What is follicular monitoring?

Many couple who wish to conceive, are advised a follicular monitoring to plan the natural or IVF pregnancy. 

Follicular monitoring is a simple process done by sonologist/radiologist/fertility specialist, where they count and measure eggs in each ovary at regular intervals during menstrual cycle. When the egg reaches a certain size (usually more than 18 mm in diameter), it can ovulate (i.e. egg release) any time in next 3-4 days. This is the time period, when the chances of successful pregnancy is maximum. 

In most set-ups, follicular monitoring starts at Day 3 of cycle, when a baseline egg size is taken, to plan the follicular monitoring. At this time, some people may have a cyst or a large ballooned egg from prior cycle. In that case, it is sometimes better to abandon the study in this cycle, and better to proceed again in next cycle, when cyst is gone. Although, its not a hard and fast rule, and pregnancy may very well happen even if cyst is there. If there is no cyst, size and number of eggs are taken. Usually, at this time i.e on day 3 of cycle, egg sizes are 3-5 mm.

On day 3, gynecologists/fertility specialists prescribe some medicines to grow the egg, which is taken for 4-5 days. By day 7-8, after induction (i.e. taking these prescribed medications), eggs grow close to 10 mm. This is confirmed by scan on day 7/8, when again size and number of eggs is counted. Sometimes, eggs are overgrown, while sometimes they don't grow. If we have good number of eggs grown close to 10 mm at this time, chances of success are higher.

Then, radiologist/gynecologist decide to monitor the eggs closely on alternate day, and then on daily basis. Once the egg reaches a size of 16-18 mm, it may naturally ovulate and release the egg. If it rather reaches 20 mm and doesn't ovulate, a gonadotropin (HCG) injection is given, to release the egg. Egg release is seen on ultrasound, as some fluid released around ovaries, and also the sudden shrinkage in size of egg.

Now, this released egg is healthy for the period of 12-24 hours, whether to try natural pregnancy or IVF.

For more technical details, you may refer my article "follicular monitoring".

3D/4D scan for pregnancy

3D/4D ultrasound scanning is relatively latest addition to ultrasound. Apart from detecting many problems of baby, it has an entertainment or pleasure value to mother. Most of the mothers are worried about if everything is fine inside. While black-and-white 2D images look dull to them, colored 3D/4D images of face is reassuring to mother (or father). By just looking at face, they get a lot of assurance that everything is safe, in addition to radiologist's assurance.

These are few of the 3D/4D images taken at our clinic (Pace Ultrasound Clinic), which can give you an idea. Images are acquired on Mindray DC-7 machine.

Baby at ten weeks

 

BABY AT 11 WEEKS

Baby at 22 weeks

Baby at 28 weeks

Baby at 34 weeks

'V' for victory

Only thing is "Try to be in touch with your radiologist before hand, as 4D images may not come properly due to technical reasons and as the age advances. You can't do anything, if baby doesn't want to be snapped!"

Image Courtesy:
Dr. Praveen Jha
Pace Ultrasound Clinic.
Opp. Vignana Nagar bus stand,
Malleshpalaya main road,
New Thippasandra post
Bangalore - 75.

(For appointments call 8147158595)

Which Ultrasound you should go for?

Ultrasound can be performed for any part of body from head to toe, and thus different names have been given to them.

1. US Cranium- This cannot be done in adults because of their hard skull. However, newborn or infants have some soft opening (fontanelle), through which we can see brain of neonate. If your pediatrician observes baby's head is too large, or baby did not cry at birth or some problem was detected in antenatal pregnancy scan, this particular ultrasound is advised. As doing a CT or MRI scan of brain is little difficult for small babies, this is an easy and pretty accurate test to perform.

2. US Neck/Thyroid -  If you feel some lump in neck, or if you have thyroid issue, or some unexplained pain in cheek or below jaw, you may go for neck scan in consultation with your doctor.

3. US Doppler carotid- If you are experiencing giddiness or imbalance (vertigo), this particular scan can tell about the blood flow to the brain. Also, people who have weakness or paralysis, need this particular scan to check if any blood vessel to brain is blocked.

4. US Chest/Thorax - One of the common cause of chest pain and cough, is filling up of water around lungs (pleural effusion). While a simple X-Ray can tell about it, exact amount and how it can be taken care of, is better assessed by ultrasound. Also, for any visible or palpable lump, ultrasound is recommended.

