Skip to main content
SpringerLink
Log in

Ultrasound in Follicle Monitoring for Ovulation Induction/IUI

  • Chapter
  • First Online:
Book cover Ultrasound Imaging in Reproductive Medicine

Abstract

Over the past several decades, there have been a number of technical advances that currently allow for superb imaging of female pelvic structures. Ultrasound plays a significant role in diagnosing and treatment of infertility. It is now clear that transvaginal ultrasound (TVUS) holds tremendous potential as a radiological tool in the evaluation of infertility. This chapter presents to you the basic information about the role of ultrasound in ovulation induction and intrauterine insemination (IUI). For ease of understanding we begin this chapter with the physiological concept of follicular selection and then proceed to the role of ultrasound in various steps of assisted reproductive technology (ART). The importance of baseline scan before starting ART is emphasized; this not only helps to rule out any underlying pathology but checks the ovarian reserve which in turn helps us in the selection of patients for the ideal treatment protocol.

The various medications and protocols used for ovulation induction are discussed along with their mechanism of action and the side effects. Various studies are cited explaining the efficacy of each treatment protocol. The significance of stimulated IUI cycles in ART and the role of ultrasound in detecting and preventing complications of ovulation induction are explained in depth. Incorporation of ultrasonographic imaging into routine clinical investigations for infertility is rapidly occurring. The best is yet to come as basic research in ultrasonography evolves and its use for treating infertility is incorporated into clinical and research programs.

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 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight 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

Abbreviations

AFC:

Antral follicle count

AIUM:

American Institute of Ultrasound in Medicine

AMH:

Anti-Mullerian hormone

AVC:

Automatic volume calculation

CC:

Clomiphene citrate

COS:

Controlled ovarian stimulation

EFG:

Early follicular stage

EFP:

Early follicular phase

FI:

Flow index

FSH:

Serum follicle-stimulating hormone

GC:

Granulosa

hCG:

Human chorionic gonadotropin

HPO:

Hypothalamic-pituitary-ovarian

IUI:

Intrauterine insemination

IVF:

In vitro fertilization

IVF-ET:

Ovulation induction in in vitro fertilization programs

LH:

Luteinizing hormone

OHSS:

Ovarian hyperstimulation syndrome

PCOS:

Polycystic ovary syndrome

PFBF:

Perifollicular blood flow

TC:

Theca cells

uLH:

Urinary LH testing

VFI:

Vascularization flow index

VI:

Vascularization index

References

  1. Aboulghar MM. Chapter 20: Ultrasound monitoring for ovulation induction: pitfalls and problems. In: Ovarian stimulation. Cambridge: Cambridge University Press; 2009. Online publication. ISBN 9780511762390.

    Google Scholar 

  2. Pierson RA, Olatunbosun OA, et al. Transvaginal ultrasonography and the evaluation of female infertility. In: Sciarra JJ, editor. Gynecology and obstetrics, vol. 5. Saskatoon: University of Saskatchewan; 2004. p. 1–12.

    Google Scholar 

  3. Blankstein J, Arora S, Brasch J. Ultrasound to monitor ovulation induction. In: Rizk B, Puschek E, editors. Ultrasonography in gynecology. Cambridge University Press. [In press].

    Google Scholar 

  4. Baerwald A, Walker R, Pierson R. Growth rate of ovarian follicles during natural menstrual cycles, oral contraceptives cycles and ovarian stimulation cycles. Fertil Steril. 2009;91(2):440–9.

    Article  PubMed  Google Scholar 

  5. Palatnik A, Strawn E, Szabo A, Robb P. What is the optimal follicular size before triggering ovulation in intrauterine insemination cycles with clomiphene citrate or letrozole? Fertil Steril. 2012;97(5):1089–94. e1–3.

    Article  CAS  PubMed  Google Scholar 

  6. Shrestha SM, Costello MF, Sjoblom P, McNally G, Bennett M, Steigrad SJ, Hughes GJ. 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. Epub 2006 Apr 22.

