Infertility in women is still a significant problem in today’s culture; roughly 20% of people experience fertility problems. Women’s infertility tests and fertility treatments are not complete without ultrasound scans, which can also be utilized for various purposes during pregnancy.
Using ultrasound to examine the ovaries, endometrium, uterus, and fallopian tubes can help doctors identify potential infertility causes. Different kinds of ultrasounds can be performed depending on where you are in your pregnancy.
In the middle to late stages of pregnancy, typically abdominal ultrasounds are done. A transducer – a device that releases and absorbs sound waves- is moved across the abdomen during the ultrasound. High-frequency sound waves used in ultrasound exams then generate an image of the internal organs. The sound waves will not be audible to you.
An ultrasonic transducer is an apparatus that is used for transmitting and receiving high-frequency sound waves. The technician will probably utilize two types of transducer devices during fertility testing and treatment: one for an abdominal ultrasound and the other for a transvaginal ultrasound.
A fertility scan will confirm the state of the uterus and both ovaries. Most ultrasounds for fertility testing or fertility scan and treatment are performed transvaginally (through the vagina) using a thin, specialized wand. While not painful, ultrasounds can be slightly uncomfortable.
An infertility scan is a crucial initial examination for any woman who may be having trouble conceiving. Additionally, a detailed assessment of the uterine morphology, state of the fallopian tubes, and ovarian reserves can also be made using specialized ultrasounds.
Ultrasound is used during fertility treatment to track the growth of follicles in the ovaries and the thickness of the endometrial lining. In IVF for egg retrieval, ultrasound is also utilized to direct the needle through the vaginal wall to the ovaries. While transferring embryos, some doctors employ ultrasonography.
Let’s read about some ultrasounds that you might undergo while attempting to conceive or after learning you are pregnant before being transferred back to your normal OB/GYN by your infertility specialist (reproductive endocrinologist).
What Takes Place Throughout an Ultrasound
Your abdomen is sprayed with gel during an abdominal ultrasound. The transducer is then delicately brushed across the abdomen. The transducer can move more easily across your skin thanks to the gel.
The transducer used for transvaginal ultrasonography has the appearance of a long, thin wand. A condom is positioned over the wand, and then a generous amount of lubrication gel is squirted over the condom.
The transducer wand’s handle will be handed to you by the technician, and you can gently insert it as far as it will comfortably fit inside your vagina. The technician will then start the examination after you hand them the handle.
The transducer emits sound waves into the air. They resound (or bounce back) when they strike your interior organs. These impulses are interpreted by ultrasound equipment, which converts them into digital images.
Your doctor could advise you to consume several cups of water in the hour leading up to an abdominal ultrasound, but they might also ask you to refrain from using the restroom if you feel the urge to pee. A full bladder pulls your intestines out of the way, making your reproductive organs easier to see. You can use the restroom after the abdominal ultrasound is finished.
However, transvaginal ultrasound offers superior images to see the finer details required for fertility testing and treatment. The transvaginal transducer tip is positioned directly beneath the cervix to be closer to your reproductive organs.
Your doctor might order one of many specialty ultrasound scans in addition to abdominal and transvaginal scans.
Ultrasound for Antral Follicle Count
The typical transvaginal ultrasound device is used for this treatment, but the technician needs specialized training to perform it correctly. Ultrasounds of your antral follicle count can assist you in assessing your ovarian reserves and perhaps even detect polycystic ovarian syndrome (PCOS). An antral follicle count examination may or may not be a part of a basic reproductive workup. Furthermore, a regular ultrasound scan can be scheduled simultaneously or independently.
The majority of ultrasound images are two-dimensional. Three-dimensional images can now be generated due to advancements in the field of technology. Sometimes, a standard 2D ultrasound scan cannot detect some uterine abnormalities and fallopian tube issues and thus can be detected better with a 3D ultrasound.
To conduct a sonohysterogram, a catheter is inserted into the uterus to put saline solution. Once filled with saline, It helps to see if the uterus has formed and any potential adhesions. A sonohysterogram is more frequently conducted under special circumstances.
Sonography using hysterosalpingo-contrast (HyCoSy)
Similar to a sonohysterography, an HSG, is a special X-ray and is increasingly frequently used by clinicians to determine whether the fallopian tubes are open or blocked, and it is performed by using a dye or a saline solution containing air bubbles.
