Skip to main content
SpringerLink
Log in
Book cover

Ultrasound Imaging in Reproductive Medicine pp 49–62Cite as

The Normal Ovary (Changes in the Menstrual Cycle)

  • Chapter
  • First Online:

  • 2083 Accesses

Abstract

The ovaries can be sonographically visualized by transabdominal, transrectal, and transvaginal approach. The golden standard today is the transvaginal approach. Ultrasound provides insight into the psychological changes during the ovarian cycle. Ovaries are imaged as homogeneous, hypoechogenic ovoid structures with slightly echogenic central part. The dominant follicle can be detected between 8th and 12th day of the cycle. The dominant follicle has a linear daily diameter growth of 2–3 mm per day until ovulation, when the diameter of the dominant follicle is 18–28 mm. After ovulation the follicle is transformed in corpus luteum. Transvaginal color Doppler (TVCD) helps in better understanding of the menstrual cycle physiology. Before ovulation perifollicular flow has moderate RI (resistance index) around 0.54 ± 0.04. RI gradually declines and at ovulation measures 0.44 ± 0.04. The peak systolic velocity rises at the onset of ovulation. Corpus luteum formation is characterized with a dramatic increase of the amount of the blood flow with increased velocity and low impedance to blood flow (0.43 ± 0.04). The regression of corpus luteum is characterized with poor color Doppler signals and higher RI. The three-dimensional ultrasound (3D) can be used in order to obtain more information about the ovaries. Volume of the ovary can be measured and calculated more precisely. Dominant and other follicles can be measured automatically using SonoAVC (sonography-based automated volume count). Surface view of the inner layer of the dominant follicle can detect the cumulus oophorus. Antral follicular count can be measured by 2D or 3D ultrasound. The novel technique (SonoAVC) offers an automatic count of antral follicles. If 3D volume of the ovaries with vascularization is scanned, vascular indexes of the whole ovary can be measured (VI-vascular index, FI- flow index, and VFI- vascular flow index).

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Kratochwill A. Ein neues vaginales Schnittbildverfahren. Geburtshilfe Frauenheilkd. 1969;29:379–85.

    Google Scholar 

  2. Popp LW. Gynaekologische Endosonographie. Quickborn: Klemke; 1986.

    Google Scholar 

  3. Merz E, Miric-Tesanic D, Weber G, Bahlmann F. Sonographic size of the uterus and ovaries in pre- and postmenopausal women. Ultrasound Obstet Gynecol. 1996;7:1–5.

    Article  Google Scholar 

  4. Sladkevicius P, Valentin L, Marsal K. Transvaginal grey-scale and Doppler ultrasound examinations of the uterus and ovaries in healthy postmenopausal women. Ultrasound Obstet Gynecol. 1995;6:81–90.

    Article  CAS  PubMed  Google Scholar 

  5. Vlaisavljevic V. Echographic evidence of follicle development and maturation. Donald Sch J Ultrasound Obstet Gynecol. 2011;5(3):267–72.

    Article  Google Scholar 

  6. Picker RH, Smith DH, Tucker MH, Saunders DM. Ultrasonic signs of imminent ovulation. J Clin Ultrasound. 1983;11:1–2.

    Article  CAS  PubMed  Google Scholar 

  7. Matijevic R, Grgic O. Predictive values of ultrasound monitoring of the menstrual cycle. Curr Opin Obstet Gynecol. 2005;17:405–10.

    Article  PubMed  Google Scholar 

  8. Jarvela IY, Sladkevicius P, Kelly S, Ojha K, Nargund G, Campbell S. Three dimensional sonographic and Power Doppler characterization of ovaries in late follicular phase. Ultrasound Obstet Gynecol. 2003;22(5):520–6.

    Article  Google Scholar 

  9. Deichert U, Daume E. Zyklische Veranderungen am Ovar. In: Deichert U, Ducla V, Schlief R, editors. Funktionelle Sonographie in Gynakologie und Reproduktionsmedizin. Berlin: Springer; 1993. p. 71–132.

    Chapter  Google Scholar 

  10. Collins WP, Jurkovic D, Waterstone J, Campbell S. Ovarian morphology, endocrine function and intrafollicular blood flow during periovulatory period. Hum Reprod. 1991;6:319–24.

