A) Indications & Advantages -
If you are a woman trying to conceive, one of your biggest challenges in fertility
as you grow older is the suitability of your eggs. Egg production can be greatly
affected by your age both in quality and in number. By the time you are in your
late 30s or early 40s, you will probably have more poor quality eggs available than
good quality eggs. The impact of poor quality eggs is reflected in the general decline
of pregnancy rates as women age. One of the first steps a woman should take when
making the decision to conceive is to have Follicle (Follicular) Tracking or monitoring.
This will help to identify two things; whether or not she is ovulating and, if she
is, the scan will additionally pinpoint the exact time when the follicle ruptures
and releases the egg. This information enables a couple to time intercourse in order
to maximize their chances of conception.
In women taking fertility medication, follicle monitoring is essential to assess
her response to treatment. In order to safely proceed, it is important to know how
many eggs will ovulate and how high the estradiol level is. Each mature egg should
produce between 150 and 200 pg/ml of estradiol. Therefore, by using the hormone
levels in conjunction with the ultrasound exam, a more accurate determination of
a woman’s response to treatment can be made. Additionally, the dose of the fertility
medication can be adjusted during treatment if there is an inadequate response or
if too many eggs start to mature. If the estradiol level gets very high, a woman
may be at an increased risk for developing ovarian hyper stimulation syndrome. The
goal of follicle monitoring is to provide information about the number of mature
eggs that will ovulate and to ensure that this is accomplished safely. When the
eggs are mature, patients are advised to have planned relations or Intrauterine
Insemination or proceed with egg collection in case of an In-Vitro Fertilization
Cycle. Ultrasound Monitoring enables us to understand present status of the uterus,
endometrium and ovaries. Abnormalities in these findings could help to explain why
a woman may have difficulty conceiving. It also identifies ovarian cysts, pelvic
collection, hydrosalpinx etc.
Dr. Neelam Bhise does all follicular monitoring at at ACME fertility,
starting from baseline scan on day 2 followed by Day 6 & Day 9 after
which patient is ready for further management. Thus patient needs to come to the
clinic for a maximum of 3-4 visits.
B) Procedure –
During a normal cycle the egg develops within a follicle in the ovary. This follicle
is a thin walled structure containing fluid along with the egg attached to its inner
membrane. The follicle appears as a circular fluid-filled bubble on the screen and
can be seen when it is about 7-8 mm in size. It grows at a rate of about 1-2 mm
per day and is ready for ovulation when it measures within the correct range of
17-25 mm in diameter. During the tracking process, the number of developing follicles
and their size are measured and charted as well as ovulation being noted if and
when it occurs.
In conjunction with assessment of the follicles, the development of the lining of
the womb is also recorded during Follicle Tracking. In order for a pregnancy to
occur, the uterine lining must be receptive to a fertilized egg in order for the
embryo to implant successfully. The Follicle Tracking process measures the appearance,
development and thickness of the lining of the womb as the cycle progresses.