    Article  CAS  PubMed  Google Scholar 

  7. Coulam CB, Goodman C, Rinehart JS. Colour Doppler indices of follicular blood flow as predictors of pregnancy after in vitro fertilization and embryo transfer. Hum Reprod. 1999;14(8):1979–82.

    Article  CAS  PubMed  Google Scholar 

  8. Nargund G, Bourne T, Doyle P, Parsons J, Cheng W, Campbell S, Collins W. Associations between ultrasound indices of follicular blood flow, oocyte recovery and preimplantation embryo quality. Hum Reprod. 1996;11(1):109–13.

    Article  CAS  PubMed  Google Scholar 

  9. Jayaprakasan K, Al-Hasie H, Jayaprakasan R, Campbell B, Hopkisson J, Johnson I, Raine-Fenning N. The three-dimensional ultrasonographic ovarian vascularity of women developing poor ovarian response during assisted reproduction treatment and its predictive value. Fertil Steril. 2009;92(6):1862–9. Epub 2008 Oct 29.

    Article  PubMed  Google Scholar 

  10. Bhal PS, Pugh ND, Gregory L, O’Brien S, Shaw RW. Peri-follicular vascularity as a potential variable affecting outcome in stimulated intrauterine insemination treatment cycles: a study using transvaginal power Doppler. Hum Reprod. 2001;16(8):1682–9.

    Article  CAS  PubMed  Google Scholar 

  11. Ivanovski M, Damcevski N, Radevska B, Doicev G. Assessment of uterine and arcuate artery blood flow by transvaginal color Doppler ultrasound on the day of human chorionic gonadotropin administration as predictors of pregnancy in an in vitro fertilization program. Akush Ginekol (Sofiia). 2012;51(2):55–60.

    CAS  Google Scholar 

  12. Kim A, Han JE, Yoon TK, Lyu SW, Seok H, Won HJ. Relationship between endometrial and subendometrial blood flow measured by three-dimensional power Doppler ultrasound and pregnancy after intrauterine insemination. Fertil Steril. 2010;94(2):747–52.

    Article  PubMed  Google Scholar 

  13. Cantineau AE, Cohlen BJ, Dutch IUI Study Group. The prevalence and influence of luteinizing hormone surges in stimulated cycles combined with intrauterine insemination during a prospective cohort study. Fertil Steril. 2007;88(1):107–12. Epub 2007 Apr 18.

    Google Scholar 

  14. Manzi DS, Dumez S, Scott LB, Nulsen JC. Selective use of leuprolide acetate in women undergoing superovulation with intrauterine insemination results in significant improvement in pregnancy outcome. Fertil Steril. 1995;63(4):866–73.

    CAS  PubMed  Google Scholar 

  15. Allegra A, Marino A, Coffaro F, Scaglione P, Sammartano F, Rizza G, Volpes A. GnRH agonist-induced inhibition of the premature LH surge increases pregnancy rates in IUI-stimulated cycles. A prospective randomized trial. Hum Reprod. 2007;22(1):101–8.

    Article  CAS  PubMed  Google Scholar 

  16. Kolibianakis EM, Zikopoulos K, Schiettecatte J, Smitz J, Tournaye H, Camus M, Van Steirteghem AC, Devroey P. Profound LH suppression after GnRH antagonist administration is associated with a significantly higher ongoing pregnancy rate in IVF. Hum Reprod. 2004;19(11):2490–6.

    Article  CAS  PubMed  Google Scholar 

  17. Dickey RP, Olar TT, Taylor SN, Curol DN, Rye PH, Matulich EM. Relationship of follicle number, serum estradiol, and other factors to birth rate and multiparity in human menopausal gonadotropin-induced intrauterine insemination cycles. Fertil Steril. 1991;56(1):89–92.

