Have you heard of ‘scananxiety’? Many women feel anxious about having fertility scans during their treatment. It’s the fear of the unknown – what’s involved, what will they find, will it hurt……? So many questions.
This lovely and informative article was written for me by Nisha Nayak, who is a Sonographer at a Fertility Clinic and will be starting to train as a Fertility Coach very soon. Nisha knows exactly what it’s like to be anxious about having a fertility scan and has the most lovely manner and experience to help ladies feel reassured. Here Nisha explains exactly what’s involved in any of the fertility scans you might have during your fertility journey.
Ultrasound is a very essential part of any fertility treatment. If you are going through any type of fertility investigations or treatment, you will have a few ultrasound scans. These are usually performed transvaginally, are safe and do not expose you to any radiation.
During fertility investigations, your fertility consultant will recommend a few blood tests to check various hormone levels. They will also recommend a detailed transvaginal ultrasound to check the reproductive organs – the uterus, endometrium, ovaries and if required, a specialised test to assess the fallopian tubes. During the pelvic ultrasound, the uterus is measured and checked for fibroids and other pathology. The endometrium is assessed thoroughly using 2D and 3D ultrasound. This checks the endometrial thickness, shape and checks for fibroids and polyps within the endometrial lining. Ovarian reserve is evaluated by counting the antral follicles on the ovaries. Doppler studies are performed to assess the blood flow within the uterus and in the uterine arteries, as well as blood flow in the ovaries. All this provides the consultant with the information needed to help in the planning and managing of your fertility treatment.
If you decide to start fertility treatment, no matter what treatment protocol you are put on, you will need 3-5 fertility scans. The purpose of treatment scans is to monitor the growth of the follicles in the ovaries, as well as assessing the endometrial thickness. Follicles are small fluid-filled sacs within the ovary where the eggs mature during the stimulation phase of the treatment. As the follicles grow, they produce estrogen which in turn helps the endometrium to thicken and prepare for implantation of the embryo. The measurements are usually plotted on a folliculogram which is a simple graph like depiction of the follicle sizes and endometrial thickness. It makes it easy to monitor the progress of the treatment cycle. Most couples undergoing treatment find it easy to understand the various stages of treatment as well as the progress made during the cycle by looking at the folliculogram after each scan. Many clinics closely monitor the blood flow in the uterus and ovaries via Doppler ultrasound. All this provides valauable information to manage and modify the treatment plan as required.
Based on the treatment protocol, scans could start as early as Day-2 of your cycle with consecutive fertility scans every 48 hours until the follicles are ready. But usually scans start on Day 5 or 6 of your cycle. The number and frequency of scans can vary based on treatment protocol and individual response to medication
Once the follicles are large enough, a trigger injection is given and the egg retrieval is planned. Embryo transfer is the next step if you are meant to have fresh embryo transfer. Many women freeze their embryos and have a Frozen embryo transfer (FET) at a later time, which also involves 2-4 scans to plan the embryo transfer day.
The person performing the ultrasound scan could be an IVF consultant, fertility specialist, Sonographer or fertility nurse. They are usually very experienced and should ideally explain what to expect at each fertility scan. The scans are not painful, they can be slightly uncomfortable with a feeling of pressure in the pelvis as the ultrasound probe is moved around to get various images. The more relaxed you are during the scan, the easier and quicker it is to obtain all the images. It helps to take a few deep breaths before the scan and let the Sonographer know if you are feeling anxious so they can help you feel a bit calmer.
The initial investigation scan takes approximately 30 minutes, but subsequent treatment scans should not take more than 15 minutes. You need an empty bladder for transvaginal scans so it is best to go to the toilet once you arrive at the clinic so you are ready for your scan. Many clinics have blood tests after every treatment scan, but some clinics rely solely on ultrasound scans to monitor the treatment cycle.
The most favourite ultrasound scan for all is of course the first pregnancy scan! Hurray to the success of your treatment! This is a transvaginal scan performed around 6-7 weeks gestational age. Studies have shown that ultrasound has no harmful effects on the growing fetus. In this scan, we check for the position of the pregnancy/gestational sac, presence of yolk sac and fetal pole(s). A fetal heartbeat is usually seen at 6 weeks, so we expect to see it at this scan. After this scan, most couples are discharged from the fertility clinic, and are looked after by their NHS antenatal team. In the case of a negative outcome, NHS early pregnancy assessment units (EPAU) take over further care.
In conclusion, you will need a few fertility scans during your fertility journey. Though it can be frustrating to have regular scan appointments alongside work and other commitments, they have a very important role to play in managing the treatment and leading to the best possible outcome.