The decision to have a baby is one of the most important decisions a woman can make. Once this decision is made, some couples find it easy to get pregnant. Others may find that they are not able to conceive so easily. Couples who have been unable to conceive after at least a year of continuous trying may need medical support in the form of medications and treatment cycles to get pregnant (1). This is where the follicular scan comes into the picture.
A follicular scan or a follicular study is a series of ultrasound tests that a doctor will do. This will help them track the growth of a follicle from the start of the menstrual cycle to the ovulation phase where the ovary is ready to release the egg. Follicular tracking is an important first step in assessing female fertility and also an important part of fertility treatments.
In This Article
- What is a Follicular Scan?
- Why is Follicular Scan Important?
- How is a Follicular Scan Done?
- Who Should Get a Follicle Scan Done?
- What is the Use of Follicular Scan?
- How Long Does a Follicular Scan Take?
- How Many Follicular Scans Per Cycle Are Carried Out?
- Is There Anything Else That Follicular Study Can Help With?
- Are There Any Side Effects of Getting a Follicular Scan Done?
- FAQ’s
What is a Follicular Scan?
A follicular study is a scanning procedure that a doctor, a gynecologist, or a fertility specialist will use to monitor the development of follicles or follicles inside your ovary and predict the time of the ovulation for the purpose of diagnosing and treating infertility (2).
The female reproductive system has small tissues called ovarian follicles that contain and release eggs for fertilization during ovulation. Doctors will use the help of a small probe that is inserted into the vagina to study the follicle and egg development during the various stages of the menstrual cycle.
Generally, these scans will start around the 9th of your cycle and continue till the 20th day. The doctor will observe the follicle development occurring in your ovaries. It is a vital process for getting pregnant through fertility treatments like IVF.
Why is Follicular Scan Important?
A woman is born with millions of immature eggs waiting to be released from the ovary. When you ovulate, a mature egg is released through the fallopian tube and becomes available for fertilization (3). Since egg + sperm = baby, to prepare for the same, the uterine walls thicken in anticipation. Once an egg is released, the sperm may have only 12-24 hours to fertilize the egg. At any given ovulation cycle, only one mature egg is released with the exception of treatment cycles. In the event that no conception occurs, both the uterine lining and blood will be shed by the body during the monthly process of menstruation.
If you are trying for a pregnancy, this is the time to have intercourse to get favorable results. Most women who have regular menstrual cycles will ovulate between day 11th and day 21st of the cycle, counting from the first day of the last menstrual period. However, this is not necessary, and many women may ovulate at different times or on different days each month. This is why it is important to track your cycles and hence ovulation, especially if you are not very regular with your sexual routine.
Transvaginal ultrasound follicular tracking or folliculometry is one method that doctors use to track follicular development, egg maturation, and release to help time the intercourse or treatment accordingly.
[Read : Charting Your Cycle: Importance And How to do it]
How is a Follicular Scan Done?
A follicular study or follicular monitoring (4) examines the ovarian follicles and takes pictures of the internal organs through ultrasound. The scans involve inserting a small plastic probe into the vagina while maintaining the highest levels of hygiene and cleanliness. The process is relatively painless, and you will be asked to lie in a stirrup position while the scan is carried out. You will be covered with a sheet from your waist down.
A qualified sonographer or doctor will be able to tell the exact time of the egg release, and thus a couple can plan intercourse at that time to maximize the chances of conception. The probe clicks the pictures of the internal organs by releasing sound waves. The tissues containing eggs and the endometrial lining are studied to determine the period you are likely to ovulate.
Your doctor would then ask you to have sex during this period to increase your chances of getting pregnant. It is especially vital for women who are trying to conceive through assisted reproductive techniques like IVF.
Who Should Get a Follicle Scan Done?
Any woman trying to get pregnant can get a follicle scan. But doctors frequently recommend this as a first line of treatment for couples who have not been able to conceive even after trying for many months.
The age of the woman may also play a significant role as good eggs cease in women who are in their late 30s or in 40s. The pregnancy rates can decline sharply after a woman crosses the age of 35.
Furthermore, a follicular tracking may also be beneficial for women who:
- Do not know when they ovulate, and even after using ovulation predictor kits have not been able to get pregnant
- If a woman has had miscarriages in the early stages of pregnancy, a follicular study will help determine the causes for the same.
- If a woman is not sure if she is ovulating at all; if she does not feel any symptoms such as a little bit of pain or aching near the ovaries during ovulation.
- If a woman is on ovulation induction drugs or medications to correct luteal phase deficiency.
What is the Use of Follicular Scan?
A follicular scan helps ascertain the size of any active follicles in the ovaries that can contain an egg and effectively predicts ovulation (5). After a follicular scan, a couple can try for pregnancy when ovulation is likely to happen. In the case of treatments, doctors can time the trigger shot to maximize the chances of pregnancy. The scan helps to determine the presence of follicles and the best time to extract an egg for fertilization.
How Long Does a Follicular Scan Take?