    CAS  PubMed  Google Scholar 

  18. Stoop D, Van Landuyt L, Paquay R, Fatemi H, Blockeel C, De Vos M, Camus M, Van den Abbeel E, Devroey P. Offering excess oocyte aspiration and vitrification to patients undergoing stimulated artificial insemination cycles can reduce the multiple pregnancy risk and accumulate oocytes for later use. Hum Reprod. 2010;25(5):1213–8.

    Article  CAS  PubMed  Google Scholar 

  19. Rotterdam Eshre/ASRM-sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19–25.

    Article  Google Scholar 

  20. Kinkel K, Frei KA, Balleyguier G, et al. Diagnosis of endometriosis with imaging: a review. Eur Radiol. 2006;16:285.

    Article  PubMed  Google Scholar 

  21. de Silva KS, Kanumakala S, Grover SR, et al. Ovarian lesions in children and adolescents-an 11 year review. J Pediatr Endocrinol Metab. 2004;17:951.

    PubMed  Google Scholar 

  22. La Marca A, Argento C, Sighinolfi G, Grisendi V, Carbone M, D’Ippolito G, Artenisio AC, Stabile G, Volpe A. Possibilities and limits of ovarian reserve testing in ART. Curr Pharm Biotechnol. 2012;13(3):398–408.

    Article  PubMed  Google Scholar 

  23. Deb S, Campbell BK, Clewes JS, Pincott-Allen C, Raine-Fenning NJ. The intra-cycle variation in the number of antral follicles stratified by size and in the endocrine markers of ovarian reserve in women with normal ovulatory menstrual cycles. Ultrasound Obstet Gynecol. 2012;41(2):216–22.

    Article  Google Scholar 

  24. Frattearelli JL, Levi AJ, Miller BT, Segars JH. A prospective assessment of predictive value of basal antral follicles in in-vitro fertilization cycles. Fertil Steril. 2003;80:350–5.

    Article  Google Scholar 

  25. Jokubkiene L, Sladkevicius P, Valentin L. Number of antral follicles, ovarian volume, and vascular indices in asymptomatic women 20 to 39 years old as assessed by 3-dimensional sonography – a prospective cross-sectional study. J Ultrasound Med. 2012;31:1635–49.

    PubMed  Google Scholar 

  26. Hendriks DJ, Ben-Willem JM, Laszlo FJ, Egbert R, Broekmans FJM. Antral follicle count in the prediction of poor ovarian response and pregnancy after in vitro fertilization: a meta-analysis and comparison with basal follicle-stimulating hormone level. Fertil Steril. 2005;83(2):291–301.

    Article  PubMed  Google Scholar 

  27. Csokmay JM, Frattarelli JL. Basal ovarian cysts and clomiphene citrate ovulation induction cycles. Obstet Gynecol. 2006;107(6):1292–6.

    Article  CAS  PubMed  Google Scholar 

  28. Eissa MK, Hudson K, Docker MF, Sawers RS, Newton JR. Ultrasound follicular diameter measurement: and assessment of inter-observer and intra-observer variation. Fertil Steril. 1985;44:751–4.

    CAS  PubMed  Google Scholar 

  29. Raine-Fenning NJ, Jayaprakasan K, Chamberlain S, Devlin L, Priddle H, Johnson I. Automated measurements of follicle diameter: a chance to standardize? Fertil Steril. 2009;91(4 Suppl):1469–72.

    Article  PubMed  Google Scholar 

  30. Jirge PR, Patil RS. Comparison of endocrine and ultrasound profiles during ovulation induction with clomiphene citrate and letrozole in ovulatory volunteer women. Fertil Steril. 2010;93(1):174–83.

    Article  PubMed  Google Scholar 

  31. Wolman I, Birenbaum-Gal T, Jaffa AJ. Cervical mucus status can be accurately estimated by transvaginal ultrasound during fertility evaluation. Fertil Steril. 2009;92(3):1165–7.

