Donald School Journal of Ultrasound in Obstetrics and Gynecology

Register      Login

VOLUME 1 , ISSUE 2 ( April-June, 2007 ) > List of Articles


Clinical Applications of Ultrasound in Assessment of Follicle Development and Growth

V Vlaisavljevic, M Došen

Keywords : Ultrasound,ovarian monitoring,follicle growth,natural cycle,controlled ovarian hyperstimulation,perifollicular vascularization,monitoring

Citation Information : Vlaisavljevic V, Došen M. Clinical Applications of Ultrasound in Assessment of Follicle Development and Growth. Donald School J Ultrasound Obstet Gynecol 2007; 1 (2):50-63.

DOI: 10.5005/jp-journals-10009-1099

License: CC BY-NC 4.0

Published Online: 01-06-2008

Copyright Statement:  Copyright © 2007; The Author(s).


Monitoring of individual follicles during the menstrual cycle demonstrates in a noninvasive way the changes in their number and position during the early and the late follicular phase and the luteal phase. The differences in relations between the follicles near the dominant follicle can be demonstrated with the same technique using 3D reconstruction of the ovary.

An increased perifollicular blood flow can be measured in the perifollicular period using color and pulsed Doppler. Automated estimation of blood volume around the ovarian follicles brought a new concept to this area. Results confirm the observation that vascularity around the follicle is intense in the periovulatory period. The blood volume does not differ between follicles containing an oocyte and those with no oocyte in the aspirate, or a nonfertilizable oocyte. From our results we can hypothesize that those follicles containing oocytes able to produce pregnancy have a more uniform perifollicular vascular network .

Recognition of the follicle growth pattern has a prognostic value for the outcome of assisted reproduction methods. Follicular diameter and changes in growth patterns are more important than follicular wall thickness as parameters having an impact on clinical success.

PDF Share
  1. Predictive values of ultrasound monitoring of the menstrual cycle. Curr opin Obstetri Gynecol 2005;17(4):405-10.
  2. An ultrasound-based approach to the assessment of infertility, including the evaluation of tubal patency. Best Pract Res Clin Obstet Gynaecol 2004;18(1):13-28.
  3. Initiation of ovarian follicular growth: few facts and many hypothesis. In Filicori M, Flamingi C (Eds): The Ovary: Regulation, Dysfunction and Treatment. Excerpta Medica ICS 1006, 1996; pp 3-12.
  4. The primordial to primary follicle transition. Mol Cell Endocinol 2000;163:53-60.
  5. Ovulation: Evolving Scientific and Clinical concepts (1st edn). New York: Springer-Verlag 2000; pp 3148.
  6. The role of the oocyte in folliculogenosis. Trends Endocrinol Metab 2000;163:61-6.
  7. Evolution of diameters of the largest healthy and atretic follicles during the human menstrual cycle. J Reprod Fertil 1983;69:497-502.
  8. Morphometric studies of small follicles in ovaries of women at different ages. J Reprod Fertil 1987;81:433-42.
  9. Color doppler assessment of folliculogenesis in in vitro fertilization patients. Fertil Steril 62:1211-16.
  10. Regulation of ovarian follicular development in primates: facts and hypotheses. Endocr Rev 1996;17(2):121-55.
  11. The ovarian life cycle: a contemporary view. Rev Endocr Metab Disord 2002;3(1):5-12.
  12. The changes in the vascular pattern of the ovary of the albino rat during the estrous cycle. Am J Anat 1943;73:252-292.
  13. Blood flow velocity in the uterine and ovarian arteries during the normal menstrual cycle. Ultrasound Obstet Gynecol 1993;3:199-208.
  14. The developmental potential of the human oocyte is related to the dissolved oxygen content of follicular fluid: association with vascular endothelial growth factor levels and perifollicular blood flow characteristics. Human Reprod 1997;12:1047-55.
  15. Angiogenesis of the ovary. Am J Obstet Gynecol 2000;182:240-6.
  16. Growth patterns of non dominant ovarian follicles during the normal menstrual cycle. Fertil Steril 1990;54:638-42.
  17. Ultrasonographical and hormonal description of the normal ovulatory menstrual cycle. Acta Obstet Gynecol Scand 1994;73:790-6.
  18. Ultrasonic tomography of the ovary. Ann Chir Gynecol Fenn 1972;61:211-4.
  19. Ultraschalldarstellung von Ovarveranderungen bei Gonadotropin Stimulierung. Geburtshilfe Frauenheild 1977; 37,185.
  20. Sonographic monitoring of ovarian follicular development. J Clin Ultrasound 1981;9:275-80.
  21. Robinson HP. Monitoring ovarian follicular development with real-time ultrasound. Br J Obstet Gynecol 1980;87;613-8.
  22. Ultrasound scanning of ovaries to detect ovulation in women. Fertil Steril 1980;34:99-105.
  23. Prediction of ovarian cycle outcome by follicular characteristics, stage 1. Hum Reprod 1995;10(9):2313-9.
  24. Attending dominance in vivo: distinguishing dominant from challenger follicles in humans. Human Reprod 1997;12(12):2741-7.
  25. Ultrasonography of normal and abnormal follicular development. In Jaffe R, Pierson RA, Abramowicz JS (Eds): Imaging in infertility and reproductive endocrinology. 1st ed. Philadelphia: JB Lippincott; 1994; pp 117-28.
  26. Growth patterns of non-dominant ovarian follicles during normal menstrual cycle. Fertile Steril 1990;54:638-42
  27. Relationship of constructed follicle growth patterns in stimulated cycles to outcome after IVF. Human Reprod 1991;6:465-71.
  28. Analysis of follicular growth in conceivers and nonconceivers after intrauterine insemination. Gynecol Perinatol 1995;4:49-51.
  29. Morphological and endocrinological studies on follicular development during the human menstrual cycle. J Clin Endocrinol Metab 1986;62:305-13.
  30. Oocyte morphology in dominant and subordinate follicles. Mol Reprod Dev 1994;37:335-44.
  31. Comparable effectiveness using flexible single-dose GnRH antagonist (cetrorelix) and single-dose long acting GnRH agonist (goserelin) protocol for IVF cycles-a prospective, randomized study. Reprod Biomed Online 2003;7:301-8.
  32. Three protocols for monitoring follicle development in 587 unstimulated cycles of in vitro fertilization and intracytoplasmic sperm injection. A comparison. J Reprod Med 2001:46:892-8.
  33. Intrafollicular blood flow during human ovulation. Ultrasound Obstet Gynecol 1991;5:53-9.
  34. Sensitivity and specificity of ultrasound indices of ovulation in spontaneous cycles. Eur J Obstet Gynecol Reprod Biol 2000;91:59-64.
  35. The temporal relation between the urine LH surge and sonographic evidence of ovulation: determinants and clinical significance. Obstet Gynecol 1994;83:184-7.
  36. Transvaginal color blood flow imaging of the preovulatory follicle. Fertil Steril 1993;60:433-8.
  37. Uterine and ovarian perfusion during the periovulatory period assessed by transvaginal color doppler. Fertil Steril 1993;60:439-43.
  38. Blood flow indices as measured by color doppler ultrasonography in different regions of the human periovulatory follicle. Fertil Steril 1998;69:435-42.
  39. Three-dimensional sonographic and power Doppler characterization of ovaries in late follicular phase. Ultrasound Obstet Gynecol 2002;20(3):281-5.
  40. Measurement of perifollicular blood flow of the dominant preovulatory follicle using three-dimensional power Doppler. Ultrasound Obstet Gynecol. 2003;22(5):520-6.
  41. Gonadotropin-binding sites in the Rhesus monkey ovary: role of the vasculature in the selective distribution of human chorionic gonadotropin to the preovulatory follicle. Endocrinology 1981;109:356-62.
  42. Development of the perifollicular network. Autoradiographic and morphometric studies in the rabbit ovary. Eur J Obstet Gynecol 1989;30:163-71.
  43. Are clinical and biological parameters correlated with chromosomal disorder in early life: a multicenter study. Hum Reprod 1988;3:627-35.
  44. Maternal age effect: the enigma of Down syndrome and other trisomic conditions. Mutat Res 1992;296:69-88.
  45. Effect of maternal age and number of in vitro fertilization procedures on pregnancy outcome. Fertil Steril 1989;52:270-3.
  46. Basal follicle-stimulating hormone level is a better predictor of in vitro fertilization performance than age. Fertil Steril 1991;55:784-91.
  47. Cumulative conception and livebirth rates after in vitro fertilisation. Lancet 1992;339:1390-4.
  48. Comparison of the cumulative probability of pregnancy after in vitro fertilization-embryo transfer by infertility factor and age. Fertil Steril 1994;61:257-61.
  49. Ovarian volume: a novel outcome predictor for assisted reproduction. Fertil Steril 1995; 64:1167-71.
  50. Measurement of ovarian volume by transvaginal sonography before ovulation induction with human menopausal gonadotropin for in vitro fertilization can predict poor response. Hum Reprod 1997;12:294-7.
  51. Evaluation of ovarian reserve in young low responders with normal basal levels of follicle-stimulating hormone using three-dimensional ultrasonography. Fertil Steril 1998;70(4):671-5.
  52. The effect of aging on ovarian volume measurements in infertile women. Obstet Gynecol 1999;94:57-60.
  53. Use of microdose GnRH agonist protocol in women with low ovarian volumes undergoing IVF. Hum Reprod 2001;16:500-3.
  54. Three-dimensional ultrasonographic ovarian measurements and in vitro fertilisation outcome are related to age. Fertil Steril 2003;79(1):190-7.
  55. The role of three-dimensional ultrasonographic images in ovarian measurements. Fertil Steril 1998;69:1152-5.
  56. Multifollicular ovaries: clinical and endocrine features and response to pulsatile gonadotropin releasing hormone. Lancet 1985;ii:1375-9.
  57. Ovarian stromal blood flow in women with polycystic ovaries-a possible new marker for diagnosis? Hum Reprod 1995;6:191-8.
  58. Revised 2003 consensus on diagnostic criteria and long term health risk related to polycystic ovary syndrome (PCOS). Human Reprod. 2004;19:41-7.
  59. The significance of the number of antral follicles prior to stimulation in predicting ovarian response in an IVF programme. Hum Reprod 2000;15:1937-42.
  60. Use of antral follicle count to predict the outcome of assisted reproduction technologies. Fertil Steril 1998;69:505-10.
  61. Predictors of IVF outcome by three-dimensional ultrasound. Hum Reprod 2002;17(4):950-5.
  62. Value of stromal blood flow velocity measurement after pituitary suppression in the prediction of ovarian responsiveness and outcome of in vitro fertilization treatment. Fertil Steril 1999;71:22-9.
  63. Associations between ultrasound indices of follicular blood flow, oocyte recovery and preimplantation embryo quality. Hum Reprod 1996;11:109-13.
  64. Color Doppler assessment of folliculogenesis in in vitro fertilization patients. Fertil Steril 1994;62:1211-6.
  65. Blood flow changes in uterine and ovarian vasculature and predictive value of transvaginal pulsed colour Doppler ultrasonography in an in vitro fertilization programme. Hum Reprod 1995;10(3):688-93.
  66. Colour indices of follicular blood flow as predictors of pregnancy after in vitro fertilization and embryo transfer. Hum Reprod 1999;14(8):1979-82.
  67. Ovarian morphology, endocrine function and intrafollicular blood flow during the periovulatory period. Hum Reprod 1991;6(3):319-24.
  68. Blood flow changes in the intraovarian arteries during the preovulatory period: relationship to the time of the day. Ultrasound Obstet Gynecol 1996;7:135-40.
  69. Quantification of ovarian power Dopppler signal with threedimensional ultrasonography to predict response during in vitro fertilization. Obstet Gynecol 2003;102(4):816-22.
  70. Natural cycle in vitro fertilization. Infertil Reprod Med Clin North Am 1993;4:653-65.
  71. In vitro fertilization in completely natural cycles. Hum Reprod 1995;10(3):572-5.
  72. In vitro fertilization in natural cycles: Maribor experience. The world congress on in vitro fertilization and assisted reproduction held in Vienna, Austria, 1995 April 3-7. Aburumich A, Bernat E, Dohr G, Feichtinger W, Fischl F, Huber J, Mueller E, Szalay S, Urdl W, Zech H (Eds): Bologna: Monduzzi Editore: 1995;573-5.
  73. Controversies in assisted reproduction. Natural vs. stimulated cycles in IVF: Is there a role for IVF in natural cycle? J Assist Reprod Genet 1993;10: 406-8.
  74. In vitro fertilization without ovarian stimulation: a simplified protocol applied in 80 cycles. Fertil Steril 1989;52:617-21.
  75. Fertil Steril 1990;54:470-4.
  76. In vitro fertilization in unstimulated cycles: the University of Southern California experience. Fertil Steril 1992;57:290-3.
  77. Factors affecting pregnancy success of human in vitro fertilization in unstimulated cycles. Hum Reprod 1994;9:1571-5
  78. The preovulatory serum estradiol pattern in natural IVF/ICSI cycles. J Assist Reprod Genet 1999;16:535-9.
  79. Clinical parameters to predict the success of in vitro fertilization-embryo transfer in the natural cycle. Assisted Reproduction 1999;9:149-56.
  80. Is there any benefit from the culture of a single oocyte to a blastocyst-stage embryo in unstimulated cycles? Hum Rreprod 2001;16:101-5.
  81. Blood flow changes in the ovarian and uterine arteries during normal menstrual cycle. Am J Obstet Gynecol 1996;175(3):625-31.
  82. Dependence of the in-vitro fertilization capacity of the oocyte on perifollicular flow in the preovulatory period of unstimulated cycles. Wien Klin Wochenschr. 2001;113[Suppl 3]:21-6.
  83. Simplification of the method of in vitro fertilization: sonographic measurements of follicular diameter as a sole index of follicular maturity. J In Vitro Fert Emryo Transf 1985;2:17.
  84. In vitro fertilization program based on programmed cycles monitored by ultrasound only. Int J Gynecol Obstet 1992;39:227-31.
  85. Simplification of the clinical phase of IVF and ICSI treatment in programmed cycles. Int J Gynecol Obstet 2000;69:135-42.
  86. Ovarian hyperstimulation syndrome. Fertil Steril 2003; 80(5):1309-14.
  87. Assisted conception. III-problems with assisted conception. BMJ 2003;327(7420):920-3.
  88. Can we abandon routine evaluation of serum estradiol levels during controlled ovarian hyperstimulation for assisted reproduction? Fertil Steril 2001;76:300-3.
  89. Early timed follicular aspiration prevents severe ovarian hyperstimulation syndrome. J Assist Reprod Genet 1996;13:282-6.
  90. Multinucleation and cleavage of embryos derived from in vitro matured oocytes. Fertil Steril 2006;86:487-9.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.