An advantage of HyCoSy over an HSG is that there may be less discomfort in HyCoSy. Furthermore, there isn’t any exposure to iodine or radiation in HyCoSy, and it can simultaneously be conducted with a routine ultrasound.
What do Ultrasound Images see?
Your fertility doctor uses an ultrasound scan for infertility to assess the following.
- Structure and Location of Reproductive Organs
Your complete reproductive system will be visible to your doctor overall thanks to ultrasound. Is everything there that ought to be there? Is everything in its proper place? Although it may seem obvious, some people are born without ovaries or uteruses. Sometimes the organs may not be where they should be or may be arranged in an odd fashion (such as being tilted or retroverted).
Your ovaries will be examined by the ultrasound technician, who will note their size and form. Additionally, they will search for signs of both healthy and unhealthy cysts on the ovaries. The polycystic ovarian syndrome may be indicated by a pearl necklace-like pattern of several tiny cysts. A big endometrioma may be an indication of endometriosis. On occasion, a mass other than a cyst may be discovered on the ovaries.
- Count of Antral Follicles
This could be arranged alone or as part of a standard ultrasound for infertility. The ovaries contain a particular type of follicle called an antral follicle. They are a part of the lifetime of the egg or oocyte. A weak ovarian reserve may be indicated by a very low antral follicle count. PCOS may be indicated by an abnormally high antral follicle count.
The ultrasound technician will record the uterus’ dimensions, form, and location. It might also be able to see some uterine anomalies, such as a bicornuate or septate uterus if the ultrasound is 3D. Additionally, the technician will search for any signs of uterine lumps, such as adenomyosis, polyps, or fibroids. Regular ultrasounds only sometimes allow for the detection of them. A hysteroscopy or a sonohysterogram may be necessary for further analysis.
As your menstrual cycle proceeds, the endometrium—the uterus’ lining—thickens and changes. Depending on the day of your checkup, the ultrasound professional will search for positive signs that the endometrium is in the proper stage. The endometrium’s thickness will also be measured. Before ovulation, the endometrium should be thin, and afterward, it should become thicker.
- Fallopian tubes
A simple ultrasound cannot detect healthy fallopian tubes. However, if a fallopian tube is bloated or filled with fluid, which can happen with a hydrosalpinx, it may be visible with a standard 2D ultrasound.
It is impossible to tell if the fallopian tubes are clear and open with a simple ultrasound. Your doctor will probably request an HSG to determine if the tubes are open or closed. The hysterosalpingo-contrast sonography (HyCoSy), a specialist ultrasound, may enable your doctor to determine whether the tubes are clogged.
The technician can check to see if the reproductive organs move freely and as they should by gently pressing on them with the transvaginal transducer or if they seem to stick together.
The technician may gently push on the ovaries using the ultrasound wand to observe how they move within the pelvic cavity. “Kissing ovaries” are ovaries that appear to be glued to one another. The reproductive organs could become stuck together and unable to move freely. Endometriosis or a previous pelvic infection can cause adhesions.
- Blood Flow
Your doctor can use an ultrasound to evaluate the blood flow to your reproductive organs. The technician might be able to assess blood flow around a cyst or tumor if they are utilizing a color doppler. This can assist in differentiating between an ovarian tumor, an endometrial cyst, and a benign cyst.
- The Use of Ultrasound in Fertility Treatment
Ultrasound scans, which can be done at various times and for various purposes, are a crucial component of fertility treatment monitoring. If you see a conventional OB/GYN, ultrasound isn’t typically used to track Clomid cycles, but it might be if you visit a fertility clinic. The monitoring of gonadotropin cycles and IVF treatment cycles both typically use ultrasound.
Here are a few other reasons for using ultrasound during IVF.
During the month of your scheduled treatment cycle, your doctor will likely instruct you to phone their clinic on the first day of your menstruation. Within the next few days, they will want to arrange blood work and an ultrasound. Your ultrasound’s baseline is what it is called. Before beginning the use of fertility medications, it is important to make sure the ovaries are free of any odd cysts.
A tenacious corpus luteum cyst can occasionally persist even after the onset of your menstruation. It doesn’t cause any harm and usually goes away on its own. Treatment, though, might be postponed in the interim. Drugs used during pregnancy may make the cyst worse.
