If you have been trying to get pregnant and haven’t been able to, it’s time to have a pelvic ultrasound. Information gained during a pelvic ultrasound could tell you what the problem may be. The uterus is a pear-shaped organ that sits on top of the vagina. Embryos attach to the inside (also known as the cavity) of the uterus and grow. A pelvic ultrasound may tell you if you have a growth inside your cavity that is affecting the ability of a pregnancy to either attach and/or grow.
What are the different types of abnormalities picked up by ultrasound? Fibroids are very common growths and depending on their size or location, they can cause problems with conceiving. You may not be able to see a fibroid inside the cavity unless you fill the uterus with fluid first. Imagine a collapsed balloon. You won’t be able to see if there is something blocking the inside the balloon unless you try and blow the balloon up first. If there is a blockage inside the cavity, you will be able to see it better if you fill the cavity first. The tests that can assess the cavity include the following: saline infusion sonogram (water ultrasound); hysterosalpingogram (tubal dye test); and a hysteroscopy (similar to the saline infusion sonogram and hyseterosalpingogram but uses a camera inserted into the cavity of the uterus). A uterine polyp is a benign growth inside the cavity that can also affect your chances of pregnancy. One common sign of a fibroid or polyp inside the cavity is spotting in between menstrual cycles.
The pelvic ultrasound can also be used to look at your ovaries and will give you doctor an idea of your ovarian aging. Your doctor can count the number of follicles that she sees and she can use this information to pick the appropriate treatment and infertility drug doses for you. The pelvic ultrasound can also detect a fluid filled tube (hydrosalpinx).
When you are in a fertility treatment cycle your doctor will use ultrasound to look at the lining of your uterus. The lining is a measurement of the thickness of the tissue that lines the cavity. Your lining changes thickness and appearance as your menstrual cycle progresses. Ask your doctor how thick she wants your lining at the time of ovulation. If your lining isn’t thick enough this may be a sign that you may want to ask your doctor to evaluate you for Asherman’s syndrome (more on Asherman’s syndrome another day). We often give women estrogen tablets and baby aspirin if their lining isn’t thick enough at the time of ovulation.
The image below is an example of what a woman’s uterine lining would look like right before ovulation.
Your doctor will also look at your ovaries in order to measure the size of your follicles. Depending on the type of treatment your are having, your doctor may want you to have 1 mature follicle or many more.
This image seen below is an image of an ovary. You can see black circles which represent follicles. When a follicle is close to 2 cm, we think that the egg inside the follicle is mature.
Make sure you have the following questions answered when having a pelvic ultrasound:
- Do I have any fibroids or polyps?
- What is my antral follicle count?
- What is the thickness of my endometrial lining? Is this what is expected for this time in my cycle?
- How many mature follicles do I have? This translates into: How many eggs do you expect me to ovulate?
- Is this what you expected to see on ultrasound today? Why or why not?
Every fertility clinic operates differently. You may have your doctor plan a treatment, the ultrasound technologist will do the ultrasound, another doctor (not your doctor) will interpret the ultrasound, and a nurse will call you with the results and plan. If this is the type of clinic that you are going to, you need to be on top of everything. Keep track of your cycle days, ask for copies of your ultrasound report so that you can keep track of the size of your follicles so that if you don’t get pregnant this cycle, you will then know better than everyone else what you have done and what works for your body.
Our clinic works the following way: your doctor plans your treatment, your own doctor does your ultrasound, and your doctor talks to you about what it means. Knowing in advance what he/she is talking about will help you understand why you are in the office in the first place.
Hope this helps.