Skip to main content
SpringerLink
Log in

2D Ultrasound in Follicle Monitoring for ART

  • Chapter
  • First Online:
Ultrasound Imaging in Reproductive Medicine

  • 963 Accesses

Abstract

Ultrasound imaging is a fundamental tool for the reproductive endocrinologist who works with ART. With US technology improving continuously, it permits comprehensive diagnostic evaluation of the uterus, ovaries, and tubes and allows for noninvasive observation of the ovarian and endometrial responses to gonadotropin stimulation. In real time it permits access to safely aspirate fluid transvaginally from both ovarian follicles after maturity and from pathology identified in the pelvis. Indeed, the introduction of transvaginal ultrasound for follicle monitoring during ovulation induction has dramatically improved not only the safety of ART but the success as well. Currently, transvaginal ultrasound imaging is considered mandatory for the safe use of gonadotropins, to optimize treatment and to avoid potentially life-threatening side effects, such as the ovarian hyperstimulation syndrome. Therefore, the use of 2D ultrasound for assessing follicular development during gonadotropin stimulation for ART is essentially universal. Regardless, which 2D ultrasound characteristics of the ovarian follicles can reliably predict the retrieval of a mature and fertilizable oocyte is still a matter of debate. We review the development of 2D ultrasound monitoring over the past three decades, focusing on the literature regarding follicle characteristics (size, volume, intrafollicular fluid, and perifollicular vascularization) and endometrial sonographic architecture related to the success of ART. We also summarize other uses of 2D ultrasound in the ART patient. Furthermore, additional and more sophisticated technologies such as Doppler analysis and 3D US are briefly reviewed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hackeloer BJ, Robinson HP. Ultrasound examination of the growing ovarian follicle and of the corpus luteum during the normal physiologie menstrual cycle (author’s transl). Geburtshilfe Frauenheilkd. 1978;38(3):163–8.

    CAS  PubMed  Google Scholar 

  2. Ylostalo P, Lingren PG, Nillius SJ. Ultrasonic measurement of ovarian follicles, ovarian and uterine size during induction of ovulation with human gonadotrophins. Acta Endocrinol. 1981;98(4):592–8.

    Article  CAS  Google Scholar 

  3. Naredi N, Singh SK, Sharma R. Does perifollicular vascularity on the day of oocyte retrieval affect pregnancy outcome in an in vitro fertilization cycle? J Hum Reprod Sci. 2017;10(4):281–7.

    Article  Google Scholar 

  4. Ben-Haroush A, Farhi J, Zahalka Y, Sapir O, Meizner I, Fisch B. Small antral follicle count (2–5 mm) and ovarian volume for prediction of pregnancy in in vitro fertilization cycles. Gynecol Endocrinol. 2011;27(10):748–52.

    Article  Google Scholar 

  5. Ben-Haroush A, Farhi J, Zahalka Y, Sapir O, Meizner I, Fisch B. Correlations between antral follicle count and ultrasonographic ovarian parameters and clinical variables and outcomes in IVF cycles. Gynecol Endocrinol. 2012;28(6):432–5.

    Article  CAS  Google Scholar 

  6. Coelho Neto MA, Ludwin A, Borrell A, Benacerraf B, Dewailly D, da Silva Costa F, Condous G, et al. Counting ovarian antral follicles by ultrasound: a practical guide. Ultrasound Obstet Gynecol. 2018;51(1):10–20.

    Article  CAS  Google Scholar 

  7. Kandil M, Rezk M, Al-Halaby A, Emarh M, El-Nasr IS. Impact of ultrasound- guided transvaginal ovarian needle drilling versus laparoscopic ovarian drilling on ovarian reserve and pregnancy rate in polycystic ovary syndrome: a randomized clinical trial. J Minim Invasive Gynecol. 2018;25(6):1075–9. https://doi.org/10.1016/J.JMIG.2018.01.036. Epub 2018 Feb 21.

    Article  PubMed  Google Scholar 

  8. Kwan I, Bhattacharya S, Kang A, Woolner A. Monitoring of stimulated cycles in assisted reproduction (IVF and ICSI). Cochrane Database Syst Rev. 2014;24(8):CD005289.

    Google Scholar 

  9. Wikland M, Hillensjö T. Monitoring ovarian response in IVF cycles. In: Gardner DK, et al., editors. Textbook of assisted reproductive techniques. London: Informa Healthcare; 2012.

    Google Scholar 

  10. Penzias AS, Emmi AM, Dubey AK, Layman LC, DeCherney AH, Reindollar RH. Ultrasound prediction of follicle volume: is the mean diameter reflective? Fertil Steril. 1994;62(6):1274–6.

