Importance of Transvaginal Sonography in Infertility Diagnosis and Treatment

Transvaginal sonography is a fast and painless imaging technique to capture the view of a patient’s pelvic structures in greater detail than a conventional abdominal ultrasound. A fertility expert may recommend this scan to determine the cause of signs of infertility, diagnose it, plan for suitable treatment approaches and track your pregnancy.

What is Transvaginal Sonography?

Let’s learn what TVS ultrasound is. Transvaginal sonography or TVS ultrasound is used to examine the uterus, bladder, vagina, ovaries and fallopian tubes.

How TVS differs from abdominal ultrasound?

In TVS ultrasound, the transducer (the device to capture images of the pelvic cavity) is inserted in the vagina. However, in abdominal ultrasound, the transducer is moved across the abdomen to record images.

Overview of the procedure and how it is performed

Transvaginal sonography involves the following steps:

• The patient lies down on the back with bent knees on a table.
• The technician inserts a transducer (covered with a gel and a condom) into the patient’s vagina painlessly.
• The device transmits sound waves and captures their reflections off body structures.
• The ultrasound machine generates and displays images of those structures.
• The professional slowly moves the device around the site to view the pelvic organs.

Role of Transvaginal Sonography in Infertility Diagnosis 

The transducer used in TVS transmits sound waves through the patient’s body and they reflect like echoes. A microphone records these waves which are converted into images and displayed on a computer monitor. This way, the sonographer can assess in detail the uterus, the adnexa (comprising the fallopian tubes and ovaries) and the other pelvic organs. This comprehensive assessment paves the way for further evaluation of structural abnormalities like:

Uterine anomalies:

The transvaginal scan helps examine the uterus’s position, shape and size to identify abnormalities like fibroids or polyps. If detected, they are carefully evaluated.

Ovarian conditions:

The TVS test for females also involves assessing the ovaries’ shape and size and inspecting for anomalies like follicles, cysts or polycystic ovary syndrome. 

Fallopian tube issues:

If needed, the doctor also scans the fallopian tubes for any structural irregularities like hydrosalpinx (fluid accumulation in one or both tubes) that can hamper their functioning or lead to infertility.

Assessment of endometrial thickness and health 

Transvaginal sonography allows the doctor to measure the endometrial thickness in various phases of the menstrual cycle. The sonography also helps detect any potential causes of unusual bleeding. When the receptivity and thickness of the endometrium are optimum, healthcare providers transfer the embryo to maximise the chances of successful implantation and subsequent pregnancy.

Monitoring ovarian follicles and ovulation

TVS allows the accurate counting of antral follicles in the ovaries. These follicles are small and immature ovarian follicles that can be seen on ultrasound. A lower count of antral follicles can mean a lower ovarian reserve and low fertility potential. By monitoring follicular development, TVS can help doctors predict the occurrence of ovulation and plan suitable fertility treatment methods like IUI and IVF treatment processes at the right time to increase the chances of conception.

TVS in Monitoring Treatment Progress 

It is essential to monitor uterine, ovarian and fallopian health to identify any fertility challenges and determine the suitable treatment approaches for successful conception.

Tracking follicular development during ovulation induction.

Checking follicular development is important to assess the ovarian reserve and determine the fertility potential. Based on that, the physician plans the appropriate ART interventions.

Evaluating the uterine lining before and during embryo transfer in IVF.

Assessing the uterine lining preceding and during embryo transfer in in-vitro fertilisation helps determine whether the endometrial lining is thick enough to support a successful implantation of the embryo.

Related Read – Ways to Improve Endometrial Thickness for IVF Success

Advantages of Transvaginal Sonography in Infertility 

High-resolution images for accurate diagnosis.

TVS test for females provides detailed and high-resolution images of pelvic structures. This helps to identify subtle anomalies that might not show in other imaging techniques and contribute to diagnostic precision.

Non-invasive and relatively painless procedure.

TVS ultrasound is not painful because it is a non-invasive procedure. There is no surgical intervention, no requirement for anaesthesia, fewer risks, and minimal discomfort.

Real-time imaging allowing for immediate evaluation.

Transvaginal scan involves real-time imaging which allows doctors to assess pelvic organs comprehensively and monitor processes like blood circulation within the reproductive organs, ovulation and follicular development as they occur. This real-time information helps time fertility procedures optimally and adapt interventions as required.

Ability to perform the procedure multiple times without significant risk.

TVS is usually safe and most patients can tolerate it well. Since it uses harmless ultrasound waves, it is fit for repeated use, particularly to track the progress of fertility procedures over time.

TVS in Assisted Reproductive Technologies (ART)

Role in guiding procedures such as egg retrieval and embryo transfer. 

TVS ultrasound helps assess the ovarian reserve by counting the number of antral follicles in the ovaries accurately. This provides important insights into the number of available eggs for retrieval.

This ultrasound method also monitors endometrial changes in real time throughout the treatment cycle. It allows doctors to track the receptivity and thickness of the endometrial lining and choose the right time for embryo transfer accordingly.

Monitoring the response to fertility medications.

TVS helps clinicians foretell a patient’s response to ovarian stimulation methods in ART, for instance, IVF treatment. Predicting the ovarian response helps to make sure that the patient is getting the right dosages of medications, minimising the risk of complications, and maximising the chances of the IVF process’s success.

Evaluating the implantation environment.

Checking the endometrial health and thickness helps to ensure that the implantation environment is optimal. This is important to increase the chances of successful conception and pregnancy.

Patient Experience and Preparation

What to expect during a TVS procedure.

Generally, TVS ultrasound is not painful. Only a small part of the transducer is inserted into the vagina. Therefore, only some patients report mild discomfort but no pain.

Here are the steps to prepare for this sonography procedure:

1. The doctor will explain the procedure and purpose of transvaginal sonography in detail, including possible risks, discomfort and complications and proceed with the patient’s informed consent.
2. The patient will be asked to empty the bladder before the scan to allow accurate and clear imaging of pelvic structures.
3. The patient is requested to lie on her back and her feet are often held by stirrups. This is the lithotomy position.
4. Before starting the procedure, the doctor provides the patient with a drape or gown to cover herself. The doctor addresses any last concerns or questions and ensures the patient feels comfortable. The area from the waist down is usually uncovered to perform the ultrasound.

Conclusion

We have experienced and certified sonographers who perform transvaginal ultrasounds with utmost safety. Feel free to approach us with all your questions and we will address them and help you understand how TVS can help you with your fertility treatments.

FAQs

Q: Is transvaginal ultrasound painful?

A: Generally, transvaginal ultrasound (TVS) is not painful. The procedure involves the insertion of a small part of the transducer into the vagina, which is usually well-tolerated by most patients. Some may experience mild discomfort, but pain is not commonly reported. The process is designed to be as minimally invasive and comfortable as possible.

Q: Is it normal to bleed after TVS?

A: It is not typical to experience bleeding after a transvaginal ultrasound. If bleeding does occur, it is usually light spotting and should not be a cause for concern. However, if you experience heavy bleeding or have any other unusual symptoms, it is important to contact your healthcare provider promptly.

Q: Is TVS done during periods?

A: Yes, transvaginal sonography can be performed during your menstrual period. However, it is advisable to inform your healthcare provider about your menstrual cycle so they can determine the best timing for the scan, especially if it is being done for specific fertility assessments. The presence of menstrual blood does not generally interfere with the procedure or its results.

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