What are the sonological features of dwindling ovarian function/ reserve/ Stock In USG - what the USG image whisper us ? What an expert sonologist should look for we should look for? What mind doesn't know eyes cannot see!!!

USG will reveal followings. My dear sonologist please keep an eye and be vigil if any of the following findings are imagable in a women who has cycle was cancelled due to non development of follicle even with high dose of gonadotrophins - a gentle reminder

1) Heterogeneous myometrial area.

2) Globular asymmetric uterus.

3) Irregular cystic spaces.

4) Myometrial linear striae.

5) Poorly defined / demarcation of endometrial – myometrial junction.

6) Myometrial anterior- posterior wall asymmetry. Usually the post wall is thicker than the ant wall,

7)  Both the walls of myometrium may be thickened say anterior and posterior wall.

8) Increased or decreased echogenecity

Most of us use only USG for diagnosis confirmation as a cost savings approach while others have used all two parameters for diagnosis of adenomyosis like USG & MRI. This is truer when one considers for ART. Regarding endoscopic diagnosis the diag remains uncertain though hysteroscopy is more helpful in diagnosing than laparoscopy. In fact in fair number of cases the laparoscopy may be negative inspite of moderate to severe adenomyosis.