Skip to main content


You are viewing the new article page. Let us know what you think. Return to old version

Commentary | Open | Published:

Clarifying the role of three-dimensional transvaginal sonography in reproductive medicine: an evidenced-based appraisal


This overview describes and illustrates the clinical applications of three-dimensional transvaginal sonography in reproductive medicine. Its main applications include assessment of uterine anomalies, intrauterine pathology, tubal patency, polycystic ovaries, ovarian follicular monitoring and endometrial receptivity. It is also useful for detailed evaluation of failed and/or ectopic pregnancy. Three-dimensional color Doppler sonography provides enhanced depiction of uterine, endometrial, and ovarian vascularity.


  1. 1.

    Linney AD, Deng J: Three-dimensional morphometry in ultrasound. Proc Inst Mech Eng. 1999, 213 (3): 235-45. 10.1243/0954411991534942.

  2. 2.

    King DL, King DL, Shao MY: Three-dimensional spatial registration and interactive display of position and orientation of real-time ultrasound images. J Ultrasound Med. 1990, 9 (9): 525-32.

  3. 3.

    Brunner M, Obruca A, Bauer P, Feichtinger W: Clinical application of volume estimation based on three-dimensional ultrasonography. Ultrasound Obstet Gynecol. 1995, 6 (5): 358-61. 10.1046/j.1469-0705.1995.06050358.x.

  4. 4.

    Maymon R, Herman A, Ariely S, Dreazen E, Buckovsky I, Weinraub Z: Three-dimensional vaginal sonography in obstetrics and gynaecology. Hum Reprod Update. 2000, 6 (5): 475-84. 10.1093/humupd/6.5.475.

  5. 5.

    Heer IM, Strauss A, Muller-Egloff S, Hasbargen U: Telemedicine in ultrasound: new solutions. Ultrasound Med Biol. 2001, 27 (9): 1239-43. 10.1016/S0301-5629(01)00420-3.

  6. 6.

    Pretorius DH, Nelson TR: Three-dimensional ultrasound. Ultrasound Obstet Gynecol. 1995, 5 (4): 219-21. 10.1046/j.1469-0705.1995.05040219.x.

  7. 7.

    Gilja OH, Hausken T, Berstad A, Odegaard S: Measurements of organ volume by ultrasonography. Proc Inst Mech Eng [H]. 1999, 213 (3): 247-59. 10.1243/0954411991534951.

  8. 8.

    Kyei-Mensah A, Maconochie N, Zaidi J, Pittrof R, Campbell S, Tan SL: Transvaginal three-dimensional ultrasound: reproducibility of ovarian and endometrial volume measurements. Fertil Steril. 1996, 66 (5): 718-22.

  9. 9.

    Raine-Fenning NJ, Campbell BK, Collier J, Brincat MB, Johnson IR: The reproducibility of endometrial volume acquisition and measurement with the VOCAL-imaging program. Ultrasound Obstet Gynecol. 2002, 19 (1): 69-75. 10.1046/j.0960-7692.2001.00608.x.

  10. 10.

    Farrell T, Leslie JR, Chien PF, Agustsson P: The reliability and validity of three dimensional ultrasound volumetric measurements using an in vitro balloon and in vivo uterine model. Bjog. 2001, 108 (6): 573-82. 10.1016/S0306-5456(00)00148-0.

  11. 11.

    Riccabona M, Nelson TR, Pretorius DH: Three-dimensional ultrasound: accuracy of distance and volume measurements. Ultrasound Obstet Gynecol. 1996, 7 (6): 429-34. 10.1046/j.1469-0705.1996.07060429.x.

  12. 12.

    Raine-Fenning NJ, Clewes JS, Kendall NR, Bunkheila AK, Campbell BK, Johnson IR: The interobserver reliability and validity of volume calculation from three-dimensional ultrasound datasets in the in vitro setting. Ultrasound Obstet Gynecol. 2003, 21 (3): 283-91. 10.1002/uog.61.

  13. 13.

    Riccabona M, Nelson TR, Pretorius DH, Davidson TE: In vivo three-dimensional sonographic measurement of organ volume: validation in the urinary bladder. J Ultrasound Med. 1996, 15 (9): 627-32.

  14. 14.

    Kyei-Mensah A, Zaidi J, Pittrof R, Shaker A, Campbell S, Tan SL: Transvaginal three-dimensional ultrasound: accuracy of follicular volume measurements. Fertil Steril. 1996, 65 (2): 371-6.

  15. 15.

