Pitfalls in Imaging of Female Infertility.

Infertility is a worldwide disease affecting 12–15% of couples and is defined as a couple’s inability to achieve a pregnancy following an entire year of unprotected, regular sexual intercourse. Causes are multifactorial with 40% of etiologies identified as male and 40% female. Pelvic causes include a variety of ovarian, uterine (acquired and congenital), and tubal and peritubal abnormalities as well as pelvic deep infiltrating endometriosis. Affected couples should undergo a comprehensive diagnostic evaluation including a complete review of medical history, detailed physical examination, laboratory assessment consisting of semen and hormonal analysis, and imaging examinations. Diagnostic imaging investigation of female infertility consists of a multimodality imaging approach of the reproductive organs. Depending on the suspected etiologies, these may range from ultrasound (US) to hysterosalpingography (HSG), hysterosalpingo-contrast sonography (HyCoSy), and magnetic resonance imaging (MRI). The latter is an excellent problem-solving imaging modality in cases of indeterminate adnexal masses, Mullerian duct anomalies, and deep infiltrating endometriosis.