Pre-Treatment

Burton Fertility in partnership with Nurture in  Nottingham is one of just a few clinics in the country to have a Consultant Gynaecologist specialising in gynaecological ultrasound.  Dr. Nick Raine-Fenning, an Associate Professor of Reproductive Medicine at the University of Nottingham, is an internationally renowned speaker on advanced ultrasound in gynaecology and fertility. His PhD looked the role of 3D imaging and Doppler ultrasound (blood flow assessment)

Dr Raine-Fenning leads a team of highly trained doctors and ultrasonographers who use the latest 3D and 4D ultrasound machines as part of their daily clinical work and for research. Over the past seven years the group have conducted a series of ethically approved studies which have enabled us to develop several evidence-based ultrasound protocols that are now in daily use. This allows us to offer individualised treatment which increases your chances of conceiving as reflected in our excellent pregnancy rates which continue to improve year on year.

For patients undergoing fertility treatment, and IVF / ICSI in particular, we recommend a pre-treatment 3D scan because:

  • It can predict your response to the drugs used to stimulate your ovaries (see Antral Follicle Count).
  • It can identify problems that may reduce the chances of your treatment working (see Common anomalies seen on ultrasound scan).
  • It can give accurate, quantitative diagnosis of polycystic ovaries and polycystic ovarian syndrome.
  • It can identify abnormalities of the womb that may reduce fertility and increase the risk of miscarriage and late pregnancy loss (see Miscarriage and Repeated Unsuccessful IVF).

What is an "Antral Follicle Count" (AFC)?

Follicles are small fluid-filled areas in the ovary which look black on ultrasound. Each follicle contains an oocyte or egg. The small follicles, those measuring between 2-8mm, are called "antral follicles" and it is these that develop in response to the drugs given during IVF treatment.

Prior to commencing treatment we offer an AFC scan on day 2-5 of your cycle. During the scan we measure the size of the ovaries (ovarian volume) and count the number of antral follicles present in each ovary. We can also use sophisticated 3D software that automatically measures the size of each follicle (see image).  Based on this information the clinician can calculate the optimum dose of drugs required to stimulate your ovaries prior to egg collection.  We would expect to recruit around 60% of the total number of follicles seen on scan and for these to yield an egg at the time of egg collection.

What are the advantages of having a pre-treatment scan?

A pre-treatment scan gives the clinician the information they need to decide on the most appropriate treatment pathway for you. This allows the team to optimise your chances of achieving a pregnancy.  It also allows us to identify those women likely to have a poor or exaggerated response before treatment is started. This information ensures we can accurately counsel couples about their chances and the risks involved ensuring they are able to make an informed decision before proceeding with treatment.

Common anomalies seen on a pre-treatment ultrasound scan

In addition to calculating your ovarian volume and number of follicles, a pre-treatment scan allows the ultrasonographer to identify any anomalies that may compromise your treatment such as:

Ovarian cyst

An ovarian cyst is simply a fluid-filled sac. Cysts are often solitary but can be multiple and affect both ovaries. There are many different types of ovarian cyst all of which require different treatment. In certain circumstances it may be necessary to remove or aspirate the cyst before commencing treatment.

Endometrial polyp

An endometrial polyp is a benign (non-malignant) tumour or overgrowth of the lining of the womb.  They are very common and can be solitary or multiple.  The majority of polyps do not cause any problems but in a small number of cases they may interfere with implantation and increase the risk of miscarriage.

Fibroids

A fibroid is a benign (non-malignant) tumour or overgrowth in the muscle layer of the womb.  They are very common and can range in size from very small (less than the size of a pea) to very large (the size of a grapefruit).  Depending on the location of the fibroid, surgery may be required to remove it.

Hydrosalpinx (a swollen Fallopian tube)

Generally, the presence of a hydrosalpinx means that the Fallopian tube is damaged.  The fluid within a hydrosalpinx tends to leak back into the womb and reduces the chances of conception both naturally and after IVF treatment. Removal of the tube is recommended as this has been shown to almost double the chances of pregnancy.

Miscarriage and Repeated Unsuccessful IVF

Unfortunately despite falling pregnant, either naturally or after fertility treatment, some couples experience the tragedy of a miscarriage. Miscarriage is extremely common and is thought to affect 1 in 7 couples. In the vast majority of cases there is nothing wrong and subsequent pregnancies proceed uneventfully but miscarriage can recur. One reason for this is an abnormality of the shape of the womb known as a "uterine anomaly". 3D ultrasound allows us to ensure the uterus is normal or to detect these anomalies with absolute confidence allowing us to offer reassurance or surgery where appropriate. We also check the blood flow to the womb which may relate to repeated unsuccessful IVF treatments.