cancer. Vaginal ultrasound at six months will identify regression of most simple cysts. CA19-9 and CEA at the initial diagnosis are useful parameters to predict future regression of ovarian cysts.

The significance of transvaginal ultrasonographic evaluation of the cervix in women treated with emergency cerclage

OBJECTIVE: Our purpose was to determine whether perioperative transvaginal ultrasonographic evaluation of the incompetent cervix treated with emergency cerclage is predictive of pregnancy outcome. STUDY DESIGN: Twenty-nine women who underwent emergency cerclage at 16 to 26 weeks of gestation had transvaginal ultrasonographic evaluation of the cervix within 48 hours before and after surgery and at least three times thereafter until 28 weeks of gestation. The following measurements were obtained: (1) funnel width, (2) funnel length, (3) endocervical canal length, (4) the distance between the internal and external os, (5) upper cervix (length of closed endocervical canal above the cervical cerclage), (6) lower cervix (endocervical canal length below suture), and (7) cervical index (1 + Funnel length/Endocervical canal length). Values are reported as the median in millimeters, and statistical analysis was performed by use of the Mann-Whitney U test, Wilcoxon signed-rank test, Spearman rank correlation, 2 × 2 contingency tables, and multiple regression analysis with significance set at p < 0.05. RESULTS: Cerclage procedures resulted in significant improvement in postoperative median measurements of funnel width (15 vs 4.0 mm, p < 0.0001), funnel length (29 vs 3 mm, p < 0.0001), and endocervical canal length (2 vs 27 mm, p < 0.0001). There was a significant relationship between gestational age at delivery and the following measurements: preoperative funnel width ( r = -0.51, p = 0.007), postoperative endocervical canal length ( r = 0.39, p = 0.04), length of the lower cervix ( r = 0.39, p = 0.038), and the cervical index ( r = -0.39, p = 0.038). An upper cervical length <10 mm was a good predictor of delivery before 36 weeks of gestation, sensitivity 85.7% (12/14), specificity 66.7% (10/15), positive predictive value 70.6% (12/17), negative predictive value 83% (10/12), and Fisher's exact p = 0.008. Postoperatively all patients had upper cervical lengths <10 mm by 28 weeks of gestation. Preoperative digital assessments of cervical dilatation before surgery did not correlate with gestational age at birth ( r = -0.031, p = 0.36). CONCLUSIONS: In cases of cervical incompetence treated with emergency cerclage, perioperative transvaginal ultrasonographic assessment of the cervix reveals that the procedure results in improved ultrasonographic status of the cervix and that the ultrasonographic cervical findings before and after surgery correlate with pregnancy outcome. (Am J Obstet Gynecol 1996;175:471-6.)

Outcome of ovum donation in Turner’s syndrome patients

To determine whether there is a difference in the pregnancy rate in women with Turner's syndrome (45,X) in an ovum donation program compared with women with other causes of premature ovarian failure.Retrospective chart review of women with Turner's syndrome (n = 11) and premature ovarian failure (n = 38) in a donor ovum program using variable dose and duration of E2 replacement therapy for endometrial preparation and using only transvaginal ultrasonographic assessment of endometrial response before ET.The pregnancy rates in Turner's syndrome patients and control subjects were 27% and 25%, respectively. Pregnancy rates were higher in the first cycle than in subsequent cycles for both groups (40% versus 8%).Turner's syndrome patients given a variable dose of estrogen, for endometrial preparation, with response assessed exclusively by transvaginal ultrasonography demonstrated pregnancy rates equal to patients with other causes of premature ovarian failure.