Skip to main content
SpringerLink
Log in
Book cover

Ultrasound Imaging in Reproductive Medicine pp 249–271Cite as

Ultrasound in Follicle Monitoring for Ovulation Induction/IUI

  • Chapter
  • First Online:

  • 1030 Accesses

Abstract

Ultrasound is the most powerful tool to monitor normal and stimulated cycles, and predictions of the assumed time of ovulation allow optimal timing of various procedures such as insemination, ovum aspiration, etc. In this chapter, we highlight the role of transvaginal ultrasound in the treatment of ovulation using medication such as Clomid and gonadotropins to enhance fertility. Accumulating data based on the Cochrane Database indicate that there is no evidence from randomized trials to support cycle monitoring by ultrasound plus serum estradiol as more efficacious than cycle monitoring by ultrasound only on outcomes of live birth and pregnancy rates.

This is a preview of subscription content, 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

Learn about institutional subscriptions

References

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

    Google Scholar 

  2. Pierson RA, Olatunbosun OA. 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, Malepati S, Brasch J. Ultrasound to monitor ovulation induction. In: Ultrasonography in gynecology. Cambridge University Press: Publisher Springer; 2014. p231–50.

    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  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  Google Scholar 

  6. Shrestha SM, Costello MF, Sjoblom P, McNally G, Bennett M, Steigrad SJ, et al. 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  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  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  Google Scholar 

  9. Jayaprakasan K, Al-Hasie H, Jayaprakasan R, Campbell B, Hopkisson J, Johnson I, et al. 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  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  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  Google Scholar 

  13. 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.

    Article  CAS  Google Scholar 

  14. Kolibianakis EM, Zikopoulos K, Schiettecatte J, Smitz J, Tournaye H, Camus M, et al. 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  Google Scholar 

  15. 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.

    Article  CAS  Google Scholar 

  16. Stoop D, Van Landuyt L, Paquay R, Fatemi H, Blockeel C, De Vos M, et al. 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  Google Scholar 

  17. 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 

  18. 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 

  19. Kinkel K, Frei KA, Balleyguier G, Chapron C. Diagnosis of endometriosis with imaging: a review. Eur Radiol. 2006;16:285.

    Article  Google Scholar 

  20. de Silva KS, Kanumakala S, Grover SR, Chow CW, Warne GL. Ovarian lesions in children and adolescents-an 11 year review. J Pediatr Endocrinol Metab. 2004;17:951.

    PubMed  Google Scholar 

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

    Article  Google Scholar 

  22. 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 

  23. Hsu A, Arny M, Knee AB, Bell C, Cook E, Novak AL, et al. Antral follicle count in clinical practice: analyzing clinical relevance. Fertil Steril. 2011;95(2):474–9.

    Article  Google Scholar 

  24. 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.

    Article  Google Scholar 

  25. 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  Google Scholar 

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

    Article  CAS  Google Scholar 

  27. 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.

    Article  CAS  Google Scholar 

  28. 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  Google Scholar 

  29. 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  Google Scholar 

  30. 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  Google Scholar 

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

    Article  CAS  Google Scholar 

  32. 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  Google Scholar 

  33. 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.

    Article  Google Scholar 

  34. Shoham Z. Ultrasound is the only monitoring modality necessary for ovulation induction. OBGyn.net. 21 July 2011. http://hcp.obgyn.net/fetal-monitoring/content/article/1760982/1911450. Last accessed on 30 May 2013.

  35. 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  Google Scholar 

  36. 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  Google Scholar 

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

    Article  CAS  Google Scholar 

  38. Kwan I, Bhattacharya S, et al. (Systemic review). Cochrane Menstrual Disorders and Sub-fertility Group. (MDSG). Cochrane Database Syst Rev. 2008;(4):40.

    Google Scholar 

  39. Vural F, Vural B, Doğer E, Çakıroğlu Y, Çekmen M. Perifollicular blood flow and its relationship with endometrial vascularity, follicular fluid EG-VEGF, IGF-1, and inhibin-a levels and IVF outcomes. J Assist Reprod Genet. 2016;33(10):1355–62. Epub 2016 Aug 2.

    Article  Google Scholar 

  40. Huyghe S, Verest A, Thijssen A, Ombelet W. The prognostic value of perifollicular blood flow in the outcome after assisted reproduction: a systematic review. Facts Views Vis Obgyn. 2017;9(3):153–6.

    CAS  Google Scholar 

  41. Chen HJ, Lin YH, Huang MZ, Seow KM, Huang LW, Hsieh BC, et al. Dose-finding study of Leuplin depot for prevention of premature luteinizing hormone surge during controlled ovarian stimulation: a pilot study in intrauterine insemination treatment. Taiwan J Obstet Gynecol. 2016;55(2):235–8.

    Article  Google Scholar 

  42. Wadhwa L, Khanna R, Gupta T, Gupta S, Arora S, Nandwani S. Evaluation of role of GnRH antagonist in intrauterine insemination (IUI) cycles with mild ovarian hyperstimulation (MOH): a prospective randomised study. J Obstet Gynaecol India. 2016;66(Suppl 1):459–65. doi: Epub 2016 Feb 26.

    Article  CAS  Google Scholar 

  43. Franik S, Eltrop SM, Kremer JA, Kiesel L, Farquhar C. Aromatase inhibitors (letrozole) for subfertile women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2018;24(5):CD010287.

    Google Scholar 

  44. Hu S, Yu Q, Wang Y, Wang M, Xia W, Zhu C. Letrozole versus clomiphene citrate in polycystic ovary syndrome: a meta-analysis of randomized controlled trials. Arch Gynecol Obstet. 2018;297(5):1081–8.

    Article  CAS  Google Scholar 

  45. Wang S, Zhang Y, Mensah V, Huber WJ III, Huang YT, Alvero R. Discordant anti-müllerian hormone (AMH) and follicle stimulating hormone (FSH) among women undergoing in vitro fertilization (IVF): which one is the better predictor for live birth? J Ovarian Res. 2018;11:60.

    Article  Google Scholar 

  46. Peeraer K, Debrock S, De Loecker P, Tomassetti C, Laenen A, Welkenhuysen M, et al. Low-dose human menopausal gonadotrophin versus clomiphene citrate in subfertile couples treated with intrauterine insemination: a randomized controlled trial. Hum Reprod. 2015;30(5):1079–88. Epub 2015 Mar 18.

    Article  CAS  Google Scholar 

  47. Youssef MA, van Wely M, Mochtar M, Fouda UM, Eldaly A, El Abidin EZ, et al. Low dosing of gonadotropins in in vitro fertilization cycles for women with poor ovarian reserve: systematic review and meta-analysis. Fertil Steril. 2018;109(2):289–301. Epub 2018 Jan 6.

    Article  CAS  Google Scholar 

  48. Azziz R. Reproductive endocrinology and infertility: clinical expert series -polycystic ovary syndrome. Obstet Gynecol. 2018;132(2):321–36.

    Article  Google Scholar 

  49. Nelson SM, Klein BM, Arce J-C. Comparison of antimüllerian hormone levels and antral follicle count as predictor of ovarian response to controlled ovarian stimulation in good-prognosis patients at individual fertility clinics in two multicenter trials. Fertil Steril. 2015;103(4):930.e1. https://www.clinicalkey.es/playcontent/1-s2.0-S001502821402545X. https://doi.org/10.1016/j.fertnstert.2014.12.114.

    Article  CAS  Google Scholar 

  50. Zhang S, Zhang J, Wang Y, Chen Q, Hong Q, Cai R, et al. Dual trigger of final oocyte maturation in poor ovarian responders undergoing IVF/ICSI cycles. Reprod Biomed Online. 2017;35(6):701–7. https://www.sciencedirect.com/science/article/pii/S1472648317304194. https://doi.org/10.1016/j.rbmo.2017.09.002.

    Article  CAS  PubMed  Google Scholar 

  51. Lehmann P, Vélez M, Saumet J, Lapensée L, Jamal W, Bissonnette F, et al. Anti-müllerian hormone (AMH): a reliable biomarker of oocyte quality in IVF. J Assist Reprod Genet. 2014;31(4):493–8. https://www.ncbi.nlm.nih.gov/pubmed/24573377. https://doi.org/10.1007/s10815-014-0193-4.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Kollmann M, Martins WP, Lima MLS, Craciunas L, Nastri CO, Richardson A, et al. Strategies for improving outcome of assisted reproduction in women with polycystic ovary syndrome: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2016;48(6):709–18. https://onlinelibrary.wiley.com/doi/abs/10.1002/uog.15898. https://doi.org/10.1002/uog.15898.

    Article  CAS  PubMed  Google Scholar 

  53. Hodgen G. Ovarian physiology and in vitro fertilization. In: Collins RC, editor. Ovulation induction. New York: Springer; 1990. p. 22–40.

    Google Scholar 

  54. Blankstein J, Mashiach S, Lunenfeld B. Ovulation induction and in vitro fertilization, vol. 27. Chicago: Year Book Medical Publishers; 1986.

    Google Scholar 

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

    Article  Google Scholar 

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

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Rosalind Franklin University of Medicine and Science, Chicago, IL, USA

    Josef Blankstein

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

    Josef Blankstein & Peter Aziz

  3. Trios Medical Group – Obstetrics & Gynecology, Kennewick, WA, USA

    Shumal Malepati

  4. Rosalind Franklin University of Medicine and Science, The Chicago Medical School, Chicago, IL, USA

    Jawaria Amir

Authors
  1. Josef Blankstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter Aziz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shumal Malepati
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jawaria Amir
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Josef Blankstein .

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

Blankstein, J., Aziz, P., Malepati, S., Amir, J. (2019). Ultrasound in Follicle Monitoring for Ovulation Induction/IUI. In: Stadtmauer, L., Tur-Kaspa, I. (eds) Ultrasound Imaging in Reproductive Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-16699-1_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-16699-1_15

  • 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