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Follicular tracking (antral follicular count)

Case contributed by Mr. Dennis Odhiambo Agolah

Presentation

Twelfth day of her cycle. On FSH and cetrorelix acetate stimulants. Transvaginal scan for antral follicular count, patient preparing for ovum pick-up.

Patient Data

Age: 20 years
Gender: Female

Both ovaries are well visualized within their respective adnexal regions and maintain their morphology with evidence of different antral waves of folliculogenesis bilaterally. The right ovary measure 58.67 cc in volume and has multiple follicles (at least 19) within it, whilst the left ovary measures 45.03 cc in volume and has multiple follicles (at least 17) as well within it. Sampled follicles measures:

Right ovarian follicles                                       Left ovarian follicles

21.1 x 13.0 mm (mean diam= 17.1mm).           18.4 x 17.0 mm (mean diam = 17.7mm).

15.3 x 13.1 mm (mean diam= 14.2mm).           17.2 x 11.2 mm (mean diam = 14.2mm).

17.9 x 15.6 mm (mean diam= 16.8mm).           15.9 x 13.3 mm (mean diam= 14.6mm).

14.1 x 10.2 mm (mean diam= 12.2mm).            15.0 x 9.4 mm (mean diam= 12.2mm).

18.8 x 10.6 mm (mean diam= 14.7mm).            15.5 x 11.0 mm (mean diam= 7.85mm).

16.9 x 11.4 mm (mean diam= 14.2mm).             10.8 x 10.6 mm (mean diam= 10.7mm).

14.1 x 9.2 mm (mean diam= 11.7mm).               6.4 x 3.5 mm (mean diam= 5.0mm).

12.4 x 9.2 mm (mean diam= 10.8mm).               5.8 x 3.6 mm (mean diam= 4.7mm).

 18.3 x 13.1 mm (mean diam= 15.7mm).            6.5 x 6.1 mm (mean diam= 6.3mm).

14.2 x 8.2 mm (mean diam= 11.2mm).               14.5 x 6.8 mm (mean diam= 10.7mm).

21.4 x 9.6 mm (mean diam= 15.5mm).              10.2 x 9.5 mm (mean diam= 9.9mm).

23.7 x 11.6 mm (mean diam= 17.7mm).              8.6 x 8.2 mm (mean diam= 8.4mm).

14.8 x 11.0 mm (mean diam= 12.9mm).             17.2 x 11.2 mm (mean diam= 14.2mm).

12.2 x 7.6 mm (mean diam= 9.9mm).                15.9 x 13.3 mm (mean diam= 14.6mm).

8.7 x 8.5 mm (mean diam= 8.6mm).                  15.0 x 9.4 mm (mean diam= 12.2mm).

13.5 x 11.5 mm (mean diam= 12.5mm).           21.0 x 13.3 mm (mean diam= 17.2mm).

8.7 x 4.7 mm (mean diam= 6.7mm).                 

8.6 x 4.2 mm (mean diam= 6.4mm).                 

16.2 x 9.4 mm (mean diam= 12.8mm).

No adnexal masses or free cul-de-sac fluid collections. The uterus is anteverted, non-gravid, measures 7 x 3.8 x 4.6 cm = 63.1 mL with smooth outer contours. No fibroid is noted. The double laminar endometrial stripe thickness of 14 mm (in the AP diameter) is within normal limits and in the proliferative phase. The cervix and the visualized vaginal vault grossly look normal. The urinary bladder is unremarkable.

Case Discussion

Evenly populated bilateral ovaries with healthy looking follicles (smooth regular walls/interphase outlines, clear anechoic fluid contents and round to oval-shaped follicular orientations).

The follicles are more than 10 in number on either side showing good antral follicular count (good response to ova stimulation with more than five follicles in each side having mean diameters ranging from 14 mm and above). There is however, mild hyperstimulation bilaterally.

The follicles are evenly distributed within the ovarian parenchyma and are of varying sizes excluding a possibility of induced polycystic ovarian disorder that sometimes occur during such procedures. There are no abnormal fluid collections within the pelvis or upper abdominal quadrants either which may occur as a result of ascites or ruptured follicles.

Oftentimes, small-sized, thin-walled intrafollicular structures may be evident within the larger follicles consistent with cumuli oophori (a.k.a discus proligerus) which are the egg/oocyte-bearing clouds ready for harvesting/ovulation.

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