    Amer A, Hammadeh ME, Kolkailah M, Ghandour AA: Three-dimensional versus two-dimensional ultrasound measurement of follicular volume: are they comparable?. Arch Gynecol Obstet. 2003, 268 (3): 155-7. 10.1007/s00404-002-0315-6.

  16. 16.

    Pairleitner H, Steiner H, Hasenoehrl G, Staudach A: Three-dimensional power Doppler sonography: imaging and quantifying blood flow and vascularization. Ultrasound Obstet Gynecol. 1999, 14 (2): 139-43. 10.1046/j.1469-0705.1999.14020139.x.

  17. 17.

    Raine-Fenning NJ, Campbell BK, Clewes JS, Kendall NR, Johnson IR: The reliability of the semi-quantification of ovarian, endometrial and sub-endometrial perfusion using three-dimensional power Doppler angiography and shell-imaging. Ultrasound Obstet Gynecol. 2003, 22 (12): 633-639. 10.1002/uog.923.

  18. 18.

    Jarvela IY, Sladkevicius P, Tekay AH, Campbell S, Nargund G: Intraobserver and interobserver variability of ovarian volume, gray-scale and color flow indices obtained using transvaginal three-dimensional power Doppler ultrasonography. Ultrasound Obstet Gynecol. 2003, 21 (3): 277-82. 10.1002/uog.62.

  19. 19.

    Kupesic S: Clinical implications of sonographic detection of uterine anomalies for reproductive outcome. Ultrasound Obstet Gynecol. 2001, 18 (4): 387-400. 10.1046/j.0960-7692.2001.00539.x.

  20. 20.

    Homer HA, Li TC, Cooke ID: The septate uterus: a review of management and reproductive outcome. Fertil Steril. 2000, 73 (1): 1-14. 10.1016/S0015-0282(99)00480-X.

  21. 21.

    Jurkovic D, Geipel A, Gruboeck K, Jauniaux E, Natucci M, Campbell S: Three-dimensional ultrasound for the assessment of uterine anatomy and detection of congenital anomalies: a comparison with hysterosalpingography and two-dimensional sonography. Ultrasound Obstet Gynecol. 1995, 5 (4): 233-7. 10.1046/j.1469-0705.1995.05040233.x.

  22. 22.

    Raga F, Bonilla-Musoles F, Blanes J, Osborne NG: Congenital Mullerian anomalies: diagnostic accuracy of three-dimensional ultrasound. Fertil Steril. 1996, 65 (3): 523-8.

  23. 23.

    Wu MH, Hsu CC, Huang KE: Detection of congenital mullerian duct anomalies using three-dimensional ultrasound. J Clin Ultrasound. 1997, 25 (9): 487-92. 10.1002/(SICI)1097-0096(199711/12)25:9<487::AID-JCU4>3.0.CO;2-J.

  24. 24.

    Woelfer B, Salim R, Banerjee S, Elson J, Regan L, Jurkovic D: Reproductive outcomes in women with congenital uterine anomalies detected by three-dimensional ultrasound screening. Obstet Gynecol. 2001, 98 (6): 1099-103. 10.1016/S0029-7844(01)01599-X.

  25. 25.

    Jurkovic D, Gruboeck K, Tailor A, Nicolaides KH: Ultrasound screening for congenital uterine anomalies. Br J Obstet Gynaecol. 1997, 104 (11): 1320-1.

  26. 26.

    Salim R, Regan L, Woelfer B, Backos M, Jurkovic D: A comparative study of the morphology of congenital uterine anomalies in women with and without a history of recurrent first trimester miscarriage. Hum Reprod. 2003, 18 (1): 162-6. 10.1093/humrep/deg030.

  27. 27.

    Salim R, Woelfer B, Backos M, Regan L, Jurkovic D: Reproducibility of three-dimensional ultrasound diagnosis of congenital uterine anomalies. Ultrasound Obstet Gynecol. 2003, 21 (6): 578-82. 10.1002/uog.127.

  28. 28.

    La Torre R, De Felice C, De Angelis C, Coacci F, Mastrone M, Cosmi EV: Transvaginal sonographic evaluation of endometrial polyps: a comparison with two dimensional and three dimensional contrast sonography. Clin Exp Obstet Gynecol. 1999, 26 (3–4): 171-3.

  29. 29.

    Sylvestre C, Child TJ, Tulandi T, Tan SL: A prospective study to evaluate the efficacy of two- and three-dimensional sonohysterography in women with intrauterine lesions. Fertil Steril. 2003, 79 (5): 1222-5. 10.1016/S0015-0282(03)00154-7.

