Adenomyosis is often called the “sister” of endometriosis, where the endometrial glands grow into the muscular wall (myometrium) of the uterus. While it often results in a “globular” or enlarged uterus, accurate diagnosis requires advanced imaging like 3D Ultrasound and sometimes MRI.

3D Ultrasonography & Junctional Zone

3D sonography is a game-changer for identifying the Junctional Zone (JZ)—the inner layer of the myometrium. On a coronal view, we look for:

• An ill-defined or distorted junctional zone.
• Infiltration of the hypoechoic inner myometrium.
• Localised or diffuse thickening of the transition zone (the hypoechoic halo).

Specific Sonographic Signs

At Talwar Fertility & Child Health Centre, we look for these specific “fingerprints” of adenomyosis during your scan:

The Role of Colour Doppler

Unlike fibroids which often have a clear circular blood supply, Adenomyosis shows diffuse hypervascularity throughout the stroma. Colour Doppler helps us identify these intramural cysts and distinguish them from other uterine masses.

MRI: When Do We Need It?

MRI is an excellent confirmatory tool. The key MRI criteria for adenomyosis include:

• Increased JZ Thickness: A junctional zone thickness of ≥12 mm (or 0.15 mm in specific T2 weighted sequences).
• Globular Enlargement: Uterine length often reaching up to 12 cm.
• High Intensity Spots: Diffuse widening of the JZ on T2 weighted images.

Impact on IVF

Adenomyosis can affect embryo implantation. Once we manage the condition and the follicles reach the optimal size (≥2 follicles over 18 mm), we proceed with a carefully timed HCG/GnRH trigger to ensure the best chances for IVF success in a receptive environment.

In the field of reproductive medicine, ultrasound is the most fundamental diagnostic tool. It allows us to visualize the uterus, ovaries, and other pelvic structures with high precision. Depending on the clinical requirement, ultrasound is performed using two primary methods:

Clinical Benefits of Fertility Ultrasound

Ultrasound helps in the comprehensive evaluation of the reproductive system to detect any underlying issues:

• Uterus: We assess the size, shape, mobility, and position. We look for the Endometrial Thickness (ET) and use Color Doppler to predict uterine receptivity. It also helps detect fibroids, polyps, or adenomyosis.
• Ovaries: We measure ovarian volume and the Antral Follicle Count (AFC). It helps in identifying cysts (follicular, dermoid, or endometriotic) and tumors. Color Doppler of a dominant follicle helps assess oocyte quality.
• Fallopian Tubes: While normal tubes aren’t usually visible, conditions like Hydrosalpinx (fluid-filled tubes) are easily detected on USG.
• Adnexa: Identifying other pelvic masses, such as pedunculated fibroids or paraovarian cysts.