Chapter 20 - Ultrasound monitoring for ovulation induction: pitfalls and problems

Summary

Ovulation induction using stimulation drugs has now been in practice for over 40 years. All infertile patients, especially those scheduled for IVF, should have a basic infertility scan. This scan is best done in the early follicular phase and should be performed using transvaginal ultrasound. Abnormalities detected during examination of the endometrium include polyps, submucous fibroids, and intrauterine synechiae. Assessment of the ovaries is an essential part of this basic scan, in an attempt to predict the response of the patient to ovulation induction. Many infertile patients have had pelvic surgeries with recurrent ovarian cystectomies that might leave minimal non-visualized ovarian tissue. Measurement of follicles is more difficult during stimulation as they attain an ellipsoid shape. Maternal habitus and high BMI pose difficulties during examination, in spite of performing the examination transvaginally, due to manipulation of the probe and need for abdominal pressure.