  30. 30.

    Kiyokawa K, Masuda H, Fuyuki T, Koseki M, Uchida N, Fukuda T, et al: Three-dimensional hysterosalpingo-contrast sonography (3D-HyCoSy) as an outpatient procedure to assess infertile women: a pilot study. Ultrasound Obstet Gynecol. 2000, 16 (7): 648-54. 10.1046/j.1469-0705.2000.00327.x.

  31. 31.

    Sladkevicius P, Ojha K, Campbell S, Nargund G: Three-dimensional power Doppler imaging in the assessment of Fallopian tube patency. Ultrasound Obstet Gynecol. 2000, 16 (7): 644-7. 10.1046/j.1469-0705.2000.00302.x.

  32. 32.

    Sankpal RS, Confino E, Matzel A, Cohen LS: Investigation of the uterine cavity and fallopian tubes using three-dimensional saline sonohysterosalpingography. Int J Gynecol Obstet. 2001, 73 (2): 125-9. 10.1016/S0020-7292(01)00363-0.

  33. 33.

    Jarvela IY, Mason HD, Sladkevicius P, Kelly S, Ojha K, Campbell S, et al: Characterization of normal and polycystic ovaries using three-dimensional power Doppler ultrasonography. J Assist Reprod Genet. 2002, 19 (12): 582-90. 10.1023/A:1021267200316.

  34. 34.

    Wu MH, Tang HH, Hsu CC, Wang ST, Huang KE: The role of three-dimensional ultrasonographic images in ovarian measurement. Fertil Steril. 1998, 69 (6): 1152-5. 10.1016/S0015-0282(98)00092-2.

  35. 35.

    Dolz M, Osborne NG, Blanes J, Raga F, Abad-Velasco L, Villalobos A, et al: Polycystic ovarian syndrome: assessment with color Doppler angiography and three-dimensional ultrasonography. J Ultrasound Med. 1999, 18 (4): 303-13.

  36. 36.

    Pan HA, Wu MH, Cheng YC, Li CH, Chang FM: Quantification of Doppler signal in polycystic ovary syndrome using three-dimensional power Doppler ultrasonography: a possible new marker for diagnosis. Hum Reprod. 2002, 17 (1): 201-6. 10.1093/humrep/17.1.201.

  37. 37.

    Kyei-Mensah AA, LinTan S, Zaidi J, Jacobs HS: Relationship of ovarian stromal volume to serum androgen concentrations in patients with polycystic ovary syndrome. Hum Reprod. 1998, 13 (6): 1437-41. 10.1093/humrep/13.6.1437.

  38. 38.

    Nardo LG, Buckett WM, White D, Digesu AG, Franks S, Khullar V: Three-dimensional assessment of ultrasound features in women with clomiphene citrate-resistant polycystic ovarian syndrome (PCOS): ovarian stromal volume does not correlate with biochemical indices. Hum Reprod. 2002, 17 (4): 1052-5. 10.1093/humrep/17.4.1052.

  39. 39.

    Pellicer A, Ardiles G, Neuspiller F, Remohi J, Simon C, Bonilla-Musoles F: Evaluation of the ovarian reserve in young low responders with normal basal levels of follicle-stimulating hormone using three-dimensional ultrasonography. Fertil Steril. 1998, 70 (4): 671-5. 10.1016/S0015-0282(98)00268-4.

  40. 40.

    Pohl M, Hohlagschwandtner M, Obruca A, Poschalko G, Weigert M, Feichtinger W: Number and size of antral follicles as predictive factors in vitro fertilization and embryo transfer. J Assist Reprod Genet. 2000, 17 (6): 315-8. 10.1023/A:1009448810413.

  41. 41.

    Kupesic S, Kurjak A: Predictors of IVF outcome by three-dimensional ultrasound. Hum Reprod. 2002, 17 (4): 950-5. 10.1093/humrep/17.4.950.

  42. 42.

    Schild RL, Knobloch C, Dorn C, Fimmers R, van der Ven H, Hansmann M: The role of ovarian volume in an in vitro fertilization programme as assessed by 3D ultrasound. Arch Gynecol Obstet. 2001, 265 (2): 67-72. 10.1007/s004040000138.

  43. 43.

    Scheffer GJ, Broekmans FJ, Bancsi LF, Habbema JD, Looman CW, Te Velde ER: Quantitative transvaginal two- and three-dimensional sonography of the ovaries: reproducibility of antral follicle counts. Ultrasound Obstet Gynecol. 2002, 20 (3): 270-5. 10.1046/j.1469-0705.2002.00787.x.

