Ultrasounds | Worth A Thousand Words

When navigating the rough and rocky road of assisted reproductive therapy (ART), it’s nice to have a spotlight illuminating the path. Think of the ultrasound as your personal spotlight, shedding light into areas that have been, until recently, shrouded in darkness and mystery. For many who have struggled with infertility, ultrasounds, both vaginal and abdominal, have been an irreplaceable tool in reaching their fertility goals.

For Randi Clarken, mother of 4-year-old twins from Hillsborough, N.J., ultrasounds were an important component to her eventual conception success. Clarken chose to begin having children later in life, and she and her husband had a difficult time conceiving. Because of her age, the Clarkens began aggressive ART almost immediately, and ultrasounds played a large part.

“I had four IUIs (intrauterine inseminations) with injectable drugs,” says Clarken. “I injected the drugs into my abdomen and then went for ultrasounds to determine how many eggs were appearing on my ovaries and what their sizes were.”

When that failed, Clarken was put on a round of drugs to prepare her for in vitro fertilization (IVF). Technicians performed ultrasounds almost daily during that period of time. The second IVF worked, and at age 41, she conceived her twins.

“All throughout the pregnancy, right from the beginning, I was having post-conception ultrasounds to track the status of my babies,” says Clarken. Through ultrasounds, Clarken and her doctors were able to track the progress of both her fertility cycles and the development of her babies.

How Ultrasounds Work

An ultrasound is an imaging technique that uses high-frequency sound waves and a computer to create images of tissues and organs. These images give doctors a clear picture of maternal structures as well as fetal development. There are two types of ultrasounds frequently used in fertility care: the abdominal ultrasound where the ultrasound probe is used on the mother’s abdomen or the transvaginal ultrasound in which the probe is inserted in her vagina. The probe, or transducer, transmits sound waves that echo back and are transformed into a picture on a video screen.

Dr. Mark R. Bush, a reproductive endocrinologist at Conceptions Reproductive Associates in Denver, Colo., believes that ultrasound technology has revolutionized fertility care. “With this modality, we can accurately assess ovarian follicle development for intrauterine insemination cycles and in vitro fertilization cycles,” says Dr. Bush.

Ultrasounds are an important screening tool to evaluate the possible presence of uterine fibroids, polyps, ovarian cysts (such as those caused by endometriosis, dermoids, and other abnormal masses), and other conditions which may affect fertility.

During ART, transvaginal ultrasounds allow safe retrieval of eggs for IVF by attaching a needle guide to the transvaginal probe and aspirating the ovarian follicular fluid with a needle placed through the back of the vagina into the ovary.

“This breakthrough replaced the former method of retrieving eggs via laparoscopy which necessitated general anesthesia,” says Dr. Bush.

Preparing for Your Ultrasound

“A transvaginal ultrasound is one of the easiest tests for women to undergo,” says Dr. Ronald F. Feinberg, the IVF medical director for the Reproductive Associates of Delaware and author of Healing Syndrome O: A Strategic Guide to Fertility, Polycystic Ovaries, and Insulin Imbalance (Avery Penguin, 2004). “An empty bladder is encouraged, and the imaging picture of the uterus and ovaries is usually clear and understandable. There is rarely any pain, unless the woman has prior underlying disease or problems.”

Dr. Feinberg says that vaginal ultrasounds have pretty much replaced abdominal ultrasounds for most issues in gynecology. For obstetrical issues beyond the first trimester, abdominal ultrasound is still primarily used.

During a vaginal ultrasound the doctor inserts a slender, wand-shaped probe into the vagina. The wand is covered with a latex sheath for sanitation and lubricant for comfort. The doctor will then move the probe according to what she needs to see. There may be a bit of discomfort, but no pain. It helps to relax and keep your mind focused during the procedure.

An abdominal ultrasound typically requires a full bladder for optimal visualization, but Dr. Feinberg is quick to point out that the bladder doesn’t usually have to be full to the point of discomfort. During an abdominal ultrasound, gel is placed on the abdomen, and the probe is moved around for visibility.

After Conception

After conception, ultrasounds are used to check on the development of the baby, especially if there was difficulty conceiving. They are used to look for fetal abnormalities, to detect multiple pregnancies and to determine the position and size of the baby.

For Krissi Danielsson of Marina, Calif., ultrasounds of her growing fetus were the reward of months of heartbreak during reproductive therapy and recurrent miscarriages. “During the fourth and successful pregnancy, they were the only things that kept me sane during that stressful first trimester when I woke up every morning convinced I was miscarrying again,” says Danielsson. “Plus it also let the doctor see that the placenta was developing normally. Having the doctor monitor the development of the placenta and my daughter’s heart rate was a big stress reducer.”

This type of ultrasound helps reassure those women who have had difficulty conceiving or carrying a child to term. Going in for your post conception ultrasound can be the most exciting and rewarding time of the pregnancy, as you get a bird’s eye view into your baby’s life before he is even born. This is a time of bonding for the parents, and it helps them feel even closer to the baby they are carrying around inside of them. There is nothing like holding the very first picture of your baby – even if you aren’t sure what you are seeing!

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