Imaging plays a key role in the diagnostic evaluation of women for infertility. The pelvic causes of female infertility are varied and range from tubal and peritubal abnormalities to uterine, cervical, and ovarian disorders. In most cases, the imaging work-up begins with hysterosalpingography to evaluate fallopian tube patency. Uterine filling defects and contour abnormalities may be discovered at hysterosalpingography but typically require further characterization with hysterographic or pelvic ultrasonography (US) or pelvic magnetic resonance (MR) imaging. Hysterographic US helps differentiate among uterine synechiae, endometrial polyps, and submucosal leiomyomas. Pelvic US and MR imaging help further differentiate among uterine leiomyomas, adenomyosis, and the various müllerian duct anomalies, with MR imaging being the most sensitive modality for detecting endometriosis. The presence of cervical disease may be inferred initially on the basis of difficulty or failure of cervical cannulation at hysterosalpingography. Ovarian abnormalities are usually detected at US. The appropriate selection of imaging modalities and accurate characterization of the various pelvic causes of infertility are essential because the imaging findings help direct subsequent patient care.

The objective of this series was to assess sonographic and clinical findings in patients with hyperreactio luteinalis (HL; enlarged ovaries). We retrospectively identified 31 patients with HL and collected data including gestational age, maximum ovarian size, and pregnancy outcomes. Hyperreactio luteinalis was detected at a mean gestational age of 21.6 weeks, reaching average maximum ovarian volumes of 417 and 359 mL on the right and left, respectively. After the first trimester, HL appears to be associated with multiple gestations, twin-twin transfusion syndrome, gestational trophoblastic disease, and Beckwith-Wiedemann syndrome. When HL is present, maternal complications such as preeclampsia are common, and preterm delivery often results.

In children with known or suspected CD, our MRE protocol has a high specificity and positive predictive value for terminal ileitis. Severity of inflammation on MRE had a statistically significant positive correlation with PCDAI.

The ultrasound findings in the postpartum uterus will be described with a focus on differentiating normal from pathologic conditions. Imaging of the postpartum uterus will include a discussion of the normal postpartum uterus, postpartum hematomas, and retained products of conception. Clinical management and therapeutic implications based on sonographic findings will be emphasized.