Folliculometry

Folliculometry is a short ultrasound examination that monitors the growth of the follicle containing the egg. It also monitors the growth of the endometrium, in a natural or stimulated cycle. Multiple folliculometry in the same cycle is called ovulation stimulation monitoring.

Monitoring ovulation stimulation (folliculometry) is a particularly important part of the procedure – assisted reproduction. A great deal of knowledge and experience in this area is needed to accurately determine the number and size of follicles and to correlate that finding with the thickness of the uterine lining. With this, we assess the risk of possible complications, and decide which is the most favorable moment to complete the procedure. Sometimes, in addition to the classic ultrasound examination, it is necessary to perform an ultrasound with color Doppler, a three-dimensional (3D) or four-dimensional (4D) ultrasound examination.

Innaturalcycle, when the patient is only timing intercourse, folliculometry alone will be sufficient for monitoring. It starts from the 10th-12th day of the cycle, and serial ultrasound examinations are used to determine ovulation. Sometimes it is necessary to perform a serum progesterone test on the 21st day of the cycle, which will confirm quality ovulation.

Due to variability in the menstrual cycle and response to therapy, in stimulated cycle, each patient needs to be monitored. The development of the follicles is monitored so that the dose of the medication the patient receives can be adjusted. This determines the optimal time for timing ovulation with hcg injection. The first examination is usually scheduled on the sixth to eighth day of the cycle. Then an ultrasound examination is performed and sometimes the levels of estradiol and other hormones are checked.

Follicular-Study

During folliculometry, follicles are counted and measured. The measurement is made in two planes perpendicular to each other because due to the pressure of the ovarian capsule, the follicle is often irregular in shape. Thus, measuring in one plane would give an unrealistic value. The obtained values ​​are added and divided by two, which gives us the average diameter of the observed follicle. The thickness of the endometrium at the widest part in the longitudinal section through the uterus is also measured and its quality is assessed.

The stimulation phase usually lasts 10-12 days. When the follicles reach a size of 12-14 mm, they continue to grow at a rate of 2-3 mm/d. When the size of the leading follicle is over 18 mm, all hormonal stimulation is stopped. In addition to the follicles, the quality and thickness of the endometrium must be satisfactory, and the estradiol level must correspond to the size and number of follicles. Then an hCG injection is given, which stimulates the LH surge in the woman and induces ovulation, which will occur 34-36 days later. For technical reasons, the HCG injection is usually given in the evening so that the follicle aspiration can be done in the morning.

 

Occasionally, the procedure has to be abandoned. The reasons for this are too strong a reaction, when we are afraid of the occurrence OHSS-a, or a reaction that is too weak, when further stimulation would not result in the development of egg cells and a realistic chance of pregnancy. A reaction that is too strong is common in women whose ovaries appear polycystic on ultrasound, while a weak reaction is common in older women and in women with reduced ovarian reserve, or elevated FSH.

Sometimes, in the stimulated procedure, it happens that only 1-2 follicles develop, and the fallopian tubes in women are passable and the semen is of appropriate quality. Then the patient can be suggested to give up the procedure aspirations and transfer in favor of intrauterine insemination.

For more information, please contact us at the following phone numbers:

+387 33 781 735

+387 62 048 119

or send us an e-mail:

info@northwesternmedicalctr.com

or visit us at the following address:

Bulevar Mese Selimovica 17a

Sarajevo

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