Five Fertility Ultrasound Findings: What Does Your Doctor Mean? Should You Be Concerned?

hi friends I'm Dr Natalie Crawford I'm a board certified OBGYN and REI I'm a fertility doctor and every day I talk about fertility your hormones your ovaries your eggs and this channel exists so that you can learn about it too so please subscribe and follow [Music] along today I am talking about things you commonly here at the OBGYN office or the fertility doctor specifically the fertility doctor when it comes to your old ultrasound so what does your doctor mean are you really running out of eggs what does that cyst because we say things and I know it's just us trying to make small talk or using normal rhetoric and it leaves you with a lot of questions so I'm going to go over a few of the top ones right here so we can dive into them all right so the first thing that I often hear patients be very confused about that we say is are like oh your uterus is tilted or oh your uterus is retroverted antrovert it oh you have a tilted uterus this throws patients through Loops all the time and the reality is we're just commenting on it because often it's taking us a little bit longer to find it we're just making small talk we can't help but comment when we see it this way what's that means is that the uterus is naturally a little more considered like neutral in your body if we want to think about it it is attached to the cervix and you're standing up the cervix you know is anchored in your pelvis and here is the uterus and the uterus be tilted backwards so that it's touching like the top of it's tilted towards your back and the cervix is more touching towards the anterior your belly it can be tilted antivert which is more common where the uterus is tilted upward like towards your stomach and your cervix is tilted down this can be pathologic but it can also just be normal variant meaning you have red hair you have blonde hair you have brown hair we don't worry about it does not decrease your chance of getting pregnant does not cause infertility for having a tilted uterus now the big Aster is why do you have a tilted uterus because sometimes we see that your uterus is tilted and the ideology potentially can make a difference so the biggest one is going to be a retroverted uterus where the top of the uterus is pointed backwards in somebody who potentially has abdominal Scar Tissue endometriosis going to be a big player here because if the uterus is in that position and stuck is it sign there could be endometriosis and we know Indo does cause infertility and I have a big video on that the other thing if it's antivert so if it's really attached kind of towards that abdominal wall did you have a prayer C-section could it be stuck that way now C-section alone does not cause infertility I had a C-section with my first child and tons of infertility getting pregnant with her and my second not but I'd already had a C-section and everything was fine so c-section do not cause infertility but sometimes they can like so if you're uterus didn't in heal all the way or you have an ismos heal that potentially could be something contributing and there are often some signs or ultrasound findings of that so that would be something else that would be noted so that would be if you have a very anted uterus or anterior uterus or a tilt and you have a history of a prior C-section especially if you have any weird discharge spotting bleeding patterns pregnancy loss is that's something to talk about your doctor like oh did my c-section scar heal all the way the next thing is talking about endometriosis so there's this huge misconception and I hear patients say every day oh I'm to I don't have endometriosis because I had an ultrasound in my doctor didn't see it endometriosis is not diagnosed on ultrasound most of the time endometriosis is a surgical diagnosis endometriosis is where you have implants of endomet mum endometrial like tissue which is the lining of the uterus that grow outside the uterus in what we call the perianal cavity these implants are hormonally sensitive they grow and they change based on what's going on in your body but what happens is they can cause inflammation it's on the autoimmune spectrum and they can cause scarring but you can't see that most of the time the ultrasound is perfectly normal the uterus is not stuck in any position the uterus looks fine in Demetrios beyond having the endometrium word is not a disease inside the uterus The Only Exception here is if you potentially have an endometrioma an endometrioma is where endometriosis gets inside a follicle so remember as that egg grows the follicle grows it ruptures to allow the egg out when you ovulate reforms and becomes a corpus ludum which gets tons of blood supply as it pumps out that progesterone for the ludal phase well if you have indom rosis and some little endometriosis swings in and gets in there it loves the blood supply of that Corpus ludum and it just grows and grows in that environment so you can see an endometrioma on ultrasound it can also look very similar to a corpus ludum so if it's a very first time look your doctor May say I see a cyst the big four-letter word cyst it might be an endometriosis cyst it might be a normal functional ovulatory cyst I don't know we're going to need to repeat the ultrasound and see what happens endometriosis Sy do not go away unless you have surgery Corpus Lums go away when you're not pregnant that month so seeing what happens can help differentiate other signs that can be suggestive of endometriosis can be as we said like a very retroverted uterus or having your ovaries look very stuck in places like distorted Anatomy but again not having that doesn't mean you don't have Indo most Indo doesn't have extreme anatomical changes that's when you get into very late stage disease so you don't know or endometriosis has not been ruled out just because you didn't see it on your ultrasound the other thing is the cyst y'all like a whole video on cyst I think this is such a fault of how we have counseled patients a cyst is a fluid filed structure and when you ovulate if you are not on birth control and you are living your natural life you should have a cyst most days of the month if you have an ultrasound a CT scan an MRI and that is because the only time you really shouldn't is right when you're having your period because a follicle is a cyst a corpus ludum is a cyst those are considered functional cysts what happen is that group of eggs comes out of the Vault and a follicle starts growing the follicle gets pretty big it can get to 2 to 3 cm it's filled with fluid it's a cyst it ovulates the fluid comes out the egg comes out it reforms and becomes the Corpus ludum as I said it's kind of bloody fatty making different types of hormones and it looks different so Corpus ludum and a follicular cyst or a follicle look different but they're both cysts and that Corpus ludum lives if you get pregnant it keeps living for the first part of pregnancy so you should even have assist in early pregnancy and if you're not pregnant it then dies it goes away your progesterone drops and you get a period but so you should have a cyst most days of the month and that's a big misconception or somebody thinks that's a big problem that they had a cyst on the offset there's other cyst that can be problematic so especially sis that do not change or do not go away or get bigger these functional cyst these cysts that are normal within your cycle they change follicle grows Corpus lodium goes away next month something different so if you have a cyst that is growing changing it's very common to do followup for a cyst to kind of see if it's changing or going away or getting worse then it's definitely something you want to follow up ovarian cancer is extremely rare in younger patients it's so hard to diagnose though so those CS typically look very different I I have diagnosed it on random ultrasound and somebody with no symptoms it looks different but if you have a cyst don't automatically jump to this is terrible it's very important to tell the person like where you are in your cycle and could it be a functional cyst or not and is this something you really need follow up on how does it look all right and the other one is your Antro follicle count we if you're coming to the fertility doctor we'll do a count of how many eggs we see and I have had so many patients believe that this is all the eggs they ever have so I do a count I see seven eggs I say this is seven we'll talk about if that's normal or not based on your age and your amh and then I will get on a follow-up call and a patient will say well gosh I only have seven eggs left so I'm going to be in menopause in seven months so there's no use in me doing anything and I'm just like oh we have failed you remember that your anal follicle count or the follicles that we can see outside the Vault and the ovary this is a this month representation so you're born with all the eggs you're ever going to have in that Vault every month a group of eggs comes out of the Vault from the group one egg is chosen to ovulate the rest of them die next month another group when we do IVF when we do egg freezing our goal is to try to get all the eggs growing and ovulating so that you have a higher chance how we're increasing the odds but that month those eggs are going to go away the eggs that are out of the Vault they're dunies those seven eggs they're gone but next month you're going to have a whole another group the size of the eggs remaining is proportional to how many come out so if you have more eggs left you have more coming out every month and if you have less eggs left you have less coming out every month there's also month-to-month variability meaning we can see a 30% swing so if you come in and I see seven I don't know if that's your average if that's your very best month or that's your worst month where you fall that's why the amh blood test test which is a hormone made from the cells that surround these follicles is also helpful in interpreting your ovarian reserve other important facts having a low egg count doesn't cause infertility having a low amh doesn't cause bad egg quality so yes it might shorten your time yes it it's going to mean you're going to get less eggs per an IA for an egg free cycle so you might need more Cycles you might have a lower chance of success Perle cycle it's why I really hate per cycle metrics for clinics because each patient is so individual but it doesn't mean that you're almost out or that that causes infertility but you might do something different you might be more aggressive you might Bank eggs or embryos so that data is very very important and then things like birth control pills or hormonal contraception in general or pregnancy can suppress amh and can suppress your follicle count it's not that they're not there the easiest way to think about it is that they still come out of the Vault during those times they just if they don't see FSH for a really long time they're not as big they can't be seen on ultrasound and they don't make as much amh now when you're more postpartum or when you have stopped the contraception for a month or so you will see a resumption to normal so if you come in and you get a follicle count and it's very low or your amh is low and you're on hormonal contraception or immediately postart or immediately off like a big loss like where you were pregnant for a while it is worth considering should you wait and repeat it versus getting started in testing or treatment kind of depends on the full picture but just know that doesn't mean that those things pregnancy or hormonal contraception hurt your egg count it's just a small suppression that it's harder to see at that moment and you have to kind of give your body some time so that the follicles perk up and can be seen on ultrasound and then the last thing to just say is that you typically cannot see Fallopian tubes on regular vaginal ultrasound so I also have patients say yeah my tubes are open my ultrasound was normal that test is not evaluating the tubes unless we do what's called a f view or bubble test where we put water and air through the Fallopian tubes on the ultrasound or you have like an X-ray test and hsg is the classic test to evaluate the fallopian tubes Only Exception here is that if you have a blocked and dilated tube sometimes we can see those on ultrasound and that's called a hydral pinks so just because we can't see them does not mean they are normal but it there are chances where we can and if we do see them it's definitely abnormal all right well I hope this helped you understand I guess a few common ultrasound myths things we say that need further explanation and just helping you understand what we can and can't do when we are doing an ultrasound to evaluate your fertility all right friends thanks so much for being here as always you can get more information on the as awoman podcast or over on Instagram at Natalie Crawford MD we would love it if you want to ask other questions things your doctor says questions you have about things that may be occurring in the clinic or on ultrasound so that we can answer those for you bye friends

Channel: Natalie Crawford, MD

Views: 8,553

Keywords: fertility, infertility, natalie crawford md, dr natalie crawford, as a woman podcast

Id: z1z9pBqOeyw

Length: 13min 57sec (837 seconds)

Published: Thu Nov 09 2023