    CAS  PubMed  Google Scholar 

  11. Kurjak A, Schulman H, Sosic A, Zalud I, Shalan H. Transvaginal ultrasound, color flow and Doppler waveform of the postmenopausal adnexal mass. Obstet Gynecol. 1992;80:917–21.

    CAS  PubMed  Google Scholar 

  12. Kurjak A, Kupesic S. Ovarian senescence and its significance on uterine and ovarian perfusion. Fertil Steril. 1995;64:532–7.

    CAS  PubMed  Google Scholar 

  13. Bourne T, Jurkovic D, Waterstone J, Campbell S, Collins WP. Intrafollicular blood flow during human ovulation. Ultrasound Obstet Gynecol. 1991;1:53–9.

    Article  CAS  PubMed  Google Scholar 

  14. Kupesic S, Kurjak A. Uterine and ovarian perfusion during the periovulatory period assessed by transvaginal color Doppler. Fertil Steril. 1993;3:439–43.

    Google Scholar 

  15. Van Blerkom J, Antczak M, Schrader R. 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. Hum Reprod. 1997;12:1047–55.

    Article  PubMed  Google Scholar 

  16. Nargund G, Doyle PE, Bourne TH, Parsons JH, Cheng WC, Campbell S, et al. Ultrasound derived indices of follicular blood flow before hCG administration and the prediction of oocyte recovery and preimplantation embryo quality. Hum Reprod. 1996;11:2512–7.

    Article  CAS  PubMed  Google Scholar 

  17. Lovrec VG, Vlaisavljevic V, Reljic M. 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.

    PubMed  Google Scholar 

  18. Vlaisavljevic V, Reljic M, Lovrec VG, Zazula D, Sergent N. Measurement of perifollicular blood flow of the dominant preovulatory follicle using three-dimensional power Doppler. Ultrasound Obstet Gynecol. 2003;22:520–6.

    Article  CAS  PubMed  Google Scholar 

  19. Vlaisavljevic V, Borko E, Radakovic B, Zazula D, Dosen M. Changes in perifollicular vascularity after administration oh human chorionic gonadotropin measured by quantitative three-dimensional power Doppler ultrasound. Wien Klin Wochenschr. 2010;122 Suppl 2:85–90.

    Article  CAS  PubMed  Google Scholar 

  20. Kupesic S, Kurjak A, Vujisic S, Petrovic M. Luteal phase defect: comparison between Doppler velocimetry, histological and hormonal markers. Ultrasound Obstet Gynecol. 1997;9:105–12.

    Article  CAS  PubMed  Google Scholar 

  21. Pavlik EJ, DePriest PD, Gallion HH, Ueland FR, Reedy MB, Kryscio RJ, et al. Ovarian volume related to age. Gynecol Oncol. 2000;77:410–2.

    Article  CAS  PubMed  Google Scholar 

  22. Kupesic S, Kurjak A, Bjelos D, Vujisic S. Three-dimensional ultrasonographic ovarian measurements and in vitro fertilization outcome are related to age. Fertil Steril. 2003;79:190–7.

    Article  PubMed  Google Scholar 

  23. Bernaschek G, Lubec G, Schaller A. Sonographische Untersushungen uber das Wachstum von Uterus und Ovarien zwischen dem 1.-14. Lebensjahr. Geburtshilfe Frauenheilkd. 1984;44:727–30.

    Article  CAS  PubMed  Google Scholar 

  24. Jayaprakasan K, Campbell B, Hopkisson J, Johnson I, Reine-Fenning N. A prospective, comparative analysis of anti-Mullerian hormone, inhibin-B, and three-dimensional ultrasound determinants of ovarian reserve in the prediction of poor response to control ovarian stimulation. Fertil Steril. 2010;3:855–64.

    Article  Google Scholar 

  25. Henriks DJ, Kwee WS, Mol BW, te Velde ER, Broekmans FJ. Ultrasonography as a tool for the prediction of outcome in IVF patients: a comparative meta-analysis of ovarian volume and antral follicle count. Fertil Steril. 2007;87:764–75.

    Article  Google Scholar 

  26. Broekmans F, de Zieger D, Howles C, Gougeon A, Trew G, Olivennes F. The antral follicle count: practical recommendations for better standardization. Fertil Steril. 2010;94(3):1044–51.