The follicular tracking scan will generally take about 5 to 10 minutes, provided you are maintaining a good stirrup position and are cooperative with the doctor.
How Many Follicular Scans Per Cycle Are Carried Out?
Because the ovulation window is wide, each cycle will require a minimum of about 4-6 scans. The types of scans include
1. Baseline Scan
The baseline scan will help the doctor know and understand the initial stages of the follicle (6). This scan is usually performed during the first three days of the menstrual cycle and gives the baseline status of the ovary and the uterus. It also helps assess the resting pre-antral follicular count, checks the endometrial thickness, and checks for the possible presence of cysts or polyps. The readings form the basis for the rest of the scans.
2. Serial Scans
The baseline scan is followed by the series scans which are performed once every 2 or 3 days or as decided by the doctor or fertility specialist. These scans help track the antral follicular count or the number of follicles and their growth (7).
3. Rupture Scan
This scan is used to check for ovulation by measuring the presence of free fluid and checking for the collapse of the follicle. Both these factors indicate that ovulation has happened.
Is There Anything Else That Follicular Study Can Help With?
Yes, a follicular study will also detect some other issues that may impede a pregnancy. A follicular scan may help
- Determine the follicles that do not grow properly before rupturing
- Check the thickening of the womb lining in conjugation with the follicular release
- Check for follicles that do not grow at all or do not rupture at the correct time
- Detect the risk of early menopause in women who are trying to conceive
All these parameters help the doctor and you to know what and when things are happening, and what is not happening. It makes it easier to identify the problems and thus impart treatment or corrective measures.
Are There Any Side Effects of Getting a Follicular Scan Done?
Medically there are no side effects of follicular scan. Some women can experience mild pain and discomfort during and post the scan. These will resolve on their own with time. However, couples can find these regular scans taxing and stressful. Some couples feel that such scans ruin their sexual compatibility and thus give way to marital disharmony. Men tend to feel that the way to make a baby is by having regular sex, while women want to have sex only when they are ovulating.
Follicular scan or study is an essential tool that allows doctors to help women and couples trying to conceive and failing. These scans often help understand the root cause of delayed conception or why the couple is unable to get pregnant. Doctors can decide the future course of treatment for the couples or advise them on timing their intercourse.
However, it is always a good idea to avoid repeated scans. To track ovulation, you can take the help of ovulation calendars, and ovulation prediction kits, and study and chart your cervical discharge. But remember never to make eggs, sperm, and charting an obsession. Try and make baby making fun and stay away from stress.
All the best!
[Read : How To Detect Fertility Period With Cervical Mucus?]
FAQ’s
1. Can We Have Food Before a Follicular Scan?
Yes, in most cases, you can have food up to a couple of hours before the scan. Overnight fasting is not needed for a follicular scan and there are no dietary restrictions. However, you can consult the doctor for better clarity. Ensure that you take any medications suggested by the doctor to be taken before the scan.
2. Which Scan is Done on The 2nd Day of Period?
The scan done during the second day of the period is known as a baseline scan. This scan helps create a baseline in terms of the resting pre-antral follicle numbers. This scan is also the first scan in an infertility treatment cycle.
3. How Many Times is Follicular Study Done?
You will need to get an average of 4 to 6 scans done during your cycle. The number of scans may vary as per the doctor’s observations and the number that they deem necessary. The types of scans include baseline scan, series scans, and rupture scan.
4. Which is The Best Size of Follicle to Conceive?
Follicles that reach 18-20mm in diameter are considered the best to conceive. The size and progress of follicles is done with the help of follicular scans or studies. Once follicles reach 18-20mm, your doctor may give you a trigger shot to release the mature eggs in preparation to receive the sperms or for egg collection.
5. Is Follicular Study Painful?
No, the follicular study is not painful. But there may be a slight discomfort or pain when the probe is being inserted into the vagina. This is usually short-lived. You will have a more comfortable experience if you relax and follow the doctor’s instructions properly during the procedure.
References
- Diagnosis and Management of Infertility – [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9302705/]
- Monitoring techniques to predict and detect ovulation – [www.sciencedirect.com/science/article/pii/S0015028216500028]
- Embryology, Fertilization – StatPearls – [https://www.ncbi.nlm.nih.gov/books/NBK542186/]
- Follicle Monitoring and Endometrial Correlation – [https://www.pajtcces.com/abstractArticleContentBrowse/DSJUOG/22436/JPD/fullText]
- Transvaginal Sonographic Study Of Follicular Dynamics In Spontaneous And Clomiphene Citrate Cycles – [www.ncbi.nlm.nih.gov/pmc/articles/PMC5532050/]
- Streamlining follicular monitoring during controlled ovarian stimulation: a data-driven approach to efficient IVF care in the new era of social distancing – [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7665450/]
- Counting ovarian antral follicles by ultrasound: a practical guide – Coelho Neto – 2018 – Ultrasound in Obstetrics & Gynecology – [https://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.18945]
Read Also: Sex Position to Conceive a Baby
