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Sonography & Follicular study

What is Follicular study?

Follicular study or ovulation cycle tracking is the process involving serial sonography examinations to identify which days of the cycle are the most fertile for planning a pregnancy. It helps in identifying the fertile window and helps improve the chances of natural conception. The sonography examination also gives additional information about the ovaries, uterus and its lining and may help to identify undiagnosed causes of infertility.

The monitoring procedure:

This involves monitoring of the ovulation cycle through pelvic ultrasounds. This will give information on the development of follicles, the days of expected ovulation and the endometrial pattern. Generally, these scans usually start on the 9th day of your menstrual cycle and continue till ovulation occurs. The fertility specialist observes the follicle development occurring in the ovaries to calculate the exact time when the egg is likely to be released. This may require 2-4 visits (usually from days 9-20) in a cycle depending upon the growth of the follicle and the uterine lining. It is a painless procedure using ultrasound probes inserted vaginally and lasts about a few minutes.
 

Who should take the follicular study?

When a couple is planning pregnancy, the timing of intercourse is critical, and many couples get this wrong. This method of checking the follicles and confirming ovulation is more accurate than the arbitrary method of calculating the fertile period from the menstrual cycle days. The time at which the egg is released from the ovary, also called the fertile window, is the most appropriate time to have intercourse. The fertile window can also be tracked through blood tests and home ovulation kits, but follicular study is less invasive and the most accurate way of detecting the fertile window. It is recommended for women who have regular menstrual cycles and do not suffer from anovulation.
 

  • If you have been trying to get pregnant for a few months without success, then it is recommended that you visit your fertility specialist for basic check up and get your ovulation cycle tracked. Generally follicular study is recommended for young couples with short duration of infertility.
  • For women undertaking fertility drugs under supervision, follicular monitoring helps to assess the response of these drugs and adjust their doses if required.

What is seen in a follicular study?

In addition to monitoring the growth of follicle and ovulation, follicular study also helps to detect follicles that rupture prematurely or fail to rupture. It also helps in detecting pathologies in the uterus like fibroids pressing on the wall of uterus or polyps within the wall or improper/asynchronous growth of the uterine lining (endometrial thickness) with the follicular growth. This additional information may help in identifying the cause of infertility.
 

What happens after the follicular study?

A follicular study will help you coordinate your intercourse attempts in the fertile window. It is recommended that couples have an intercourse at least every alternate day throughout the fertile window. After ovulation, the egg survives for approximately one day in the female genital tract while the sperms retain the ability to fertilise this egg for about 2-4 days.
 

What if a woman doesn’t conceive after follicular study?

If even after ovulation tracking and timing intercourse at the appropriate time, you are still unsuccessful, then your fertility specialist may recommend you undertake further tests to determine if there are other underlying fertility issues with either partner.
 

Steps involved in IUI

    • Baseline scan:
      This scan is done on day2 / day3 of a menstrual cycle which gives additional information like:

      • Antral follicle count – which signifies the ovarian reserve
      • Simple cysts or Endometriosis cysts
      • Fibroids

    • The next scan is generally done on day 9/10 done to check the appearance of a follicle which appears as thin walled fluid-filled structure containing the egg. The follicle appears as a black bubble on the scan which grows at the rate of 1-2 mm per day

    • The subsequent scan is done on Day 11/13. This scan shows a dominant follicle of size about 17-25 mm in diameter with the endometrial thickness should also be 7-10 mm. The uterus is also checked to exclude any indenting lesion like polyps or fibroid etc. The couple is advised the optimal time of intercourse depending upon these findings.

    • The next scan is done on Day 14-16. This is done to check disappearance of the dominant follicle, and presence of irregular walled cystic structure indicating ovulation. In addition, fluid may also be present in the pelvis which supports the finding of ovulation.

    • Problems like less number of antral follicles, irregular or small follicles, follicles growing slowly or in asynchrony with the endometrium, lack of rupture of the follicle and absence of ovulation can be detected with this method and then these can be further addressed.

Some examples of the images seen on ultrasonography:

Normal Uterus

Endometrium

Follicles in the ovary

Uterine Fibroids

Uterine-fibroids

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