Ultrasound and FertilityJo-Ellen Truelove
The Use of Ultrasound in Fertility Evaluation
During a fertility evaluation, it’s likely that your doctor will order an ultrasound. You might have an ultrasound exam as part of an initial consultation with a reproductive endocrinologist, or you might have one after your hormone levels have been tested. Your doctor will use the results of the ultrasound to assess the overall condition of your uterus and ovaries, the thickness of the lining of your uterus (the endometrium), and follicle development on the ovaries.
Getting Ready for Your Ultrasound
The ultrasound scanning will be performed by a radiologist or a sonographer (ultrasound technician) in an equipment-filled examining room. You’ll change into a medical gown to expose your lower body, but you’ll probably be able to wear your bra and socks. A pelvic ultrasound exam typically lasts from 20 to 30 minutes, and during that time, you’ll see grainy, gray pictures of your innermost self, as a real-time sonogram appears on a monitor. You may or may not get immediate feedback about what you’re seeing, but the results of the test will be interpreted by your fertility specialist. The test, and your experience, will differ according to the type of ultrasound test you have.
The Transabdominal Ultrasound
For general gynecologic assessment, doctors often choose transabdominal ultrasound. It is routinely used to evaluate the condition of the uterus and ovaries, and it’s helpful in the detection of cysts.
For transabdominal ultrasound testing, all of the action will happen on your lower belly. To prepare, you may be asked to drink up to six glasses of water an hour before the test, since a full bladder will push the intestines out of the way of the other organs.
Once you’re face-up on the table, the technician will apply gel or oil (warmed, if you’re lucky!) to your abdomen. This will facilitate the movement of a small, hand-held device called a transducer. The transducer sends reflected sound waves to a nearby computer, producing images on the monitor. You’ll remain still as the transducer is moved gently but firmly over the skin. You may feel tickling or temporary pressure if the technician presses down, but the procedure is painless. When you’re done, the gel will be wiped away, and you can empty your bladder (whew!), and get dressed. You can expect to resume your normal activities right away.
The Transvaginal Ultrasound
More often, doctors request higher-resolution images, the kind that can be obtained with a transvaginal ultrasound. It may sound daunting, but it’s not so bad. The transvaginal ultrasound is performed with a small, very thin, sometimes chilly transducer that is covered and lubricated. If you’re allergic to latex, be sure to mention it to the technician before the exam so that a latex-free cover is used.
During the exam, the technician inserts the tip of the transducer two or three inches into the vagina, then captures images from different orientations. Although you may find yourself wishing you were on a beach somewhere instead of in stirrups, the procedure is not painful. Most women, in fact, find that it’s easier than a Pap smear, and when it’s over, it’s over.
Although it’s less common, your doctor might want a detailed sonogram of the inside of your uterus, in which case, a hysterosonogram (or sonohystogram) may be performed. Usually, this technique is reserved for investigating possible uterine abnormalities, including adhesions, polyps, and cysts, particularly after multiple miscarriages.
A hysterosonogram is typically scheduled one week after menstruation. The test begins with a transvaginal ultrasound, after which a speculum is inserted, the cervix cleaned, and a small, lightweight tube (catheter) introduced into the uterus. The speculum is then removed and the transducer re-inserted. The technician uses the catheter to fill the uterus with sterile saline solution that enables the doctor to see the topography of your uterus more readily. If your doctor has requested information about your blood flow, the technician will use Doppler ultrasound during the same exam; Doppler is performed using the same transducer, so you won’t notice any difference.
Overall, the hysterosonogram is somewhat uncomfortable, like a gynecological exam, and you may experience some cramping associated with the use of the saline solution. Your doctor may ask you to take ibuprofen or acetaminophen before or after the exam, and sometimes doctors prescribe antibiotics to guard against infection.
Following the exam, the saline will drain (slowly, in most cases), so be prepared to wear a pad to protect your clothing. Walking around may aid the force of gravity and help you feel better. Some women plan on having someone drive them home after a hysterosonogram; others feel just fine and return to work. Light spotting is not uncommon for a day or two afterward.
The Use of Ultrasound in Infertility Treatment
If the results of your fertility examination lead to treatment for infertility, you’ll likely be experiencing many, many more ultrasounds. Truth be told, you may get to know that transvaginal transducer almost as well as it knows you.
Ultrasound is essential for so many treatment plans. For example, it’s used for monitoring endometrial development, follicle development, and ovulation, particularly for women who are taking fertility drugs. For these monitoring exams, your reproductive endocrinologist will be present to check your progress, and the good news is that these ultrasound check-ups only last about five minutes.
Doctors also employ ultrasound to guide medical instruments during surgical procedures, such as egg retrieval for IVF. If early pregnancy is detected, ultrasound is commonly used to confirm the location of the pregnancy and assess the gestational sac. And when fertility treatments have succeeded, an ultrasound is frequently used to detect the heartbeat of a fetus, or two!
Ultrasound tests for fertility don’t produce exciting, 3-D, look-at-our-baby sonograms, but they are useful and virtually risk- and pain-free. Most importantly, they provide information that can help and your partner achieve your dreams.