The accurate diagnosis of intrauterine growth restriction (IUGR) is achieved using a combination of clinical examination, relevant laboratory tests, and a variety of ultrasound techniques, including detailed anatomical scanning, placental evaluation, and Doppler assessment of placental and fetal vessels. The risk factors for IUGR are increasing over time and these include increased maternal age, coexistent medical problems, and assisted reproductive technology. Fetal causes of IUGR may be classified according to genetic diseases, congenital malformations, infections, and multiple gestation. Once a diagnosis has been established, consideration of the need for further investigations, consultation, or advice from a regional perinatal center and ongoing maternal-fetal surveillance should be instituted. Management will be directed according to the presence or absence of uteroplacental vascular insufficiency. The optimal timing of delivery is currently the source of much controversy, due to the many relevant clinical and ultrasound factors that clinicians must consider, in addition to patient preferences.

The use of pelvic ultrasound to investigate the subfertile female needs a close collaboration between the gynecologist and the radiologist. Ultrasonography is now a must in the investigation of ovulation disorders, along with clinical findings and hormonal assays. It allows estimation of the ovarian function, mainly estrogen secretion, through measurement of the endometrial thickness: endometrial atrophy or severe hypotrophy (thickness more than 5 mm) indicates hypoestrogenism. It also contributes greatly to the diagnosis of ovulation disorders, in particular polycystic ovary syndrome (PCOS) and primary ovarian failure (POF), along with the clinical/biological data. The ultrasound is sensitive in detecting those lesions that are responsible for infertility through interference with egg migration and implantation and/or with sperm progression, such as fibroids, polyps, synechiae, or malformations. The 3D ultrasound can help in the diagnosis of uterine malformations. The majority of tubal obstructions are secondary to sexually transmitted infections, particularly gonorrhea and chlamydia.

Recurrent miscarriage (RM) affects between 1-2% of fertile couples and is a clinical condition of heterogeneous etiology. Parental structural chromosome rearrangements are reported in 3-8% of couples suffering recurrent miscarriage and testing of both partners is therefore recommended. Conventional cytogenetic analysis of miscarriage tissue from women with a history of RM has detected a 26-57% abnormality rate. In the RM population, the prevalence of reported uterine malformations range widely from between 1.8% to 37.6%. Diagnostic tools for detecting uterine anomalies include two- and three-dimensional ultrasound, hysteroscopy, laparoscopy and magnetic resonance imaging (MRI). The antiphospholipid syndrome (APS) remains entrenched as one of the most studied factors associated with RM. Natural killer (NK) cells are found in peripheral blood and within the endometrium and have been associated with RM. Presently, many of the RM investigations are controversial because of limited studies, inconsistent terminology and small and poorly designed treatment studies.