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    What does this ultrasound report indicate?

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Posted on Fri, 3 Jun 2016 in General Health
Question: Please find attached an ultrasound scan report. I have since had another scan and cyst has resolved. Do you see I still need to see a Gynaecologist though other scan was normal? Was Gynaecologist just recommended due to the cyst which has now resolved? Do you see I can conceive naturally? All hormone bloods are good. FSH, LH TFT etc. From the scan can you see I do ovulate?
doctor
Answered by Dr. Shuba Hariprasad 2 hours later
Brief Answer:
Yes it is possible , more so with some lifestyle modifications

Detailed Answer:
Hello Ms. XXXXXXX

Thank you for your query .

I have gone through your reports and your query. I understand your concerns and know how important it is, to you ,to conceive naturally.
Before I answer your query, would you please clarify a few things for me?
1)     Have you been pregnant before? If so , how did you conceive and what was the outcome?
2)     About your cycles- Do you have regular cycles? How frequently do you have them and for how long?any excess bleeding? Are your cycles getting shorter?
3)     How long have you been trying to conceive?Have you sought medical help to conceive previously?
4)     Have you had any follicular study (a series of ultrasound scans of the pelvis that follows the growth& development of the follicles, endometrium and confirms ovulation)? This is done usually from the second or third day from the start of your period and repeated at intervals based on the growth of the follicles (3rd/7th/9th/11th/12th/13th day ,for instance)
5)     Do you have any other medical illnesses? Do you take any medications?
6)     Do you smoke or consume alcohol frequently?
7)     Has your partner been evaluated for sperm quality & quantity?
8)     Have you tried to monitor your ovulation period using an ovulation prediction kit along with basal body temperature monitoring?
9)     Have you had any prior abdominal, pelvic surgeries or procedures?

To consider: The following points are meant for you to have a better understanding of your fertility and the factors involved.
-     Females are born with a fixed number of eggs to last for a few decades. This ovarian reserve can be checked by measuring the levels of the Antimullerian hormone (AMH) in concurrence with an Antral Follicular count (AFC) detected by an ultrasound on Day 2 or 3 of your cycle.
Once she attains menarche, each month , a few follicles are recruited , from both ovaries,to develop, of which only develops into the dominant follicle. This will release its egg (ovulate) which is then picked up by the fallopian tube. If sperm is present, the egg will be fertilized (conception) and move on to the uterus where it will build its home for the next 9 months (implantation).
If no sperm is present, the egg remains viable for upto 24 hours. The follicle that released the eggs becomes the Corpus Luteum (CL) which degenerates after a fixed number of days and results in a period.

-     The above process is completely controlled by different hormones that increase and decrease to regulate the cycle.
In the follicular phase (from period to ovulation), Follicle stimulating hormone (FSH) is dominant along with estrogen. Estrogen helps to develop the endometrium for a possible implantation.
The increase in estrogen then leads to the LH (lutenizing hormone) surge that triggers ovulation (usually within 24-48 hrs- mostly before 36 hrs).
After ovulation, the dominant hormone is progesterone (secreted by the CL). Progesterone supports the growth, development & implantation of the fertilized egg and increases the blood flow to your endometrium in expectation of the same.

-     A lot of things need to fall in place for a pregnancy to occur. For a woman aged below 30 yrs, if everything goes right, chances of conceiving is 25% in a given month. Well timed intercourse during the fertile period (the day of ovulation and three days prior to that) will usually result in a pregnancy within one year (more than 85%)of consistent trying.
This percentage falls to 75% when she crosses 30 yrs and to 40% -50% by the age of 40 (per year)
In addition to the above, a favourable cervical mucus (eggwhite or watery in consistency) during the ovulation phase is necessary for sperm to travel up in to uterus. Sperm quality and quantity also matters just as egg quality matters.
Being overweight, having other illness like diabetes, hypertension, for instance, can put your body in a state of inflammation that is unfavourable to conceive, even if your reproductive cycle is working fine.

To address your concerns :
-     Yes, It is possible to conceive naturally.
-     Your ultrasound shows development of follicles . Ovulation could not me made out at this point. If a repeat ultrasound was done a few days later, it could have identified if a particular follicle had ruptured (indicating ovulation).
The relevance of the findings of the scan and blood reports depend on when in your cycle you took them (follicular phase? for instance)
-     Yes, the gynecologist opinion was sought for the Ovarian cyst. Based on your query, since it is not present anymore, this voids the need to see a gynecologist for this reason.

Suggestions/Recommendations
- Take a folic acid supplement (one a day) from today. This is to prevent neural tube defects
- Stop smoking and having alcohol ( if you do)
- Reduce weight healthily. Exercise in combination with diet modification. (note: starving or omitting entire food groups is not the answer). Have a balanced meal. Monitor your calorie intake.
An approximate number of calories you need to maintain your current weight is 2200cal/day. To lose weight, reduce this to 1800 cal/ day and try to burn another 300-500 calories a day by exercise. Note: if you don’t already exercise, you will need to start slow and work the pace up. It is better to see your physician to give you the ‘go ahead’ based on a general examination. Doing too much, too fast can have harmful effects on the body.
Aim for a 3-5 kg reduction /month, initially.
-     Monitor your ovulation using an ovulation prediction kit (this detects the LH surge mentioned above). Once detected, time intercourse accordingly. Ideally two days before the LH surge to 3 days after ovulation has been confirmed. This will take a few cycles to figure out .
Ovulation can be confirmed by using the basal body temperature monitoring technique provided it is done right. Once you see the shift in temperature after ovulation, due to progesterone synthesis, use this as a reference to pinpoint a probable date of ovulation for the next cycle. Intercourse once every 36-48 hours is ideal during this fertile phase.
If you don’t see a shift in the temperature , after monitoring for 3 cycles, it could mean that ovulation is not happening.
In this case, I would advice you to do a follicular study (can be done by a sonologist or a gynecologist). Ideally a gynecologist as they can analyse and do relevant studies/tests to assess your fertility status.
If ovulation is detected, use this method to try and conceive for 3-6 months. As time is a factor, I would advice for a semen analysis for your partner, if he is willing. If no pregnancy results, I strongly recommend seeing a fertility specialist. Even if everything is right, pregnancy may still not occur, for reason unknown (unexplained infertility).
Assissted reproductive techniques like Ovulation induction & Intrauterine insemination can increase your chances, to start with.

I hope I’ve answered all your queries and addressed your concerns. I sincerely hope you conceive naturally and have a healthy & safe confinement.
Please understand that, infertility (sorry to use this word) is not always a reflection of your womanhood or ability to be a mother. A lot of factors influence this process.
Do what is necessary and the rest will fall in place. Don’t go into this with expectations, just goals (lose weight, monitor ovulation, time intercourse). This will help take the stress off the process which is important when you are trying to conceive.

Please let me know if there is anything else I can help you with. If not, please close this discussion and rate my answer.

With best regards,
Dr. Shuba Hariprasad














Above answer was peer-reviewed by : Dr. Naveen Kumar
doctor
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Follow up: Dr. Shuba Hariprasad 31 minutes later
Thank you for your help.
Answers to your questions:
1. Never been pregnant but not really been very active intercourse could be something like 1 or 2 a month.
2. Cycles are normal every 27 to 31 days bleed for 5 days which has always happened
3. Been trying to conceive for 3 months but yet again sex isnt frequent could be 1 or 2 a week
4. I have had no follicular tracking no one will refer me for this. Maybe I should pay privately? Do you recommend this and will this definitely show if I ovulate?
5. Asthma take ventolin and seretide
Taking centrum prepregnancy vitamins and folic acid
6. Dont smoke and never drink any kind of alcohol.
7. Husband sperm is good 4% morphology
8. I have tried clearblue fertility monitor this shows low and high days but no peak days this is only my first month of using it. Ovulation sticks do show ovulation. Are these reliable to say I do ovulate?
9. I have had laprascopic cholecystectomy in 2012
I personally dont think i have sex often enough i never time it. Do you agree? I always worry and panic over nothing. Will my weight stop me conceiving I am try to lose weight
doctor
Answered by Dr. Shuba Hariprasad 34 minutes later
Brief Answer:
Be positive, manage stress, more frequent/well timed intercourse

Detailed Answer:
Hello,
Thank you for the follow up.

Ovulation tests only detect the LH surge which usually leads to ovulation within 36hrs.
Basal body temperature monitoring and a scan that shows a collapsed follicle with free fluid are the only reliable ways to confirm ovulation.

Abdominal surgeries may result in adhesions (sticking together of abdominal organs after surgery) this may interfere with conceiving if your fallopian tubes are affected. (egg & sperm can't meet due to tubal blockage). This can be checked by a tubal patency test (involves injecting a radio opaque XXXXXXX into the uterus. An xray will show XXXXXXX in both sides of the uterus, within the abdominal cavity, if tubes are not blocked).
This procedure may also help to relieve minor blocks, if present.

I recommend :
- that you use the ovulation prediction along with basal body temperature monitoring to pinpoint & confirm ovulation. That your period is regular is a positive sign

-please have regular intercourse (every alternate day) during the 10th to 20th day of your cycle (most likely to ovulate in this period). Yes, intercourse frequency is an issue.

-sperm needs to be refreshed. Stored Sperm quality may be compromised. if it stagnates(without release) for more than a few days. Have regular intercourse throughout the month (twice a week-more frequently during fertile period).

-try for 3 months. If it doesn't work out, please see a fertility specialist. They can help you with a follicular study. Expect to be told that you may need assisted reproductive techniques like IVF(in vitro fertilization). Don't be alarmed.
There is a protocol in place. However, the final decision is yours. Insist on knowing all your options & deciding on a course of action based on the facts.

Your concern & worry is normal and completely understandable. Please try not to be stressed by this. Weight does affect chances of conceiving, but so does stress & dozen other things.
Doesn't mean it will prevent conception.
Try to reduce weight, manage stress well, talk to a close friend or join a forum. Having someone who knows what you are going through helps deal with the stress.
Take it one day at a time. Plan for the little one. Eat healthy, have positive thoughts. You need to practice for when you get pregnant.

Could you please elaborate on the semen analysis report- a complete report will give me a better idea.

Thanks,
Please let me know if you have any further queries that I can help you with.
Regards,
Dr. Shuba Hariprasad


Above answer was peer-reviewed by : Dr. Naveen Kumar
doctor
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Follow up: Dr. Shuba Hariprasad 1 hour later
I dont actually have the report but infertility specialist says all was good. I be discharged from specialist as my bmi is 41 and it needs to be 30 to 35 things just seem completely impossible!
If clearblue fertility monitor shows low and high and peak does.this mean I have a good chance of ovulating. Infertility specialist says there is no problem with me ovulating
doctor
Answered by Dr. Shuba Hariprasad 7 hours later
Brief Answer:
Nothing is impossible.

Detailed Answer:
Hello,
Thank you for the follow up.

-the monitor shows fertility status based on the level of estrogen and LH during the follicular phase. The LH surge indicates impending ovulation.
Given that your cycles are regular and the monitor shows a high reading, there is a very good chance that you ovulate.
However, the only way to confirm is by scan. & basal body temperature monitoring as mentioned earlier.
As long as you ovulate & eggs /semen are healthy, there is a good chance of pregnancy if intercourse is well timed.

- weight reduction will definitely improve chances, not only of conception but also to have a safe pregnancy & delivery.
It is not impossible XXXXXXX It is difficult but never impossible. Like I said, take it one day at a time. Do what needs to be done.
We can't control what may or may not happen. We can only control how and what we choose to do about it.

Your husband's sperm is fine, you have regular cycles. Have intercourse regularly, as advised in my previous reply. At the same time, monitor your basal body temperature. Use an online site like fertility friend to help you visualize how your cycles works
This in conjunction with ovulation monitor can help you pinpoint your ovulation date.
Understanding how your body Works will make you more aware of it. This automatically will translate into healthier choices.
Please be positive. Give yourself a chance. Nothing is impossible. Don't look at the size of the problem/task, see if you can handle it.
I expect to hear good news from you in the next few months.

Hope I've helped. Please let me know if there is anything else I can help you with.

If not, please close this discussion & rate my answer.

Regards,
Dr. Shuba Hariprasad
Above answer was peer-reviewed by : Dr. Sonia Raina
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Answered by
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Dr. Shuba Hariprasad

General & Family Physician

Practicing since :2002

Answered : 1087 Questions

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