  44. 44.

    Jarvela IY, Sladkevicius P, Kelly S, Ojha K, Campbell S, Nargund G: Quantification of ovarian power Doppler signal with three-dimensional ultrasonography to predict response during in vitro fertilization. Obstet Gynecol. 2003, 102 (4): 816-22. 10.1016/S0029-7844(03)00693-8.

  45. 45.

    Kupesic S, Kurjak A, Bjelos D, Vujisic S: Three-dimensional ultrasonographic ovarian measurements and in vitro fertilization outcome are related to age. Fertil Steril. 2003, 79 (1): 190-7. 10.1016/S0015-0282(02)04567-3.

  46. 46.

    Schild RL, Indefrei D, Eschweiler S, Van der Ven H, Fimmers R, Hansmann M: Three-dimensional endometrial volume calculation and pregnancy rate in an in-vitro fertilization programme. Hum Reprod. 1999, 14 (5): 1255-8. 10.1093/humrep/14.5.1255.

  47. 47.

    Yaman C, Ebner T, Sommergruber M, Polz W, Tews G: Role of three-dimensional ultrasonographic measurement of endometrium volume as a predictor of pregnancy outcome in an IVF-ET program: a preliminary study. Fertil Steril. 2000, 74 (4): 797-801. 10.1016/S0015-0282(00)01493-X.

  48. 48.

    Raga F, Bonilla-Musoles F, Casan EM, Klein O, Bonilla F: Assessment of endometrial volume by three-dimensional ultrasound prior to embryo transfer: clues to endometrial receptivity. Hum Reprod. 1999, 14 (11): 2851-4. 10.1093/humrep/14.11.2851.

  49. 49.

    Kupesic S, Bekavac I, Bjelos D, Kurjak A: Assessment of endometrial receptivity by transvaginal color Doppler and three-dimensional power Doppler ultrasonography in patients undergoing in vitro fertilization procedures. J Ultrasound Med. 2001, 20 (2): 125-34.

  50. 50.

    Wu HM, Chiang CH, Huang HY, Chao AS, Wang HS, Soong YK: Detection of the subendometrial vascularization flow index by three-dimensional ultrasound may be useful for predicting the pregnancy rate for patients undergoing in vitro fertilization-embryo transfer. Fertil Steril. 2003, 79 (3): 507-11. 10.1016/S0015-0282(02)04698-8.

  51. 51.

    Schild RL, Holthaus S, d'Alquen J, Fimmers R, Dorn C, van Der Ven H, et al: Quantitative assessment of subendometrial blood flow by three-dimensional-ultrasound is an important predictive factor of implantation in an in-vitro fertilization programme. Hum Reprod. 2000, 15 (1): 89-94. 10.1093/humrep/15.1.89.

  52. 52.

    Steiner H, Gregg AR, Bogner G, Graf AH, Weiner CP, Staudach A: First trimester three-dimensional ultrasound volumetry of the gestational sac. Arch Gynecol Obstet. 1994, 255 (4): 165-70. 10.1007/s004040050047.

  53. 53.

    Acharya G, Morgan H: Does gestational sac volume predict the outcome of missed miscarriage managed expectantly?. J Clin Ultrasound. 2002, 30 (9): 526-31. 10.1002/jcu.10107.

  54. 54.

    Babinszki A, Nyari T, Jordan S, Nasseri A, Mukherjee T, Copperman AB: Three-dimensional measurement of gestational and yolk sac volumes as predictors of pregnancy outcome in the first trimester. Am J Perinatol. 2001, 18 (4): 203-11. 10.1055/s-2001-15499.

  55. 55.

    Rempen A: The shape of the endometrium evaluated with three-dimensional ultrasound: an additional predictor of extrauterine pregnancy. Hum Reprod. 1998, 13 (2): 450-4. 10.1093/humrep/13.2.450.

  56. 56.

    Su YN, Shih JC, Chiu WH, Lee CN, Cheng WF, Hsieh FJ: Cervical pregnancy: assessment with three-dimensional power Doppler imaging and successful management with selective uterine artery embolization. Ultrasound Obstet Gynecol. 1999, 14 (4): 284-7. 10.1046/j.1469-0705.1999.14040284.x.

Download references

Author information

Correspondence to Arthur C Fleischer.

Rights and permissions

Reprints and Permissions

About this article