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Fig 2. Ultrasound scan of the uterus, showing a normal endometrium, which appears as a triple band in the center of the uterus
One of the commonest findings on an ultrasound scan is an ovarian cyst. A cyst (a fluid-filled sac) is a collection of fluid surrounded by a thin wall that develops in the ovary. Typically, ovarian cysts are functional (not disease-related) and disappear on their own. During ovulation, a follicle may grow, but fails to rupture and release an egg. Instead of being reabsorbed, the fluid within the follicle persists and forms a follicular cyst.
The other type of functional cyst is a corpus luteum cyst, which develops when the corpus luteum fills with blood. Functional ovarian cysts usually resolve on their own, and are not to be confused with other pathological conditions involving cystic ovaries, specifically polycystic ovarian disease, endometriotic cysts, or ovarian tumors. Since an ultrasound picture is just a black and white shadow, the doctor has to be skillful in interpreting what the image means. Simple cysts are thin walled, and appear as a large black bubble. Cysts that contain blood (for example, chocolate cysts found in patients with endometriosis) will have echoes within them, which appear white, and these are described as complex masses on ultrasound. The incidence of follicular cysts is increased in infertile patients taking drugs (such as clomiphene and HMG) for ovulation induction. Functional ovarian cysts usually disappear within 60 days without treatment. However, if the cyst is larger than six cm, or persists for longer than 6 weeks, then further testing may be needed.
Ultrasound scans can be done either by a radiologist or by the gynecologist or infertility specialist himself. Remember that the eye sees only what the mind knows, so you must go to a good clinic for your scans. The benefit of having the scans done by the infertility specialist himself is that he can make immediate decisions regarding your treatment based on the scan findings. If the radiologist does the scans, then you have to wait till your doctor has seen the report before knowing what to do next since the radiologist does not make the treatment decisions. In any case, it is vital that the ultrasound scans be done in the Infertility Clinic itself, so that your waiting can be minimized - and you don't have to run around from the sonographer to the gynecologist. If there are any abnormal findings, it is vital that your gynecologist sees the actual ultrasound images for himself during the scan. This provides much more information than the printed pictures.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
