Uterine fibroids, which affect approximately 20% of women of reproductive age, are a common cause of subfertility, yet the exact impact on fertility remains a topic of ongoing debate. Fibroids can affect fertility through several mechanisms, with the most common being distortion of the uterine cavity. This distortion can impair endometrial receptivity, thereby hindering the implantation of a fertilised blastocyst. Additionally, fibroids may impair endometrial and myometrial blood supply and cause changes in the uterine environment that adversely affect embryo development. Given the complexity of the relationship between fibroids and fertility, it is essential to characterise them appropriately such that we identify those at greatest risk of subfertility and tailor treatment strategies to improve outcomes in this population group.

This talk will provide an overview of the various methods used to characterise fibroids, highlighting the importance of determining the size, location, and type of fibroid and how these uniquely impact fertility. Furthermore, the talk will examine a range of treatment options from medical management, including hormonal therapies, to surgical interventions like myomectomy; which can help improve fertility in women with fibroids.

Understanding the spectrum of Mullerian Duct Anomalies (MDAs) is not just semantics. These often complex conditions can affect menstrual function, contribute to pregnancy risk and impair fertility, and making the correct diagnosis matters. This presentation will review the evolving classification, diagnostic approach and clinical implications of MDAs.

Introduction: Asherman's syndrome is a condition characterised by intrauterine adhesions. These adhesions have profound implications for women's reproductive health and require surgical treatments. This syndrome often results from trauma to the endometrial lining, such as surgery, pregnancy complications, or infections, leading to varying degrees of intrauterine scarring. Women affected by Asherman’s syndrome may experience reduced fertility, recurrent pregnancy loss, and abnormal menstrual patterns, such as amenorrhea or oligomenorrhea.
Method: This presentation will include case studies of patients with the condition outlining the transvaginal ultrasound (TVUS) features that are suspicious for Asherman’s disease and when saline infusion sonography (SIS) would be beneficial to confirm the diagnosis. A combination of TVUS and SIS results in the most sensitive non-invasive detection of adhesions.
Results: This presentation will discuss the effects of Asherman's syndrome on fertility, menstrual regularity, pregnancy outcomes and reviews the efficiency of TVUS and SIS. TVUS offers a non-invasive approach, facilitating visualisation of the uterine cavity; however, its sensitivity in detecting adhesions can be limited. In contrast, SIS enhances the assessment by instilling saline into the uterine cavity, improving delineation of the endometrial lining, thus increasing sensitivity in detecting adhesions.
Take home message: Early detection of Asherman’s increases reproductive outcomes leading to better long-term result for affected individuals.

Introduction: Torsion of non-ovarian adnexal structures (NOAT) is a rare gynaecological emergency involving twisting of the fallopian tube or adnexal structures with their vascular supply. Misdiagnosis is common due to atypical sonographic appearances and confirmation bias. Timely ultrasound diagnosis is vital to prevent ischemic injury and preserve fertility. This study reviews the literature and analyses a case series to highlight key sonographic features and recurring diagnostic themes.
Methods: A literature review examined clinical presentations, sonographic features, and contributing factors. A 15-year case series was reviewed using search terms “paraovarian torsion,” “tubal torsion,” and “whirlpool” at a tertiary hospital. Positive cases involved ultrasound-suspected adnexal torsion confirmed surgically. Cases with isolated ovarian torsion or ovarian pathology causing torsion were excluded. Also, instances where ultrasound strongly favoured NOAT however conservative management was favoured will be discussed.
Results: Thirteen surgically confirmed cases of NOAT were retrospectively identified. This included four cases of paraovarian cystic structures, two parafimbrial cystic structures, six isolated tubal torsions, and one appendiceal torsion. A further four equivocal cases were identified without surgery performed, torsion-detorsion was suspected or conservative management was favoured.
Conclusion: NOAT is a highly unusual finding that presents significant risk to pelvic organs and thus fertility left untreated. Recognition of key sonographic signs which may indicate torsion or a high risk of torsion is crucial for early diagnosis and intervention.
Take home messages:-NOAT is a rare but critical finding, -thorough early ultrasound diagnosis is crucial.

Introduction
Infertility affects 1 in 6 couples of reproductive age in Australia. As such, fertility services have rapidly expanded in recent years as women seek fertility preservation and couples opt to wait later in life to try and conceive. This has resulted in an increase in demand for pelvic ultrasound as a first line assessment for structural abnormalities in the female reproductive system prior to fertility treatment. This assessment is an integral step in the journeys of these individuals and couples, often playing a key role in determining the means and method of assisted reproduction undertaken.

Method
This presentation will provide a comprehensive approach to undertaking a baseline fertility ultrasound including the importance of clinical history. A scan protocol with fertility specific extensions that is currently undertaken in a public, tertiary fertility service and how to appropriately document findings for fertility clinicians.

Conclusion
The baseline fertility ultrasound, when performed and documented well, is an invaluable tool in shaping a women’s fertility journey and guiding treatment options and management.

Introduction: Endometriosis is a chronic inflammatory condition that results in endometrial like tissue growing outside the uterus, affecting approximately 10% of reproductive-age women and girls globally. In Australia, the prevalence is higher at 1 in 7. Early diagnosis is important for managing symptoms including severe pelvic pain, heavy menstrual bleeding and pain during intercourse, as well as impaired fertility, which is commonly associated with the condition. This presentation is aimed at sonographers performing routine female pelvis ultrasound examinations and will outline 10 key points to aid in the diagnosis of deep and superficial endometriosis.
Method: For the detection of deep and superficial endometriosis, a transvaginal ultrasound (TVUS) examination of the pelvis requires a thorough examination of the anterior and posterior compartments, with an understanding of anatomy, clinical indications, and technique and ultrasound features of the disease. This presentation will include imaging tips and tricks on how to perform the assessment as well as identifying key diagnostic features.
Results: Sonographers performing pelvic ultrasounds will gain the knowledge and skills needed to perform high-quality diagnostic imaging for the detection of deep and superficial endometriosis.
Conclusion: Sonographers performing a high quality TVUS examination is essential for the diagnosis and management of patients with endometriosis.
Take Home Message: Diagnosing superficial and deep infiltrating endometriosis requires sonographers to appreciate the anatomy, clinical indications, ultrasound features and imaging techniques.

This session will examine the role of HyFoSy (Hysterosalpingo Foam Sonography) in assessing tubal patency. It will provide an overview of the procedure's methodology, clinical indications, and contraindications, while also comparing its effectiveness to alternative methods such as HSG and HyCoSy. Additionally, the session will highlight the advantages of HyFoSy in terms of patient comfort, safety, and accessibility, emphasising its potential as a more patient-friendly and effective diagnostic option for infertility investigation.