First ultrasound after IVF

The first ultrasound after the IVF protocol is a very responsible and exciting moment. It is this examination that shows how successful the efforts of the doctors and the patient were. When is the first ultrasound scan done after embryo replanting and what it shows, we will tell in this article.

Why do an ultrasound scan after a transplant?

With the first ultrasound after the IVF protocol, oddly enough, a completely paradoxical situation develops - a long-awaited and long-suffering pregnancy turns out to be so important for a woman that she is afraid to go for an ultrasound so as not to harm this baby if it develops successfully in her body. Sometimes no arguments can make a woman who has been struggling with infertility for several years without success to go to an ultrasound diagnostic room.

We can definitely say that ultrasonic waves, on which the principle of operation of the ultrasound machine is based, do not have any negative effect on the fetus, and therefore there is no need to be afraid of ultrasound scanning. The first ultrasound after the IVF protocol is of great importance. It is done not only to make sure that the pregnancy has really come, but also to find out how many embryos have taken root if more than one embryo has been planted.

In 60% of cases, when two or three embryos are transplanted, two of them take root. The likelihood of multiple pregnancies is high. Pregnancy with twins or triplets requires a slightly different obstetric approach, which is why it is very important to determine it at the earliest possible date.

A woman whose pregnancy has become possible as a result of in vitro fertilization should generally get used to the idea that she will have to go to ultrasound more often than a woman who became pregnant naturally. Pregnancy after IVF requires more careful monitoring, since with it the risks of a threat of miscarriage, frozen pregnancy, premature birth and pathologies of placenta formation are higher.

Pregnancy after IVF is determined using a blood test for hCG - this is reliable evidence of the "interesting situation" that has come. It can be done as early as 12-14 days after embryo replanting. However, the growth of hCG and the dynamics of the increase in the concentration of this hormone, although they give an idea of the development of pregnancy, cannot describe all its features. This can be done only according to the results of an ultrasound scan.

The first ultrasound after IVF is recommended to be performed one week after the start of the delay, that is, on 21 DPP (day after transfer). It is the age of three gestational weeks that is diagnostically important. It reveals the fact of pregnancy after successful IVF, establishes the number of fetuses in the uterus, the viability of each of them, and also helps to assess the state of the ovaries after hormonal stimulation carried out in the protocol and exclude the possibility of an early miscarriage.

In addition, an ultrasound scan, which is done on 21 DPPs, allows you to find out if a woman has such complications as fetal fading and ectopic pregnancy, which, according to statistics, occurs in 2-3% after IVF.

After an unsuccessful IVF, approximately at the same time, you should also visit the office of an ultrasound diagnostician, since ultrasound of the pelvic organs makes a significant contribution to determining the cause of failure and planning a new IVF protocol.

What does it show?

In theory, ultrasound can be done earlier than 21 days after the transfer of embryos, but the problem is that even with state-of-the-art equipment it will be virtually impossible to see microscopic embryos. Only by the end of the third gestational week does the doctor have the opportunity to assess the thickness of the endometrium of the uterus, the place of attachment of the ovum and its size, the size of the yolk sac as the main food storage of the developing baby.

If you do the first ultrasound a little later - in the interval between 21 and 28 days after replanting, then you can register the true signs of the baby's vital activity - at 5-6 obstetric weeks (3-4 weeks after replanting correspond to this period), you can hear a fetal heartbeat or two fruits.

Early diagnosis of multiple pregnancy is of great importance.

If, due to the increased risks of non-survival, 3-4 embryos were implanted in a woman, and it turns out that, contrary to forecasts, all have taken root, then, at the request of future parents, a resection can be performed - the extra embryos will be removed. For this to be possible, the diagnosis must be really early.

3-4 weeks after embryo transfer, regardless of the number of fetuses, healthy embryos show approximately the same size. Lagging behind the norms may indicate the inferiority of the implanted embryo, developmental delay or its death. The most important size is the inner diameter of the ovum, the so-called SVD. At the first ultrasound, the SVD is normally 18 to 22 mm. The compliance of this parameter with the norm indicates that the growth rate is adequate, nutrition and oxygen for the fetus is quite enough. The shape of the ovum should be correct, with smooth contours, without deformations.

Closer to the 28th day after the transfer, another important size is determined - the coccygeal-parietal, or CTE. This is the distance from the coccyx to the crown, which changes at the time of maximum extension of the embryo. Normally, it is 3-6 mm. The average diameter of the yolk sac for the first ultrasound is about 3 mm.

After IVF, the sizes can be quite individual, since the implantation takes place at different times. In one woman, the transferred embryos are implanted into the functional layer of the uterus on the third day, and in another - only after 7 days. Therefore, the ultrasound data must be compared with the growth dynamics of hCG, a hormone that is produced by chorionic villi after implantation. If the concentration of the hormone increases, it is safe to say when exactly the implantation took place.

Naturally, the size of the embryo that was implanted earlier will be slightly larger than the size of the embryo that was implanted later. According to statistics, five-day-old embryos are implanted with a higher success rate than three-day-old embryos.

The heart of babies at the beginning of the sixth obstetric week (22-24 days after the transfer) is just beginning its activity, it beats at a frequency of 80-85 beats per minute. On the 28-29th day after the transfer, the heartbeat frequency of the crumbs is already normal at 103-123 beats per minute.

At the first ultrasound, the likelihood of a threat of termination of pregnancy is determined - the doctor looks to see if the cervical canal of the cervix is closed, whether there is an increased tone of the uterine muscles.

How is it going?

The first ultrasound scan after embryo transfer can be done in two ways: by placing the transducer on the anterior abdominal wall and using an intravaginal transducer. The doctor will decide which method to choose. The most preferable is the intravaginal scanning method, which allows the most accurate assessment of the state of the cervix, the size and structure of the ovaries, the size of the uterus and the presence of possible signs of a threat of spontaneous interruption.

Quite often, a vaginal (internal scan) gives more accurate results in women who are overweight and have a lot of belly fat, which makes it difficult to visualize with an abdominal examination. Sometimes there is a need for a combined examination, in which the examination will be carried out by two sensors alternately.

Preparing for an ultrasound scan is much easier than it sounds. Recommendations from the Internet to go to the doctor on an empty stomach are completely absurd. Food intake does not affect the information content of ultrasound examination, as well as having sex on the eve of the examination.

But it is still worth refraining from soda and legumes with cabbage so as not to increase gas formation in the intestines. The bowel loops can swell from gas, press on the uterus and this can create some difficulties in diagnosis. Therefore, before visiting a doctor, it is recommended to take "Smecta" or "Simethicone" in a few hours.

Whether to drink liquid before an ultrasound is a common question. You need to drink about half a liter of water only before a transabdominal ultrasound, so that the bladder is filled and the ultrasound waves pass better. You do not need to drink before a vaginal ultrasound; on the contrary, you should empty the bowels and bladder before the examination.

You should not persuade the doctor to do your first ultrasound in 3D or 4D form, as well as require an ultrasound scan with a Doppler. You can do such types of research later, since at the earliest dates they are not considered informative and neither you nor the doctor will really feel the difference between the latest 4D and conventional two-dimensional ultrasound.

The procedure takes about a quarter of an hour. The results are given to the woman immediately after the examination.

Features:

One of the distinctive features of the first ultrasound after the transfer is additional ultrasound diagnostics of the mammary glands. This is done in order to assess how well the woman has tolerated hormonal stimulation of the ovaries and whether she has problems and neoplasms in her breasts - most breast tumors are hormone-dependent and can begin to grow under the influence of hormones.

If a woman managed to become pregnant without hormonal stimulation in the natural cycle with the implantation of a fertilized egg during the implantation window, then there is no need for an ultrasound of the mammary glands.

Otherwise, ultrasound scanning after IVF differs little from a similar confirmatory diagnostic procedure after pregnancy in a natural way.

When is the next study?

After the first ultrasound scan, carried out on days 21-28 after the embryo transfer, it is often necessary to repeat the study to clarify the gestational age and the rate of development of the fetus (or fetuses). In this case, women are invited to repeat the procedure in 2-3 weeks.

If the first or second ultrasound does not show any pathologies, the woman is recommended to do such an examination within the generally accepted time frame:

at 10-12 weeks (as part of the first prenatal screening);
at 19-21 weeks (as part of the second prenatal screening);
at 30-32 weeks (as part of the final screening, which summarizes the results of the first two);
before childbirth (to choose the tactics of delivery and determine the accuracy of the expected day of delivery).

In case of multiple pregnancies, ultrasound can be prescribed not only during the indicated periods, but also in the intervals between them, the number of ultrasound scans is not regulated by WHO requirements. The doctor himself can determine when and how many times to do the examination for a particular pregnancy.

Reviews

According to women, the first ultrasound scan causes fear and great excitement, even if blood tests by this time already confirm that the pregnancy has begun. Not everyone can hear the baby's heart, but there is nothing wrong with that, after 1-2 weeks the heartbeat will be determined at the control ultrasound.

In most cases, women say, after the first or second ultrasound, the reproductive specialist wishes the couple a happy pregnancy and childbirth and transfers the patient to an ordinary gynecologist at the antenatal clinic for further observation and registration.

The downside is, according to women, that the results of the tests that were done before IVF are not accepted in the consultation, all the tests have to be done again, but already under the compulsory medical insurance, that is, completely free.