    Article  CAS  Google Scholar 

  11. Jokubkiene L, Sladkevicius P, Rovas L, Valentin L. Assessment of changes in volume and vascularity of the ovaries during the normal menstrual cycle using three-dimensional power Doppler ultrasound. Hum Reprod. 2006;21(10):2661–8.

    Article  Google Scholar 

  12. Tur-Kaspa I, Stadtmauer L. Ultrasonography in assisted reproduction. In: Gardner DK, et al., editors. Textbook of assisted reproductive techniques. London: Informa Healthcare; 2012.

    Google Scholar 

  13. Kolibianakis EM, Albano C, Camus M, Tournaye H, Van Steirteghem AC, Devroey P. Prolongation of the follicular phase in in vitro fertilization results in a lower ongoing pregnancy rate in cycles stimulated with recombinant follicle-stimulating hormone and gonadotropin-releasing hormone antagonists. Fertil Steril. 2004;82(1):102–7.

    Article  CAS  Google Scholar 

  14. Merce LT, Bau S, Barco MJ, Troyano J, Gay R, Sotos F, Villa A. Assessment of the ovarian volume, number and volume of follicles and ovarian vascularity by three-dimensional ultrasonography and power Doppler angiography on the HCG day to predict the outcome in IVF/ICSI cycles. Hum Reprod. 2006;21(5):1218–26.

    Article  Google Scholar 

  15. Teissier MP, Chable H, Paulhac S, Aubard Y. Comparison of follicle steroidogenesis from normal and polycystic ovaries in women undergoing IVF: relationship between steroid concentrations, follicle size, oocyte quality and fecundability. Hum Reprod. 2000;15(12):2471–7.

    Article  CAS  Google Scholar 

  16. Shmorgun D, Hughes E, Mohide P, Roberts R. Prospective cohort study of three- versus two-dimensional ultrasound for prediction of oocyte maturity. Fertil Steril. 2010;93(4):1333–7.

    Article  Google Scholar 

  17. Ectors FJ, Vanderzwalmen P, Van Hoeck J, Nijs M, Verhaegen G, Delvigne A, Schoysman R, Leroy F. Relationship of human follicular diameter with oocyte fertilization and development after in-vitro fertilization or intracytoplasmic sperm injection. Hum Reprod. 1997;12(9):2002–5.

    Article  CAS  Google Scholar 

  18. Inaudi P, Germond M, Senn A, De Grandi GP. Timing of hCG administration in cycles stimulated for in vitro fertilization: specific impact of heterogeneous follicle sizes and steroid concentrations in plasma and follicle fluid on decision procedures. Gynecol Endocrinol. 1995;9(3):201–8.

    Article  CAS  Google Scholar 

  19. Wittmaack FM, Kreger DO, Blasco L, Tureck R, Mastroianni LJ, Lessey BA. Effect of follicular size on oocyte retrieval, fertilization, cleavage, and embryo quality in in vitro fertilization cycles: a 6-year data collection. Fertil Steril. 1994;62(6):1205–10.

    Article  CAS  Google Scholar 

  20. Vandekerckhove F, Gerris J, Vansteelandt S, De A, Baerdemaeker TK, De Sutter P. Delaying the oocyte maturation trigger by one day leads to a higher metaphase II oocyte yield in IVF/ICSI: a randomised controlled trial. Reprod Biol Endocrinol. 2014;12(31):1–9.

    Google Scholar 

  21. Detti L, Yelian FD, Kruger ML, Diamond MP, Puscheck EE. Endometrial thickness dynamics and morphologic characteristics during pituitary downregulation with antagonists in assisted reproductive technology cycles. J Ultrasound Med. 2008;27(11):1591–6.

    Article  Google Scholar 

  22. Kader MA, Abdelmeged A, Mahran A, Abu Samra MF, Bahaa H. The usefulness of endometrial thickness, morphology and vasculature by 2D Doppler ultrasound in prediction of pregnancy in IVF/ICSI cycles. Egypt J Radiol Nucl Med. 2016;47(1):341–6.

    Article  Google Scholar 

  23. Kasius A, Smit JG, Torrance HL, Eijkemans MJ, Mol BW, Opmeer BC, Broekmans FJ. Endometrial thickness and pregnancy rates after IVF: a systematic review and meta-analysis. Hum Reprod Update. 2014;20(4):530.

    Article  Google Scholar 

  24. Liu KE, Hartman M, Hartman A, Luo ZC, Mahutte N. The impact of a thin endometrial lining on fresh and frozen-thaw IVF outcomes: an analysis of over 40 000 embryo transfers. Hum Reprod. 2018;33(10):1883–8.

