Brief Answer:
Your ultrasound is essentially normal

Detailed Answer:
Hello, and I hope I can help you today.

I am not sure why you were having this ultrasound... if you are undergoing an evaluation for infertility ultrasound is a poor tool to evaluate egg quality- measuring hormone levels is more accurate. but I will review your ultrasound results with you.

Your uterus is normal and has appear ace of a lining of about the third week of your cycle. This means you ovulated that cycle. The ultrasound shows some immature eggs, which is a finding in 20 percent of all women, and a small (less than 4cm is considered small) ovarian cyst which is a normal finding in the third to fourth week of your cycle. This type is cyst is called a corpus luteum and it disappears and a new one is formed in your next cycle.

What I recommend you do is to wait until you have your period and then repeat the ultrasound test. If the cyst was a normal one formed by ovulation, it would be gone by then.

I hope my explanation answeres your question today and that my advice was helpful. If you need any further clarification or need more information, please do not hesitate to contact me.

Best wishes,

Dr. Brown

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Brief Answer:
Hyperechoic is just a descriptive term not a disease

Detailed Answer:
Hello again,

So the term hyperechoic just means that something appears more solid on the ultrasound. It is a term radiologists use to describe a finding, it is not a diagnosis or a disease. It is not a finding associated with malignancy, and you are correct that there is nothing on the scan to suggest cancer.

So if this ultrasound is correct, even though you haven't had your period in 53 days you should be getting it in a week or two.

Regarding your immature eggs, the size being less than 1 cm is normal when they are dormant. One egg at a time matures to be released at ovulation, and at that time the follicle can reach up to 3-4 cm in size.

Regarding your fertility, there is no way to know if you are fertile until you actually try to conceive. Many women with irregular periods can conceive without a problem. 80 percent of couples who have regular (at least 2-3 days per week) intercourse will conceive within a year. You cannot diagnose infertility before trying for a year.

So I would try to relax and wait for your period, it should come in the next two weeks or less. If you are not trying to conceive right now, there is nothing you need to do. Unfortunately there is no "fertility test" that can predict who will be able to conceive. But I can reassure you that there is nothing on this ultrasound to indicate you will have any trouble conceiving.

I hope this information is reassuring and if you need anything else please let me know.

Take care,

Dr. Brown

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Brief Answer:
I am sure your period will start on its own and that you ovulated

Detailed Answer:
So your ovaries are normal in size and volume (the range is from 1.5-4 cm).

Regarding ovulation, the ultrasound for this cycle shows your uterine lining to be in the secretory phase. That means the cells are mature and have an appearance of tissue that is going to be shed as menstruation soon.

The hormone progesterone causes these changes in your endometrium, and your ovary produces progesterone from the cyst that is left in the ovary after an egg is released (the corpus luteum cyst that you have).

A good website that explains this further is http://www.womenshealth.gov/publications/our-publications/fact-sheet/menstruation.html

Anyway, your ultrasound this past month has evidence you ovulated. The only way to know in each cycle whether you ovulated, other than an ultrasound, is to use an ovulation predictor, which tests your LH hormone in your urine which has a high peak at ovulation.

But again, if you are not trying to become pregnant now, charting your ovulation or anything like that is really not necessary as it does not in any way tell if you are fertile. Many women who ovulate normally still cannot conceive. Your FSH level is normal, which is the best test for ovarian reserve, so there is no reason to suspect you are infertile.

However, again, I remind you that no one cannot predict fertility until you try.

So I would wait for your period for 2 more weeks and if you don't get it, you may want to see a gynecologist as they can give you medication that will restart your cycle. Then I would repeat the ultrasound after you get a period - on your own or with medication. Many women become irregular in their 40s but this is not necessarily a risk factor for infertility.

I hope this additional advice is helpful,

Sincerely,

Dr. Brown

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Brief Answer:
There is no way to know, but you should see a specialist at 6 months

Detailed Answer:
You do not have anything on your blood work or ultrasound that is abnormal, but you have not yet had a full infertility evaluation- with a test to check if your Fallopian tubes are blocked and also your partner should have a semen analysis (50 percent of the time there is a male factor. as well). I recommend you see a specialist and do these tests after trying for 6 months.

