Role of Ultrasonography in Infertility Management : Ovulation Monitoring and Assisted Conception

Abstract

Infertility causes great stress to many couples. Most of those presenting with childlessness have reduced fertility, rather than absolute sterility, and many are likely to conceive spontaneously. In this “ultrasonographic monitoring of growing follicles, in ovaries to determine the day of ovulation and its coordination with time of intercourse” has a well established role in the management of „unexplained infertility‟. This study was conducted to find out its efficacy in our setup. 86 female‟s patients of unexplained infertility, with different post-marital time period, underwent ultrasonographic ovulation monitoring each with follow up for minimum of four menstrual cycles. Average follicular growth rate was 2 mm a day, which increased to 3 mm a day, two days prior to ovulation. Follicular diameter at the time of ovulation ranged from 22 mm to 27 mm with a mean of 24 mm. We observed ovulation in 79.2% of our patients. In 8.1% patient‟s dominant follicle ceased to grow beyond 18 mm size and gradually become atretic. Leutinized unruptured follicle was documented in 12.7% of our patients in whom follicular size reached to periovulatory range but did not rupture. Uterine endometrial thickness at the time of ovulation varied from 7 mm to 13 mm and multilayered appearance (triple line sign) was observed in 57.3% of patients. Overall con-ception rate was 16.3% whereas it was much more encouraging to see in 23.5% of patients who were in less than 5 years of their marriage. Keeping in view of easy to workup as out patient basis in large numbers of patient, less time consuming, pro-mising results, cost effectiveness and non invasive nature of technique; ultrasonographic monitoring of ovulation is recom-mended as a part of management in all patients of unexplained infertility.
Keywords: Infertility, ultrasound, ovulation monitoring.