    Article  PubMed  Google Scholar 

  32. Homburg R. Clomiphene citrate – end of an era? Hum Reprod. 2005;20(8):2043–51.

    Article  CAS  PubMed  Google Scholar 

  33. Coughlan C, Fitzgerald J, Milne P, Wingfield M. Is it safe to prescribe clomiphene citrate without ultrasound monitoring facilities? J Obstet Gynaecol. 2010;30(4):393–6.

    Article  CAS  PubMed  Google Scholar 

  34. Shoham Z, DiCarlos C, Patel A, Conway GS, Jacobs HS. Is it possible to run a successful ovulation induction program based solely on ultrasound monitoring? The importance of endometrial measurements. Fertil Steril. 1992;56:836–41.

    Google Scholar 

  35. Shoham Z. Ultrasound is the only monitoring modality necessary for ovulation induction. OBGyn.net. 2011. http://hcp.obgyn.net/fetal-monitoring/content/article/1760982/1911450. Last accessed on 30 May 2013.

  36. Wiser A, Gonen O, Ghetler Y, Shavit T, Berkowitz A, Shulman A. Monitoring stimulated cycles during in vitro fertilization treatment with ultrasound only-preliminary results. Gynecol Endocrinol. 2012;28(6):429–31.

    Article  CAS  PubMed  Google Scholar 

  37. Abdelazim IA, Makhlouf HH. Sequential clomiphene citrate/hMG versus hMG for ovulation induction in clomiphene citrate-resistant women. Arch Gynecol Obstet. 2013;287(3):591–7.

    Article  CAS  PubMed  Google Scholar 

  38. Blankstein J, Shalev J, Saadone T, Kukia EE, et al. Ovarian hyperstimulation syndrome; prediction by number and size of preovulatory follicles. Fertil Steril. 1987;47(4):597–602.

    CAS  PubMed  Google Scholar 

  39. Kwan I, Bhattacharya S, et al. (Systemic review) Cochrane Menstrual Disorders and Sub-fertility Group (MDSG). Cochrane Database Syst Rev. 2008:(4).

    Google Scholar 

  40. Hodgen GD. Ovarian physiology and in vitro fertilization. In: Collins RC, editor. Ovulation induction. New York: Springer; 1991. p. 22–40.

    Chapter  Google Scholar 

  41. Palleres P, Lealier C, Gonzales-Bulnes A. Progress toward “in vitro virtual histology” of ovarian follicle and corpora lutea by ultrasound. Fertil Steril. 2009;91(2):624–6.

    Article  Google Scholar 

  42. Bromer JG, Aldad TS, Taylor HS. Defining the proliferative phase endometrial defect. Fertil Steril. 2009;91(3):698–704.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Rosalind Franklin University of Medicine and Science, Mount Sinai Hospital, 15th St at California Ave, Chicago, IL, 60608, USA

    Josef Blankstein MD, ARDMS

  2. Department of Obstetrics and Gynecology, Mount Sinai Hospital, Chicago, IL, USA

    Shumal Malepati MD

  3. Department of Obstetrics and Gynecology, Rosalind Franklin University of Medicine and Science, The Chicago Medical School, Chicago, IL, USA

    Joel Brasch MD

Authors
  1. Josef Blankstein MD, ARDMS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shumal Malepati MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joel Brasch MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Josef Blankstein MD, ARDMS .

Editor information

Editors and Affiliations

  1. Department of Obstetrics and Gynecology, Eastern Virginia Medical School Jones Institute for Reproductive Medicine, Norfolk, Virginia, USA

    Laurel Stadtmauer

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

    Ilan Tur-Kaspa

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Blankstein, J., Malepati, S., Brasch, J. (2014). Ultrasound in Follicle Monitoring for Ovulation Induction/IUI. In: Stadtmauer, L., Tur-Kaspa, I. (eds) Ultrasound Imaging in Reproductive Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9182-8_18

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-9182-8_18

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-9181-1

  • Online ISBN: 978-1-4614-9182-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation