Pelvic Examination

An ultrasound scan is a simple and easy outpatient procedure to examine the internal reproductive organs. It will show clearly the position and size of the uterus, endometrial lining, ovaries, and follicles. Certain abnormal conditions such as fibroid, double uterus, and ovarian cyst can be diagnosed using an ultrasound scan alone. In addition, an ultrasound scan can be used for the diagnosis of ovulation.

Ultrasound scan appears as a routine practice in the management of infertility, from the initial stages of diagnosis of the cause of infertility to the eventual confirmation of pregnancy, including routine monitoring of early pregnancy. An ultrasound scan is probably the most important test in the investigation of infertility. A well-preformed and detailed ultrasound scan of the female pelvis will give more information than any other single test.

Before the use of ultrasound was introduced in the management of infertility, the monitoring and determination of ovulation were based on basal body temperature charts, changes in cervical mucus, and serum progesterone. Nowadays, an ultrasound scan can determine ovulation by the appearance of the corpus luteum after ovulation.

During the treatment of infertility where ovarian stimulation is involved, an ultrasound scan is repeated to monitor the growth of eggs (follicular tracking) and endometrial lining. The follicles grow at an average rate of 1.5mm per day. Follicular tracking is started on Day 7 of a menstrual cycle and every 2 days until the eggs are mature. It is essential that serial ultrasound scans are performed to monitor normal follicular growth. Normally the mature egg, with a size of 18mm, will ovulate between Day 12 to Day 14.