    Article  PubMed  Google Scholar 

  27. Ruess ML, Kline J, Santos R, Levin B, Timor-Tritsch I. Age and the ovarian follicle pool assessed with transvaginal ultrasonography. Am J Obstet Gynecol. 1996;174:624–7.

    Article  CAS  PubMed  Google Scholar 

  28. Scheffer GJ, Broekmans FJ, Looman CW, Blankenstein M, Fauser BCJM, de Jong FH, et al. The number of antral follicles in normal women with proven fertility is the best reflection of the reproductive age. Hum Reprod. 2003;18:700–6.

    Article  CAS  PubMed  Google Scholar 

  29. Chang MW, Chiang CH, Hsieh TT, Soong YK, Hsu KH. Use of antral follicle count to predict the outcome of assisted reproductive technologies. Fertil Steril. 1998;69:505–10.

    Article  CAS  PubMed  Google Scholar 

  30. Kline J, Kinney A, Kelly A, Reuss ML, Levin B. Prediction of antral follicle count during reproductive years. Hum Reprod. 2005;20:2179–89.

    Article  CAS  PubMed  Google Scholar 

  31. Almog B, Shehata F, Suissa S, Holzer H, Shalom-Paz E, La Marca A. Age-related nomograms of serum antimullerian hormone levels in a population of infertile women: a multicenter study. Fertil Steril. 2011;7:2359–63.

    Article  Google Scholar 

  32. Ng EH, Yeung WS, Fong DY, Ho PC. Effects of age on hormonal and ultrasound markers of ovarian reserve in Chinese women with proven fertility. Hum Reprod. 2003;18:2169–74.

    Article  PubMed  Google Scholar 

  33. Salama S, Arbo E, Lamazou F, Levaillant JM, Frydman R, Fanchin R. Reproducibility and reliability of automated volumetric measurement of single preovulatory follicles using SonoAVC. Fertil Steril. 2010;93:2069–73.

    Article  PubMed  Google Scholar 

  34. Rodriguez-Fuentes A, Hernandez J, Garcia-Guzman R, Chinea E, Iaconianni L, Palumbo A. Prospective evaluation of automated follicle monitoring in 58 in vitro fertilization cycles: follicular volume as a indicator of oocyte maturity. Fertil Steril. 2010;93:616–20.

    Article  PubMed  Google Scholar 

  35. Jokubkiene L, Sladkevicius P, Rovas L, Valentin L. Assessment of changes in volume and vascularity of the ovaries during the normal menstrual cycle using three-dimensional power Doppler ultrasound. Hum Reprod. 2006;10:2661–8.

    Article  Google Scholar 

  36. Hope JM, Long K, Kudla M, Arslan A, Tsymbal T, Strok I, et al. Three-dimensional power Doppler angiography of cyclic ovarian blood flow. J Ultrasound Med. 2009;8:1043–52.

    Google Scholar 

  37. Engels V, Sanfrutos L, Perey-Medina T, Alvarez P, Zapardiel I, Godoy-Tunidor S, et al. Periovulation follicular volume and vascularization determined by 3D and power Doppler sonography as pregnancy predictors in intrauterine insemination cycles. J Clin Ultrasound. 2011;5:243–7.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Sveti Duh Clinical Hospital, Sveti Duh 64, Zagreb, 10000, Croatia, Europe

    Renato Bauman MD, PhD

  2. Department for infertility, Medical Center Dravlje, Ulica bratov Babnik 10, Ljubljana, 1000, Slovenia, Europe

    Ursula Reš Muravec MD Msc

Authors
  1. Renato Bauman MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ursula Reš Muravec MD Msc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ursula Reš Muravec MD Msc .

Editor information

Editors and Affiliations

  1. Department of Obstetrics and Gynecology, Eastern Virginia Medical School Jones Institute for Reproductive Medicine, Norfolk, Virginia, USA

    Laurel Stadtmauer

  2. Institute for Human Reproduction, Chicago, Illinois, USA

    Ilan Tur-Kaspa

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Bauman, R., Muravec, U.R. (2014). The Normal Ovary (Changes in the Menstrual Cycle). In: Stadtmauer, L., Tur-Kaspa, I. (eds) Ultrasound Imaging in Reproductive Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9182-8_5

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-9182-8_5

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-9181-1

  • Online ISBN: 978-1-4614-9182-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation