Fertility Docs Uncensored Today’s episode of Fertility Docs Uncensored is hosted by Dr. Carrie Bedient from the Fertility Center of Las Vegas, Dr. Susan Hudson from Texas Fertility Center, and Dr. Abby Eblen from Nashville Fertility Center. In this episode, the hosts explain why vaginal ultrasounds are a cornerstone of fertility care, highlighting how they provide more detailed and accurate imaging than abdominal ultrasounds for evaluating reproductive anatomy and guiding treatment. The discussion reviews the use of transvaginal ultrasound in both diagnostic and therapeutic settings. The physicians describe saline infusion sonography (also called hydrosonogram) as a key test to evaluate the uterine cavity and assess whether the fallopian tubes are open, noting that tubes are typically only visible when abnormal, such as when blocked and dilated. They outline how ultrasound allows visualization of the uterus, measurement of the endometrial lining, and confirmation of a trilaminar pattern prior to embryo transfer. Structural findings such as fibroids and adenomyosis are discussed, including when fibroids may require surgical removal due to distortion of the uterine cavity or large size. The episode also explains how ultrasound is used to evaluate the ovaries, including identifying common cysts. Functional cysts such as follicles, corpus luteum cysts, and hemorrhagic corpus luteum are described as normal, benign, and self-resolving. Other cysts, including endometriomas and dermoid cysts, are reviewed with a focus on when surgical management is appropriate versus when observation is preferred to preserve ovarian reserve. The hosts also highlight how ultrasound is essential for monitoring follicle development during IVF cycles and is used in real time during egg retrieval procedures, emphasizing its central role throughout fertility treatment. This podcast was sponsored by Shady Grove Fertility.

Episode Transcript:

Susan Hudson (00:01)

You’re listening to the Fertility Docs Uncensored podcast, featuring insight on all things fertility from some of the top rated doctors around America. Whether you’re struggling to conceive or just planning for your future family, we’re here to guide you every step of the way.

Abby Eblen MD (00:22)

Hi everyone, we’re back with another episode of Fertility Docs Uncensored. I’m one of your hosts, Dr. Abby Eblen from Nashville Fertility Center. Today I’m joined by my beautiful and talented co-host, Dr. Carrie Bedient from Fertility Center of Las Vegas.

Carrie Bedient MD (00:37)

Hello ⁓

Abby Eblen MD (00:39)

and Dr. Susan Hudson from Texas Fertility Center.

Susan Hudson MD (00:42)

Hello everyone.

Abby Eblen MD (00:44)

Hey guys, what have you been up to lately?

Susan Hudson MD (00:47)

Well, not as busy as you.

Carrie Bedient MD (00:48)

Yeah, and I feel like, wait, Abby, before you say anything, you need intro music. I’m just a bill sitting on Capitol Hill.

Abby Eblen MD (00:59)

That’s right up there with conjunction junction, watch your function. These are all Saturday morning cartoon little things that we would talk kids about bills and all that stuff. But what Carrie and Susan are referring to, it’s been a really unusual week. I usually spend most of the week in my office and I actually can look out my window and see the state capitol, but that’s usually about as close as I ever get. So this week we have a very important bill coming up in the House. where our Congress, our legislators want to limit the ability for us to do, primarily do genetic testing in this particular bill, and also want to really add a lot more layer of departments that screen us and that come to investigate us. So we already screened by this group called CLIA and CAP and the FDA, and there’s just a lot of groups that really, that we have to be certified by. And so, part of what I did this week is we tried to help the legislators understand that we are very regulated, although they don’t think we are. And then the other part of it was trying to explain to them why we do genetic testing. And that was really the part that I felt really most strongly about because they really wanted to limit it to something called fatal fetal anomalies. And we didn’t really know what that meant since that’s really not a term a genetics counselor would use. So we had to help them understand that people can have new mutations all the time that we discover. So if you wrote a bill and listed just certain things we could test for, it would exclude those patients. We also had to help them understand that if somebody gives a gene to their child, it may present differently in different children, different family members. It may be fetal really early in some people, but maybe it may not be. And so we just had to really educate them about genes. And so I felt really great by the time we finished meeting with them on Wednesday.

At the very end, four legislators who were there with us with the bill sponsor basically just said, I think we just need to leave the gene part out. That can’t be part of our legislation. To the dismay of the bill sponsor, I think that’s what the final bill is going to have in it. I don’t know exactly what it’s going to look like at the end, but that was really important piece for all of us. So it really felt great when we left there on Wednesday. Anyway, so it was really interesting seeing government in action. ⁓

Susan Hudson MD (03:09)

Thank you, Abby.

It’s so important for people to have their voice heard because it in defense of the legislators, they’re getting input from constituents. But constituents are a wide variety of people. If you know of something that’s brewing in your legislature, it’s important to let your voice be heard because defending access to fertility care and testing. These are so important to us helping people achieve good pregnancy rates in a safe fashion and helping us increase the chances of healthy babies.

Carrie Bedient MD (03:53)

Personal stories from patients go not just miles and miles. I mean, they cross continents. Like, it is really huge how someone can walk in and say, look, I’ve had seven miscarriages. The third time I had to have a D&C and I hemorrhaged and nearly died because I needed four units of blood transfusion, blah, blah, blah. And putting a face to that makes a world of difference because it means it’s not some abstract whatever, it’s, Jessica and her husband, Mike, who have been through all of this and they’re very normal people and she’s a teacher, he’s an engineer, it really puts a face on it and it proves this is normal every day, what happens. And it’s hugely important for patients to get involved too because the doctor is like, we can make our scientific arguments of, no, you can’t do that, but nothing replaces the faces of the patients who have been through it of, couldn’t do this because of this law and this doesn’t make sense, or I need to be able to do this, don’t block me from doing this because it has such a huge impact on health and happiness and family building and all of it.

Abby Eblen MD (04:47)

Right.

Yeah, Carrie, that is an excellent point. And that’s exactly, the tipping point for why that legislator spoke up. She’s from Chattanooga and she said, I’ve had so many people call me and talk to me about their personal stories. And I just don’t feel like we need to get into dictating legislation for genetic testing. This is a time if you’ve never spoken to your legislator before, no matter what state you’re in, because I guarantee you it’s hitting lots of states in the country this year, whatever state you’re in, please go to your legislators and they will listen to you. They hear the scientific part, like Carrie said, from doctors, but from patients, it makes a huge difference. And so now is the time to speak up for sure or so.

Susan Hudson MD (05:45)

And all you have to do is go on the web, look up who your legislators are, and through their governmental links, they always have links on how you can communicate to them. They really do try to make it easy so that they can hear your voice. And whether that’s your written voice or your oral voice, just make sure your voice is heard.

Abby Eblen MD (06:05)

That’s right, that’s right. Well, thanks.

Susan Hudson MD (06:07)

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Abby Eblen MD (07:25)

So today we have a patient question. Give us our listener question today, Susan.

Susan Hudson MD (07:31)

Our question today is, I am 37 and have had one healthy child at 35 without medical intervention. It took us over a year to conceive her and we were considering medical IUI and IVF when I got pregnant. Towards the end of my pregnancy around 34 to 35 weeks, they diagnosed me as having a placental lake and our baby had IUGR. Her belly was measuring under the fifth percentile. I also had some blood pressure issues at the end, but never developed full blown preeclampsia.

I delivered her at 37 weeks. I have since had one miscarriage due to maternally caused triploidy around nine weeks. If I’m able to get pregnant again, is there anything I can do to reduce my risk for IUGR and placental issues?

Abby Eblen MD (08:15)

What do you think, Carrie?

Carrie Bedient MD (08:17)

So I’m only partially resisting the smart ass comment of, well, stop doing cocaine and heroin and all those things, which I have yet to ever have a patient who has been doing any of those things currently. They may or not have had a history, but certainly not currently. So some of the things to think about for this, making sure your health is as good as it can be.

Particularly when you were mentioning, yeah, there was some potential blood pressure issues with IUGR and a placental issue. That to me always signals like, wonder what…version of a hypertensive disorder, maybe not full-blown preeclampsia, but maybe there’s something going on there. There are certain things you can do to improve that prior to ever getting pregnant, which is make sure your weight is in healthy range. Make sure your blood pressure is well managed. It’s okay to be on medications, not every medication.

But there are ones that are safe in pregnancy. Make sure that that’s well managed. Make sure you’ve gone to your primary doc and have had all of the usual things screened for so that whatever needs to be optimized can because sometimes it’s, you are not responsible for this. Like this is not your fault. I’m not saying that at all. But there are very few things we can control. And some of the things that we can are, those lifestyle issues, those general medical issues of let’s get this under the best control we can and hope that it makes an improvement. And that’s got two sides to it. One is you may have a better outcome, but two is there’s no guilt later of, my gosh, I shoulda, woulda, coulda. And that relieves you of some of that burden.

Susan Hudson MD (09:52)

So some of my words of advice in addition to the things that Carrie said, make sure no nicotine use, no vaping. I mean, it sounds obvious, no marijuana, we have patients every day who come in who are still using these substances. When you get pregnant, starting on a low dose aspirin throughout your entire pregnancy does have some evidence that it helps improve the likelihood of not having placental issues or things like preeclampsia. I would also say that you’re somebody that we need to reduce the risk of multiples. You’re getting a little bit older, you’re 37. I don’t do hardly any fully injectable cycles anymore. However, not everybody practices that way. So, sticking to fertility treatments that have a lower risk of multiples because no matter how healthy a pregnancy is, a multiple pregnancy is always exponentially a little more dangerous. And you’ve already shown that you have some tendencies in that direction, plus you’re getting older. Making the pregnancy as non-eventful as possible, as Carrie said, with the things that we can control is super important.

But it’s also one of those things that, you can’t prevent everything.

Abby Eblen MD (11:10)

And I would add that there’s a really good book called the IVF Blueprint that has lots and lots of great information. And I believe someone by the name of Susan Hudson wrote, I think it was chapter four, I believe that you wrote, all about how to get everything in order before you get pregnant. So I’m saying that kind of tongue in cheek, but it is a great book and it does have a lot of information. if you need more information about all that stuff, that chapter is a really great, chapter to read. So today our topic is going to be why do we do ultrasounds, specifically vaginal probe ultrasounds for our infertility patients? So, Carrie, start out and tell me, why do we do a vaginal probe ultrasound? Because people always look at me like I have two heads and five arms when I tell them we’re gonna put a vaginal wand in them. They’re like, what? That’s not the kind of ultrasound I thought I was gonna get.

Carrie Bedient MD (11:59)

It’s because we want to annoy you as much as we possibly can. And we decided that this was the most effective way to do that. ⁓

That and it gets us close to the organs that we are most interested in. And so people always say, well, why can’t you do an abdominal ultrasound, which is where you’ve got the little probe and they put all the gel on your belly that even as, even as they try and get all of it away, there’s always some that’s left on your shirt or in your belly button or in your pant line or underpants line that comes back to, and irritate you later. But when we’re doing the vaginal ultrasounds, it gets us so much closer because the abdominal ultrasounds, they have to go through all the layers of skin and fat and potentially other organs in the way. And it just makes it harder to see. And if you’re carrying extra weight, that makes it more challenging. But even patients who are very slender, who aren’t carrying extra weight, there are some people who just have more difficult tissue to see. And so when we’re using a vaginal ultrasound, we’re having to go through that considerably less. The vaginal wall is not terribly thick. And so when we place the vaginal ultrasound, just by moving it a little bit in one direction or the other, can look directly at the uterus, we can look at either ovaries, we can see the adnexa, which is the general term for everything between the body of the uterus and all of the other reproductive organs right in that area. And so it gets us a lot closer and we can see more clearly what’s going on. You can use fancier tools like 3D, things that you can do much more easily with a vaginal ultrasound because you are closer to your target.

Abby Eblen MD (13:34)

So Susan, can we see the actual tubes with ultrasound? Carrie said we can see the ovaries, we can see the uterus, can we see the tubes? And what can we do to make that easier for us?

Susan Hudson MD (13:44)

So ideally in a normal vaginal ultrasound, you should not see the fallopian tubes. And if we do see the fallopian tubes, that means they have gotten really big and swollen and that’s actually not a good thing. So I often will have patients who are like, did you see my tubes? I’m like, no, and that’s fantastic. Exactly, exactly. And so in general, no, you should not see fallopian tubes. If you do, then that is probably part of your fertility challenge. In some offices, they may do some tubal patency tests, either using fluid with bubbles or different types of foam, that type of thing to be able to see the fallopian tubes under ultrasound. Otherwise, like in my clinic, we have people get an HSG test, which is another type of radiology test where we put some dye and pictures are taken over your belly. Just different ways of doing things. There’s pros and cons to both methods. But in general, you should not be able to see fallopian tubes. You should not be able to see kidneys through a vaginal ultrasound. ⁓ If we see a kidney, that also kind of points us to some other diagnostic criteria that can have some fertility implications as well.

Abby Eblen MD (15:03)

So Carrie, tell me specifically, if you’re looking at the ovaries, what are the kinds of things that you can see on the ovaries? Why would we wanna look at that initially when we see patients as a new patient in the office?

Carrie Bedient MD (15:15)

So first and foremost, you want to see that the ovaries exist. Because this is important.

Abby Eblen MD (15:18)

That’s an important one. And every now and then I found that an ovary didn’t exist actually. Yeah.

Carrie Bedient MD (15:24)

Yeah, and you never want to be in a retrieval trying to search for an ovary that doesn’t exist. And so we want to know that from the very beginning. So first of all is presence or absence of the ovaries and general location. Most of the time the ovaries fall back behind the uterus and they’re somewhat close to the vaginal area.

But that’s not always true. And so you want to take a look and see where are they. There are cases where the only time you can see them is with an abdominal ultrasound. And when that occurs, that is a message to us of there’s scar tissue in there. Perhaps there’s a fibroid uterus. Perhaps it will be more difficult to access during an IVF cycle. Perhaps the anatomy is distorted so that if we’re trying to do an insemination or ovulation induction cycle, that is less reliable. So we’re looking at positioning and placement. We’re looking at the size. Do we have an average sized ovary? Do we have one that is itty bitty teeny tiny that may indicate a lot of suppression or very, very decreased ovarian reserve or menopausal status? Do we have ovaries that are really big? And are they really big because they’ve got a ton of follicles in that are just teeny tiny? Or are they really big because we’ve got a cyst in there somewhere? And cysts come in all different flavors. And I’m sure Abby, you’re going to ask a question about that later. So I’m not going to dive into that right now.

Abby Eblen MD (16:49)

Okay, good, Carrie, you’re right.

Carrie Bedient MD (16:52)

But we’re just looking to see what’s the anatomy. Sometimes we’re looking to see if there’s blood flow there. And this is more often when a patient has a specific reason, usually pain, but we’ll typically throw on our dopplers and say, hey, blood flow look reasonable, great, yes, okay, keep moving on. We’re checking to see…Is it the normal size? Is it in the normal location? Is there anything weird there that we need to pay attention to that’s not the standard government issue ovary that we’re expecting to see?

Susan Hudson MD (17:22)

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Abby Eblen MD (17:59)

So, Carrie brought us to the next question for Susan. So, what types of cysts do we see? Are all cysts bad? And if not, what are the good ones and what are the bad ones?

Carrie Bedient MD (18:09)

Wait, wait, wait, I’m gonna get her soap box out so that she can just very easily step on it for the discussion that I know is about to come.

Abby Eblen MD (18:18)

We’re gonna have, yeah, we know. It starts with a P, right?

Carrie Bedient MD (18:20)

Yep, here’s your soapbox. There’s red velvet carpet leading up to it. Your majesty, here you go.

Susan Hudson MD (18:27)

Thank you very much. Thank you, thank you, thank you. So my little soapbox is first of all, for all of you with PCOS or polycystic ovarian syndrome, realize that you have a condition that’s very poorly named. You have lots of follicles, not cysts. So cysts are something that are generally greater than two centimeters in diameter. So all those ladies with PCOS, those are usually somewhere between maybe three to eight millimeters on average. much, much smaller. So a cyst is something greater than two centimeters that should not be there at a particular point in time. And the reason why that’s important is because as you go through your normal menstrual cycle and we have follicular recruitment, meaning we’re watching that follicle get bigger and bigger so that the egg within it can go through all the changes it needs to to be able to become a mature egg and actually ovulate that follicle that’s supposed to be there at mid cycle is not a cyst. It is a follicle that is supposed to be there. Again, it is something that’s supposed to be there at a certain point in time. So back to different types of cysts. Again, the next one I’m to talk about a little bit is not really a cyst because it’s supposed to be there. It’s a corpus luteum. So that follicle I just mentioned that you ovulate from, after you ovulate, it undergoes a conformational change and it starts producing lots of progesterone and some estrogen. And it is there to help support a pregnancy until the little yolk sac within the pregnancy develops.

And that corpus luteum has a very unique appearance. It kind of looks usually a little wavy along the outsides and has a little white stuff going on and it’s something that we all know what to recognize. Now kind of a cousin to this is a hemorrhagic ovarian cyst and also realize if you have PCOS that is not related to hemorrhagic ovarian cysts, however, there’s lots of people who have had hemorrhagic ovarian cysts. So what this means is that you have had probably a corpus luteum because they become very, very vascular. One of the blood vessels can rupture. You can have bleeding within that corpus luteum and it can make it even bigger and it can cause some pain. And under severe circumstances, sometimes you might even have to have surgery for that. Lots of people have these, most of them end up not being surgical, but this is one of those things that sometimes you do need to have surgery. Now, the nice thing is, is just like you all learned during first aid, when you put pressure on bleeding, generally the little platelets, the blood clotting agents work, and it limits how big these things get. And so usually, the bleeding stops on its own, we watch it, you end up in a few weeks, this thing goes away on its own. Now we also have cysts called endometriomas. So this is one of the big ones in fertility care that we have a lot of concern about. And that’s where you have a collection of endometriosis, which are the same cells are usually inside the lining of the uterus, which is where they’re supposed to be, but in places they’re not supposed to be, like your ovary.

And that type of cyst has what we call a ground glass appearance. Sometimes they’re well defined, sometimes they’re not well defined, and they can vary from being very small to being very, very big and complex. Outside of those, we have simple ovarian cysts, so it’s a big white circle with black on the inside of it. There’s no lines or irregularities on the inside of it. These are usually not anything that’s a big deal. And sometimes they have different types of fluid in them, but nothing we really need to get into today. And let’s see. And then we of course have cysts that are concerning for things like cancer. And in the reproductive age population, that is a very, very, very, very, very small portion of the ovarian cysts we’re gonna see. We always have our eyes out for the things that make us concerned. But if you have a cyst on your ovary, your mind should not be the first thing like, my goodness, I have cancer. Because ovarian cancer, one, is relatively rare. Number two, lots of these things we just talked about happen every day and they are not cancerous.

And then you have things like dermoids. Dermoids are kind of the odd child of the ovary, literally. And essentially they’re cysts that contain different types of cells and they can contain things like, please don’t get grossed out, bones, teeth, hair, fat cells. They can be kind of grody, to be honest. But…those are often some types of cysts that we do remove, though I have to say removing cysts is something we’re doing less and less nowadays, just because every time we remove cysts, we do lose some eggs. But dermoids are generally one that we do have removed, especially if they appear to be getting bigger.

Abby Eblen MD (23:57)

That is a great summary. So Carrie, now you’re up. Tell me what other things we might see on ultrasound outside of cysts, because as Susan mentioned, there’s lots of different, and there’s even other things we could talk about in terms of malignant cysts and things like that. But most of what we see is what Susan described. So tell me kind of the other things we might find by looking at the uterine tissue or the endometrial lining or things in the abdomen we might see coincidentally.

Carrie Bedient MD (24:22)

When we are looking at the uterus, a couple of things that we are automatically gonna get on everybody. We’re gonna get measurements of the uterus itself. The height, the length, the width, and get a general idea of is this really small, really large or about average size. You expect the uterus in someone who’s given birth before to be a bit bigger than someone who maybe never has, but we’re also checking to see what’s the lining of the uterus and how thick is it. And when we’re looking at this, time of the month matters. And so I’m sure you have all experienced every time you walk into your REI’s office, one of the most common questions is, so when was the first day of your last menstrual period? And the reason for that is because the endometrial thickness is going to depend on that timing. If you are in the midst of a heavy period day, we may see that it’s thicker and it looks really junky inside, and that’s because there’s blood clots and fluid that is in the process of exiting. If you have just finished your period relatively earlier, you’re in the last couple of days of spotting, we expect that lining to be very thin. And if you are mid-cycle right before you ovulate, we expect it to be very thick.

In addition to being thick or thin, we’re looking at the appearance of the endometrium. And usually when it’s thin, there’s not a whole lot of differentiation there because there’s not much to see. But when it’s thick, we’re looking for whether or not it is something called trilaminar, which is three layers. And the comparison is opaque.

Where it’s all just kind of bright and glowing and there’s no differentiation between the three layers. It’s just all one thick layer. And the reason that that’s important is because it gives us an indication of what hormones are acting. If you see a nice trilaminar appearance, usually that’s estrogen only. If it’s turned opaque, there’s been significant exposure to progesterone. And so that helps us to know where you are in your cycle, what kind of response you’re getting, is there an appropriate match to where we think it should be? Besides just straight up thickness and general pattern, we’re looking to see are there any irregularities? And on just a regular 2D ultrasound, sometimes you can see those and sometimes you can’t. And sometimes you can not see anything even though there is actually something there. And that’s because that is not the gold standard, just a plain 2D ultrasound. That’s not the gold standard of getting information about polyps. But there will be some cases where there’s just a circular area that’s lighting up that we can see, that’s probably a polyp. So we’re checking to see that as well. Within the body of the uterus, we want to see is it fairly uniform? Or is there an area that’s considerably, usually, thicker because there is a fibroid there? And a fibroid is a single cell that has gone absolutely haywire and replicated itself a zillion times, this was called clonal expansion, and has turned into a large ball within the uterus. Now sometimes this is the size of a pea and sometimes it’s the size of a big old softball.

And sometimes it can be even larger than that. And we’re looking to see are those present within those. We’re looking to see is there any abnormal areas within them that could show that maybe it’s outgrown in blood supply and it’s dying in the middle. We’re looking for adenomyosis. This is those glands that are supposed to be in the lining of the uterus that have gone deep and have migrated into the muscle. Now how they got there is a big subject to debate that I’m not going to launch into now, but to see if there’s any abnormalities there. We’re looking to see is there any scar tissue. Again, a plain 2D ultrasound is not really the gold standard for that, but we’re looking to see are there any abnormalities? Is there a fibroid there, adenomyosis? Are there multiple? Are there polyps? You can have all three of those things coexisting in the same uterus. We’re looking to see if there’s any sign of an abnormal shape. Again, 2D ultrasound is probably not the gold standard for that, but we’re looking to get a general size, shape and gestalt of the uterus of is this well behaved or is it acting out and we need to look at it further.

Abby Eblen MD (28:34)

Gosh, I think you guys did a good job of covering about everything. The only other thing I could think of is sometimes we’ll see a para-ovarian cyst. And so it’s not that we worry about that at all. It’s usually no big deal. Sometimes they can be reasonable size. Most people have no pain from them, but para-ovarian just means they’re outside the ovary. And really the big reason to recognize those is because if you’re stimulating and you’re coming in and you’re waiting for your egg to develop, it develops, as Susan said, in that cyst.

If we didn’t know the parovarian cysts was there and it was large enough, sometimes we might mistake that for being the actual follicle that you’re about to ovulate. It’s just important for us to know it’s there. It doesn’t necessarily need to come out or anything like that. The other thing that we can see in addition to looking at polyps and things like that, sometimes, particularly if we do a saline infusion sonogram or put fluid inside the cavity, sometimes we can actually see malformations inside the cavity of the uterus.

Those are really tricky to see sometimes outside of doing that. Occasionally we’ll even see something called a didelphic uterus where you actually have two separate uteruses with the tube attached to them. Any type of malformation, a lot of times we’re able to pick up much better with vaginal probe ultrasound really than most other modalities that are out there. Ultrasound’s very important. And one really important way we use ultrasound is not so much for, well, it is from for looking at things, but it’s also for monitoring.

Susan, as part of what we normally do, we use ultrasound to monitor ovaries before IVF, but we also use ultrasound as part of actually the egg retrieval. Can you kind of describe how we do that?

Susan Hudson MD (30:07)

So when we use the ultrasound for the egg retrieval, it’s a similar process to what you have when you’re in our normal offices. However, of course, you’re going to be asleep instead of your legs being in the stirrups like they normally are because you’re asleep. We have them in these leg supports so that you’re in the right position. It doesn’t put your hips or your back in a strain or anything like that.

And then on the ultrasound transducer, there is a little attachment called a needle guide. Nothing that you feel because of course you’re asleep. And then we place the ultrasound so that we are able to see the follicles. And then we introduce our egg retrieval needle through that needle guide. So it goes directly from the vagina into the ovary and we’re able to drain those follicles that contain your eggs.

Abby Eblen MD (31:05)

Very good. Well, I think this has been a very interesting topic that we’ve had, because I know so many people don’t understand kind of why we use ultrasound as much as we do and why we use it in the way that we do. Any other things that you guys can think about that we didn’t mention that you think may be helpful for our listeners?

Carrie Bedient MD (31:23)

We didn’t really talk about 3D ultrasound quite as much. This is not necessarily available everywhere. I think you see it a little bit more commonly in REI offices in particular, but the value of a 3D ultrasound is that when they put the probe in, it’s the same type of probe as for any other ultrasound. And usually they’ll go through and they’ll get all of their 2D pictures. They’ll look at the ovaries, the uterus, they’ll get their follicle counts. They’ll get their full survey, measure fibroids if they’re there, those types of things.

Afterwards they’ll center it and they’ll hit the 3d picture acquisition button.

And what it does is it takes a series of photos and we sit there for a minute. Sometimes there’s a little bit of vibrating, sometimes there’s a little bit of extra heat, kind of depends on the probe and the program. But we get a 3D reconstruction image of your uterus. And the place that this is most helpful is when there’s abnormalities. So you can get a good idea of, all right, how close to that lining is that fibroid? And are there truly two uteri sitting there in a didelphous or is this a bicornuate where the bottom part is unified but the two top parts aren’t? Is this an arcuate? Is this a septate? And it really helps to give us a better idea of the morphology or the shape of the uterus when we don’t have to necessarily send you out to a radiology center for an MRI, or if we do, we’ve got a much more specific idea of what we are looking for, which is really helpful both for us and the radiologists.

Abby Eblen MD (32:56)

All right, well, very good. To our audience, thanks for listening and subscribe to Apple Podcasts to have Tuesday’s episode pop up automatically for you. Also be sure to subscribe to YouTube. That really helps us spread reliable information and help to help as many people as possible.

Carrie Bedient MD (33:11)

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Susan Hudson MD (33:27)

As always, this podcast is intended for entertainment and is not a substitute for medical advice from your physician. Subscribe, sign up for emails, and we’ll talk to you soon. Bye!