5. US Breast (Sonomammogram)- For young females (<35-40 yrs age), who has breast lump, nipple discharge or unexplained pain, ultrasound is safe and accurate test to detect the problem. Also, in older age group females, it is supplemented with mammogram if necessary. Ultrasound can also help in difficult or failed biopsies.

6. US Shoulder - If you are experiencing shoulder pain with restricted movement (like pain during lifting overhead), or if you have recent injury, this scan is helpful to check if rotator cuff (muscles and tendons around shoulder) are torn. Also, sometimes water gets accumulated around joint, causing pain and swelling, which can be diagnosed with the scan, and if necessary, water can be taken out (aspirated).

7. US Doppler upper limb - For pain or swelling in arm, forearm or wrist, we may need to check the blood flow to the arm, with help of this test.

8. US Abdomen - This is the most commonly needed and advised test, which can tell about all organs inside abdomen. Abdominal pain of any nature, feeling lump in abdomen, urinary complaints, jaundice, fever of unknown cause, indigestion, swollen abdomen (abdominal distension).....and list goes on.... This test should also be done in healthy individuals as a part of regular health check-up. Routinely, we pick up many early tumours in this scan, where people did not experience any problem at all, and came for general check.

9. US Pelvis - Many females experience irregular periods, pain in lower abdomen (during menses or otherwise), urine infection, vaginal discharge, feeling lump or infertility. A pelvic scan is a MUST, and symptoms should not be ignored. US Pelvis can be done by two methods, either from top of abdomen (transabdominal) or through vaginal route (transvaginal). Needless to say, vaginal route is always better and accurate, although per abdomen route may seem comfortable.  Pelvic scan is also helpful to check the intrauterine devices (like Copper-T), especially when thread seems missing.

10. Renal doppler scan - Any hypertensive (people with high blood pressure) should go for this scan atleast once. One of the cause of hypertension is abnormal blood supply to kidneys, and this, if detected, changes the course of treatment. This test SHOULD be done in all hypertensives.

Do you really need an ultrasound? Is it safe?

Ultrasound is one of the few radiology tests, which doesn't have any radiation hazards. Its a perfectly designed and safest test, which, if done properly, can detect most of the diseases, at much affordable cost.

• Anybody, who is having abdominal pain, can get an ultrasound straightaway, and know if he has any stones, appendicitis, or any other minor or major issue.
• Many females have irregular periods or lower abdomen pain during menses or otherwise, which may be due to ovarian cysts or polycystic ovary. Ultrasound is the only way to diagnose such problems.
• Pregnancy- Well, ultrasound is lifeline of obstetricians.
• Swelling anywhere in body - Easiest way to know what it is or what it might be, is ultrasound.
• Old age urinary complaints - Things like prostate enlargement can only be documented with this test.
• Calf pain - One of the alarming reason is blockage of veins, which should be immediately taken care of. You need an ultrasound doppler test.
• Neck lump/Thyroid - If its a lump, ultrasound will tell how big it is, and what it might be? Not only that, it can be biopsied much accurately while doing the scan.
• Chest pain - You may need a battery of tests, and one of the first radiological test may be a simple chest X-ray. Once doctor sees the X-ray, and feels there may be some water (fluid) around lungs, ultrasound is needed to see the amount, as well as, can be tapped (taken out) very easily.
• Back pain - One of the common cause of back pain is urinary stones either in kidney or ureter (urinary passage from kidney). Ultrasound is first test needed in most cases.\
• Indigestion - Check for gallstones on ultrasound, apart from other things which your doctor might ask.
• Shoulder pain and restricted movements - You need to check if rotator cuff is torn. Although, MRI is best test to diagnose it, but ultrasound is much affordable and has pretty good results, if done properly.
• Pain or swelling in testes - Be it hydrocele (water in testes sac), hernia, or twisted testes (torsion), it can be only diagnosed with ultrasound.
• Male or female infertility - You need to check the genital organs with ultrasound.

TECHNICALLY, IT LOOKS LIKE EVERYBODY NEEDS AN ULTRASOUND, BUT IT IS ADVISABLE TO CONSULT YOUR DOCTOR BEFOREHAND