So again for now- I cannot say if you will conceive successfully in 6 months, but for right now there are no abnormal findings to suggest a problem.

After age 40 I usually recommend trying on your own for 6 months and then seeing a specialist, because delaying treatment further can possibly decrease your chances of having a successful pregnancy if you do fertility treatment.

I wish you and your partner the best of luck in trying to conceive. You do not need to try at this point until your next period begins because you already ovulated this cycle (according to your ultrasound)

Take care,

Dr. Brown

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Brief Answer:
The shape of the follicle does not matter

Detailed Answer:
So the shape of your dominant follicle has no bearing on the quality of that egg inside. And there is nothing anyone can do to change your egg quality, you or any physician. Again, I want to stress to you that there is no evidence that there is anything wrong with your eggs on the ultrasound. Your FSH level is low which is an indirect test of how well your ovaries work.. so that result points to good ovarian reserve.

I hope this eases your mind and I encourage you to just relax and wait for your period and then start trying again. It is hard to be patient but the stress of worrying about pregnancy can affect your cycle. Try to be optimistic- most women can still get pregnant in their early 40s.

Best, Dr. Brown

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Brief Answer:
No that is not helpful for you at this time

Detailed Answer:
As I stated earlier, you should try on your own for 6 months and then if you don't conceive you should see a specialist who can offer evaluation and treatment. But now I would just have regular (at least 3 times per week) intercourse from
the time your period finishes until you feel PMS. Also begin taking prenatal vitamins if you haven't done so already. You do not need to time the peak of ovulation; if you have sex often enough there will be sperm around no matter when you ovulate.

Dr. Brown

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Brief Answer:
Any prenatal vitamin is fine.

Detailed Answer:
Hello again,

Any brand of prenatal vitamins is fine. And as I said before, you certainly can monitor your ovulation, but you don't need to if you have sex every other to every third day. I know it may seem you have to "do something" to get pregnant, but it happens every day, naturally, to thousands of women, even into their early 40s.

For now, all you need to do is wait for your period to come. I know it is hard to relax and be patient, but that is really the best thing at this point.

Take care, Dr. B

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Brief Answer:
The number of visible eggs are irrelevant and can change over time

Detailed Answer:
Hello again,

The number of follicles visible on your ultrasound has no bearing on your fertility potential, unless you are getting fertility treatment where it can be used to see if the medication is working. It is only important to ovulate one egg... which may or not be visible before it is recruited to develop to be ovulated (you are born with millions of eggs and still have thousands left until after menopause). 30 percent of women have multiple follicles visible on a routine ultrasound, but that does not indicate how many total eggs you have. If you repeat an ultrasound after a menstrual cycle you will most likely see most of the same follicles still there because normally only one egg ovulated per month.

Again I want to re-emphasize for you that you may have a certain number of arrested follicles visible in your ovaries now- but those eggs are not necessarily the ones that are selected for ovulation. You have thousands of eggs left- many more than what may be visible at this time. Most normal women get pregnant with only one follicle on ultrasound.

I really encourage you to try not to think about follicles, or hormone levels, or even timed intercourse in the beginning. Try not to worry about your ability to conceive until you actually give it a chance. Stress can definitely affect your cycle and may delay your period more. You could always get a second opinion from a fertility specialist, but again, there is no evidence you will be unable to conceive. Your visible follicles do not reflect your ovarian reserve- your FSH levels are the most sensitive and the fact that they are low is a positive sign.

So in summary the fact that you have visible follicles on ultrasound really does not predict your fertility potential. The only way to know if you can get pregnant is to try and see what happens. No doctor can tell you for sure what will
happen- it is impossible to know.

I wish I could be more helpful but at this point there is nothing you need to do. If after trying for 6 months you are unsuccessful, I recommend you consult with a fertility doctor.

Sincerely,

Dr. Brown

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