Your first transvaginal ultrasound will likely take place during your period. You shouldn’t be embarrassed if you’re uncomfortable; it’s nothing to be ashamed of.
Assessment of Follicle Growth
The main monitoring focus during in vitro fertilization is on this. All of these scans are transvaginal ultrasounds, and depending on your course of treatment, you might visit the clinic once every few days for a scan. The number of follicles that are growing and how quickly they are growing will be examined by the doctor or ultrasound technician.
Depending on follicle growth, your fertility medicines may need to be increased or decreased. Your “trigger shot” (an injection of hCG) or egg retrieval will be scheduled after the follicles reach a specific size. Additionally, either too few or too many follicles can form. Your cycle can be canceled if you are undergoing IVF treatment and few or no follicles are developing.
Your cycle might be stopped if you’re receiving IUI or gonadotropin therapy and there are too many follicles developing in order to reduce the possibility of developing high-order multiple pregnancies.
Endometrial thickness measurement
Your endometrial thickness will likely be measured by the ultrasound technician as well. Your doctor might adjust the dosage of your fertility medicine following the thickness of the tissue, just like with follicle growth.
Procedures Using Ultrasound
In the form of an ultrasound-guided procedure, ultrasonography can also be used during the treatment. For instance, an ultrasound-guided needle is used to remove eggs from the ovaries during egg retrieval for IVF treatment. When transferring embryos, some clinicians additionally employ successful embryo transfer ultrasound.
Early Pregnancy Ultrasound Scans
You won’t be immediately transferred back to your usual OB/GYN if you become pregnant while undergoing reproductive therapy. Your fertility specialist will first check if the pregnancy is developing as anticipated, at least in the initial weeks.
Around week six, the first ultrasound is most likely to be planned. Your menstruation or pregnancy test day is now two weeks past due. A gestational sac will be the object of the technician’s search. Don’t get concerned if you don’t see a heartbeat at this time because it’s rare for one to be found.
Additionally, your doctor will check to discover if you are carrying multiples. It’s sometimes difficult to tell for sure if you are expecting more than one fetus at this point.
The pregnancy is regarded as being a clinical pregnancy after a gestational sac has been seen. 16 When pregnancy hormone is found in the blood, but no other outward indicators of pregnancy are yet present, the pregnancy is said to be chemical.
You’ll most likely have another ultrasound a few weeks later. The goal of this is to search for a fetal pole and, ideally, a heartbeat. Once more, they’ll check to see if you’re carrying a singleton, twins, or more.
You will be referred to your normal OB/GYN for prenatal care as soon as a heartbeat is found. A high-risk OB/GYN is typically not required in a healthy pregnancy, even after infertility.
Fertility Ultrasound cost in India
As we read above, different scans may be needed to assess and determine the causes of infertility or during different phases of fertility treatments. Ultrasound cost in India will vary based upon several factors, such as the type of ultrasound, the city you live in, the imaging facility or hospital, etc. Prices can range from INR 950-INR 18,750.
What is the purpose of a sonohysterogram?
Many issues, such as irregular uterine bleeding, infertility, and recurrent miscarriage, can be resolved through sonohysterography by identifying their root causes. It can identify the following:
- Abnormal uterine growths, such as polyps or fibroids, and details on their size and depth
- Intimal scar tissue in the uterus
- Unusual uterine form
When is successful embryo transfer ultrasound conducted?
It should be performed between weeks five and seven of the pregnancy or three to five weeks after embryo transfer. Usually, a hypothetical last menstrual cycle date 14 days before egg retrieval is chosen to determine the pregnancy following IVF. The successful embryo transfer ultrasound scan can be performed exactly one month after the embryo transfer and will allow you to determine whether the pregnancy is progressing.
For fertility testing and treatment, ultrasound is a non-invasive, more comfortable, safe, affordable, and time-efficient approach. It has changed how an infertile couple is treated and the exploratory process. It can give the couple useful knowledge regarding fertility and aid in making a more informed decision about the treatment.
An ultrasound scan is a wonderful place to start when trying to figure out why you’re having trouble getting pregnant. Speak to your doctor or OB-GYN to assist you in understanding the various applications of fertility ultrasounds and to determine which one you require.