Magnetic resonance imaging in the evaluation of infertile women.

Abstract

Infertility can be due to a variety of causes, ranging from genetic or endocrine disturbances to structural abnormalities. Imaging is often used in the evaluation of anatomic abnormalities. The advent of magnetic resonance imaging (MRI) has greatly improved diagnostic accuracy in the workup of several entities causing infertility. Developmental abnormalities of the reproductive tract are particularly well suited to diagnosis by MRI, which clearly demonstrates the zonal anatomy of the corpus, cervix, and vagina. Correct classification of an anomaly can spare the patient unnecessary laparoscopy or surgery. Leiomyomas, another cause of infertility, are optimally evaluated by MRI, since the size, number, location, and extent of degeneration can be identified. These factors are important in deciding how the leiomyomas will be treated. Adenomyosis can cause uterine enlargement and can be misconstrued as fibroids. MRI is the only noninvasive method that can prospectively diagnose adenomyosis. Ovarian masses can also give rise to infertility. MRI is particularly well suited to clarify whether a mass is uterine or ovarian. It is also much more specific than ultrasound in the differential diagnosis of a mass, especially endometriomas, dermoids, and fibromas. Polycystic ovarian disease, usually diagnosed via hormonal measurements, also has a characteristic appearance on MRI.