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Ultrasound or sonography has helped revolutionize our approach to the infertile patient. Ultrasound gynecologist's helps the doctor to "image" or see structures in the female pelvis. Ultrasound uses high frequency sound waves much like SONAR machines used in ships for detecting submarines underwater. The high frequency sound waves are bounced off the pelvic organs; and the reflected sound waves are received by the probe (transducer) and a computer is used to reconstruct the waves into black and white images on the monitor. Ultrasound machines today are all real-time machines, which give dynamic images.
In the old days, ultrasound for infertility was done through the abdomen. This required you to fill up your bladder (till it was ready to burst!) so that the sound waves could be transmitted into the pelvis. However, the standard ultrasound technique today for infertility is vaginal ultrasound (endovaginal scanning) in which a long, slim, slender probe is inserted into the vagina and used for imaging the pelvic organs. Not only is this much more comfortable for you; but it also gives much sharper and clearer pictures, since the probe is much closer to the pelvic structures.
What can you see on ultrasound? The ultrasound gives clear pictures of the uterus and the ovaries. It allows the doctor to look for fibroids, ovarian cysts and ectopic pregnancies. It is also excellent for early diagnosis of pregnancies. However, the ultrasound scan is not very good for assessing whether or not the tubes are normal.
Ovulation scans allow the doctor to determine accurately when the egg matures and when you ovulate. These scans form the basis for most infertility treatment since the treatment revolves around the wife's ovulation. Daily scans are done to visualize the growing follicle, which looks like a black bubble on the screen. The follicle grows at about 1-2 mm per day, and a mature follicle is about 18-25 mm in size. Please remember that ultrasound will not allow us to see the egg directly - this is located inside the follicle and is too small to be visualized by ultrasound. Ask the doctor to show you the scan image and to explain it to you. Other useful information that can be determined by these scans is the thickness of the uterine lining - the endometrium. The ripening follicle produces increasing quantities of estrogen, which cause the endometrium to thicken. The doctor can get a good idea of how much estrogen you are producing (and thus indirectly the quality of the egg) based on the thickness and brightness of the endometrium on the ultrasound scan.
Fig 1. Ultrasound scan showing multiple follicles
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
