This chapter presents a standardized protocol for transvaginal ultrasound (TVUS) examinations of the uterus and adnexa, underscoring its pivotal role in reproductive medicine and gynecologic diagnostics. The protocol delineates systematic imaging and measurement methodologies to evaluate normal uterine anatomy, including cervical dimensions, uterine positioning (anteverted, retroverted, or midposition), endometrial thickness across menstrual phases, and corpus uteri measurements (length, width, and anteroposterior diameter). Ovarian assessment protocols focus on ovarian size, follicular measurements, and antral follicle counts (AFC) to quantify ovarian reserve. Criteria for standardized reporting are defined, mandating structured descriptions of uterine, ovarian, tubal, and pelvic findings, complemented by evidence-based diagnostic interpretations and clinical recommendations. The protocol emphasizes the importance of image storage for clinical review, legal documentation, and interdisciplinary collaboration. By integrating precise anatomical evaluation, procedural safety, and systematic reporting, this standardized approach ensures diagnostic reliability and consistency in gynecologic and fertility-related assessments.