    Article  CAS  Google Scholar 

  25. Wang J, Xia F, Zhou Y, Wei X, Zhuang Y, Huang Y. Association between endometrial/subendometrial vasculature and embryo transfer outcome: a meta-analysis and subgroup analysis. J Ultrasound Med. 2018;37(1):149–63.

    Article  Google Scholar 

  26. Zhao J, Zhang Q, Wang Y, Li Y. Endometrial pattern, thickness and growth in predicting pregnancy outcome following 3319 IVF cycle. Reprod Biomed Online. 2014;29(3):291–8.

    Article  Google Scholar 

  27. Salama S, Arbo E, Lamazou F, Levailllant JM, Frydman R, Fanchin R. Reproducibility and reliability of automated volumetric measurement of single preovulatory follicles using SonoAVC. Fertil Steril. 2010;93(6):2096–73.

    Article  Google Scholar 

  28. Singh N, Usha BR, Malik N, Malhotra N, Pant S, Vanamail P. Three-dimensional sonography-based automated volume calculation (SonoAVC) versus two-dimensional manual follicular tracking in in vitro fertilization. Int J Gynaecol Obstet. 2015;131(2):166–9.

    Article  Google Scholar 

  29. Wertheimer A, Nagar R, Oron G, Meizner I, Fisch B, Ben-Haroush A. Fertility treatment outcomes after follicle tracking with standard 2-dimensional sonography versus 3-dimensional sonography-based automated volume count: prospective study. J Ultrasound Med. 2018;37(4):859–66.

    Article  Google Scholar 

  30. Ardaens Y, Gougeon A, Lefebvre C, Thomas P, Leroy M, Leroy JL, et al. Contribution of ovarian and uterine color Doppler in medically assisted reproduction techniques (ART). Gynecol Obstet Fertil. 2002;30(9):663–72.

    Article  CAS  Google Scholar 

  31. Nargund G, Doyle PE, Bourne TH, Parsons JH, Cheng WC, Campbell S, Collins WP. Ultrasound derived indices of follicular blood flow before HCG administration and the prediction of oocyte recovery and preimplantation embryo quality. Hum Reprod. 1996;11(11):2512–7.

    Article  CAS  Google Scholar 

  32. Shrestha SM, Costello MF, Sjoblom P, McNally G, Bennett M, Steigrad SJ, Hughes GJ. Power Doppler ultrasound assessment of follicular vascularity in the early follicular phase and its relationship with outcome of in vitro fertilization. J Assist Reprod Genet. 2006;23(4):161–9.

    Article  CAS  Google Scholar 

  33. Jadaon JE, Ben-Ami M, Haddad S, Radin O, Bar-Ami S, Younis JS. Prospective evaluation of early follicular ovarian stromal blood flow in infertile women undergoing IVF-ET treatment. Gynecol Endocrinol. 2012;28(5):356–9.

    Article  CAS  Google Scholar 

  34. Gerris J. Telemonitoring in IVF/ICSI. Curr Opin Obstet Gynecol. 2017;29(3):160–7.

    Article  Google Scholar 

  35. Gerris J, Vandekerckhove F, De Sutter P. Outcome of one hundred consecutive ICSI attempts using patient operated home sonography for monitoring follicular growth. Facts Views Vis Obgyn. 2016;8(3):141–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  36. Pereira I, von Horn K, Depenbusch M, Schultze-Mosgau A, Griesinger G. Self-operated endovaginal telemonitoring: a prospective, clinical validation study. Fertil Steril. 2016;106(2):306–310.e1.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sant’Anna Hospital, University of Turin, Department of Obstetrics and Gynecology, Turin, Italy

    Gianluca Gennarelli & Alberto Revelli

  2. Wesleyan University, Middletown, CT, USA

    Tomer Tur-Kaspa

  3. Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    Mette Toftager

  4. Institute for Human Reproduction, Chicago, IL, USA

    David P. Cohen

Authors
  1. Gianluca Gennarelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tomer Tur-Kaspa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alberto Revelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mette Toftager
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David P. Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David P. Cohen .

Editor information

Editors and Affiliations

  1. The Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, Norfolk, VA, USA

    Laurel A. Stadtmauer

  2. Institute for Human Reproduction, Chicago, IL, USA

    Ilan Tur-Kaspa

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Gennarelli, G., Tur-Kaspa, T., Revelli, A., Toftager, M., Cohen, D.P. (2019). 2D Ultrasound in Follicle Monitoring for ART. In: Stadtmauer, L., Tur-Kaspa, I. (eds) Ultrasound Imaging in Reproductive Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-16699-1_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-16699-1_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-16698-4

  • Online ISBN: 978-3-030-16699-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation