SonoAVC (Sonographic-Based Automated Volume Count)

  • Adela Rodrıguez-Fuentes
  • Jairo Hernández
  • Jean Paul Rouleau
  • Angela Palumbo


Recent advances in 3D ultrasound technology have resulted in the development of specific software such as VOCAL (Virtual Organ Computer-aided AnaLysis program) and SonoAVC (Sonographic-based Automated Volume Count) (GE Healthcare, Austria) that allow automatic measures of volumes. These software tools have several applications in gynecology as well as in other medical specialties, but the most widespread is the measurement of follicular diameters and volumes during ovarian stimulation in patients undergoing in vitro fertilization (SonoAVCfollicle). More recently, a specific software to evaluate antral follicles has been developed, called SonoAVCantral.

Advantages of this technology are undeniable when evaluating multifollicular ovaries; it clearly saves time and elaborates an extensive report with additional information of every single follicle. From the patient’s point of view, it has several benefits. They spend less time in the waiting room, the exploration is shorter, and, at the same time, the visualization of the ovary with this technology makes it easier to follow follicular growth and understand how the treatment is going.

The more promising information of the report is follicular volume since it is closer to the real size of the follicle. This fact must be appreciated because it gives us the opportunity to make clinical decisions based on follicular volumes rather than diameters, making treatments highly individualized. Studies in our laboratory have shown that follicles with volumes greater than 0.7 cc are associated with mature oocytes, and this information can be helpful to decide the day of trigger.


Follicular monitoring Oocyte maturation Human chorionic gonadotropin (hCG) Automated volume calculation (SonoAVC) Follicle tracking Follicle diameter Three-dimensional ultrasound IVF (in vitro fertilization) Follicular volume Oocyte maturity 

Supplementary material

Video 17.1

This video shows how the 3D box is adjusted to cover the larger diameter of the ovary. Subsequently, the automatic acquisition is made, while the probe stands still (MP4 9614 kb)

Video 17.2

Over the multiplanar view of the ovary, the ROI (region of interest) is adjusted, as close as possible to the limits of the ovary, before the automatic volume calculation begins. In a few seconds, the results are shown with every follicle color-coded. The results are reviewed manually scrolling through each plane adding or removing follicles. In this case, some follicles (numbers 3 and 7) extend beyond the limits of the ovary, so the “cut” option is used on plane C. Finally, a 3D representation of the stimulated ovary is shown on a rotational video (MP4 46104 kb)

Video 17.3

SonoAVC follicle post-processing work (MP4 68495 kb)


  1. 1.
    Bakker M, Mulder P, Birnie E, Bilardo CM. Intra-operator and inter-operator reliability of manual and semiautomated measurement of fetal nuchal translucency: a cross sectional study. Prenat Diagn. 2013;33:1264–71.CrossRefGoogle Scholar
  2. 2.
    Chen PW, Chen M, Leung TY, Lau TK. Effect of image settings on nuchal translucency thickness measurement by a semi-automated system. Ultrasound Obstet Gynecol. 2012;39:169–74.CrossRefGoogle Scholar
  3. 3.
    Żygadło A, Kaźnica-Wiatr M, Błaut-Jurkowska J, Knap K, Lenart-Migdalska A, Smaś-Suska M, et al. Evaluation of the clinical suitability of automated left ventricles fraction and volume measurements in 3-dimensional echocardiography compared to values obtained in magnetic resonance imaging (pilot study). Pol Merkur Lekarski. 2017;43:154–7.PubMedGoogle Scholar
  4. 4.
    Duin LK, Willekes C, Vossen M, Offermans J, Nijhuis JG. Reproducibility of fetal renal pelvis volume assessed by three-dimensional ultrasonography with two different measurement techniques. J Clin Ultrasound. 2013;41:230–4.CrossRefGoogle Scholar
  5. 5.
    Raine-Fenning N, Jayaprakasan K, Clewes J, Joergner I, Bonaki SD, Chamberlain S, et al. So noAVC: a novel method of automatic volume calculation. Ultrasound in Obstet & Gynecol. 2008;31:691–6.CrossRefGoogle Scholar
  6. 6.
    Salama S, Arbo E, Lamazou F, Levailllant JM, Frydman R, Fanchin R. Reproducibility and reliability of automated volumetric measurement of single preovulatory follicles using SonoAVC. Fertil Steril. 2010;93:2069–73.CrossRefGoogle Scholar
  7. 7.
    Deutch T, Joergner I, Matson D, Oehninger S, Bocca S, Hoenigmann D, et al. Automated assessment of ovarian follicles using a novel three-dimensional ultrasound software. Fertil Steril. 2009;92:1562–8.CrossRefGoogle Scholar
  8. 8.
    Lamazou F, Arbo E, Salama S, Grynberg M, Frydman R, Fanchin R. Reliability of automated volumetric measurement of multiple growing follicles in controlled ovarian hyperstimulation. Fertil Steril. 2010;94:2172–6.CrossRefGoogle Scholar
  9. 9.
    Ata B, Seyhan A, Reinblatt SL, Shalom-Paz E, Krishnamurthy S, Tan SL. Comparison of automated and manual follicle monitoring in an unrestricted population of 100 women undergoing controlled ovarian stimulation for IVF. Hum Reprod. 2010;26:127–33.CrossRefGoogle Scholar
  10. 10.
    Rodríguez-Fuentes A, Hernández J, García-Guzman R, Chinea E, Iaconianni L, Palumbo A. Prospective evaluation of automated follicle monitoring in 58 in vitro fertilization cycles: follicular volume as a new indicator of oocyte maturity. Fertil Steril Jan; (93): 616–620.CrossRefGoogle Scholar
  11. 11.
    Hernández J, Rodríguez-Fuentes A, Puopolo M, Palumbo A. Follicular volume predicts oocyte maturity: a prospective cohort study using three-dimensional ultrasound and SonoAVC. Reprod Sci. 2016;23:1639–43.CrossRefGoogle Scholar
  12. 12.
    Wittmaack FM, Kreger DO, Blasco L, Tureck RW, Mastroianni L, Lessey BA. Effect of follicular size on oocyte retrieval, fertilization, cleavage, and embryo quality in in vitro fertilization cycles: a 6-year data collection. Fertil Steril. 1994;6:1205–10.CrossRefGoogle Scholar
  13. 13.
    Raine-Fenning NJ, Campbell BK, Clewes JS, Johnson IR. The interobserver reliability of ovarian volume measurement is improved with three-dimensional ultrasound, but dependent upon technique. Ultrasound Med Biol. 2003;29:1685–90.CrossRefGoogle Scholar
  14. 14.
    Luis T. Mercé, Gomez B, Engels V, Bau S, Bajo JM. Intraobserver and interobserver reproducibility of ovarian volume, antral follicle count, and vascularity indices obtained with transvaginal 3-dimensional ultrasonography, power doppler angiography, and the virtual organ computer-aided analysis imaging program. J Ultrasound Med. 2005;24:1279–87.CrossRefGoogle Scholar
  15. 15.
    Shmorgun D, Hughes E, Mohide P, Roberts R. Prospective cohort study of three-versus two dimensional ultrasound for prediction of oocyte maturity. Fertil Steril. 2010;93:1333–7.CrossRefGoogle Scholar
  16. 16.
    Raine-Fenning N, Deb S, Jayaprakasan K, Clewes J, Hopkisson J, Campbell B. Timing of oocyte maturation and egg collection during controlled ovarian stimulation: a randomized controlled trial evaluating manual and automated measurements of follicle diameter. Fertil Steril. 2010;94:184–8.CrossRefGoogle Scholar
  17. 17.
    Rodriguez A, Guillén JJ, López MJ, Vassena R, Coll O, Vernaev V. Learning curves in 3-dimensional sonographic follicle monitoring during controlled ovarian stimulation. J Ultrasound Med. 2014;33:649–55.CrossRefGoogle Scholar
  18. 18.
    Jurema M, Bracero N, Garcia J. Fine tuning cycle day 3 hormonal assessment of ovarian reserve improves in vitro fertilization outcome in gonadotropin- releasing hormone antagonist cycles. Fertil Steril. 2003;80:1156–61.CrossRefGoogle Scholar
  19. 19.
    Bancsi LF, Broekmans FJ, Mol B, Habbema JD, Velde ER. Performance of basal follicle-stimulating hormone in the prediction of poor ovarian response and failure to become pregnant after in vitro fertilization: a meta-analysis. Fertil Steril. 2003;79:1091–100.CrossRefGoogle Scholar
  20. 20.
    Bancsi LF, Broekmans FJ, Looman CW, Habbema JD, Velde ER. Predicting poor ovarian response in IVF: use of repeat basal FSH measurement. JRM. 2004;49:187–94.Google Scholar
  21. 21.
    Barad DH, Weghofer A, Gleicher N. Comparing anti-Mullerian hormone (AMH) and follicle-stimulating hormone (FSH) as predictors of ovarian function. Fertil Steril April. 2009;91:1553–5.CrossRefGoogle Scholar
  22. 22.
    Lekamge DN. Anti-Müllerian hormone as a predictor of IVF outcome. RBM. 2007;14:602–10.Google Scholar
  23. 23.
    Wunder DM, Guibourdenche J, Birkhauser MH, Bersinger NA. Anti-Mullerian hormone and inhibin B as predictors of pregnancy after treatment by in vitro fertilization/ intracytoplasmic sperm injection. Fertil Steril. 2008;90:2203–10.CrossRefGoogle Scholar
  24. 24.
    Lee TH, Liu CH, Huang CC, Wu YL, Shih YT, Ho HN, et al. Serum anti-müllerian hormone and estradiol levels as predictors of ovarian hyperstimulation syndrome in assisted reproduction technology cycles. Hum Reprod. 2008;23(1):160–7.CrossRefGoogle Scholar
  25. 25.
    Smeenk J, Sweep F, Zielhuis G, Kremer J, Thomas C, Braat D. Antimüllerian hormone predicts ovarian responsiveness, but not embryo quality or pregnancy, after in vitro fertilization or intracytoplasmic sperm injection. Fertil Steril. 2007;87(1):223–6.CrossRefGoogle Scholar
  26. 26.
    Broer S, Mol B, Hendriks D, Broekmans F. The role of antimullerian hormone in prediction of outcome after IVF: comparison with the antral follicle count. Fertil Steril. 2009;91(3):705–14.CrossRefGoogle Scholar
  27. 27.
    Barreto Melo M, Garrido N, Alvarez C, Bellver J, Meseguer M, Pellicer A, et al. Antral follicle count (AFC) can be used in the prediction of ovarian response but cannot predict the oocyte/embryo quality or the in vitro fertilization outcome in an egg donation program. Fertil Steril. 2009;91:148–56.CrossRefGoogle Scholar
  28. 28.
    Kupesic S, Kurjak A. Predictors of IVF outcome by three-dimensional ultrasound. Hum Reprod. 2002;17:950–5.CrossRefGoogle Scholar
  29. 29.
    Almog B, Shehata F, Shalom-Paz E, Tan SL, Tulandi T. Age-related nomogram for antral follicle count: McGill reference guide. Fertil Steril. 2011;95:663–6.CrossRefGoogle Scholar
  30. 30.
    Deb S, Jayaprakasan K, Campbell BK, Clewes JS, et al. Intraobserver and interobserver reliability of automated antral follicle counts made using three-dimensional ultrasound and SonoAVC. Ultrasound Obstet Gynecol. 2009;33:477–83.CrossRefGoogle Scholar
  31. 31.
    Deb S, Campbell BK, Clewes JS, Raine-Fenning NJ. Quantitative analysis of antral follicle number and size: a comparison of two-dimensional and automated three-dimensional ultrasound techniques. Ultrasound Obstet Gynecol. 2010;35:354–60.CrossRefGoogle Scholar
  32. 32.
    Zhang N, Hao C, Zhuang L, Liu X, Gu HF, Liu S, et al. Prediction of IVF/ICSI outcome based on the follicular output rate. RBM. 2013;27:147–53.Google Scholar
  33. 33.
    Rehman R, Mustafa R, Baig M, Arif S, Hashmi MF. Use of follicular output rate to predict Intracytoplasmic sperm injection outcome. Int J Fertil Steril. 2016;10(2):169–74.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Hassan A, Kotb M, AwadAllah A, Wahba A, Shehata N. Follicular output rate can predict clinical pregnancy in women with unexplained infertility undergoing IVF/ICSI: a prospective cohort study. RBM. 2017;34:598–604.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Adela Rodrıguez-Fuentes
    • 1
  • Jairo Hernández
    • 2
  • Jean Paul Rouleau
    • 2
  • Angela Palumbo
    • 2
  1. 1.Universidad de La Laguna, Centro de Asistencia a la Reproducción Humana de CanariasSan Cristobal de La LagunaSpain
  2. 2.Centro de Asistencia a la Reproducción Humana de CanariasSan Cristobal de La LagunaSpain

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