Transvaginal ultrasound: 8 reasons to have one

An ultrasound scan is a key pregnancy procedure. Most pregnant women have their first scan at 12 weeks’ gestation. But not everyone gets pregnant, and there may be a physical reason why. An ultrasound scan (whether trans-vaginal or trans-abdominal) is a safe and effective way to check your reproductive organs are in good shape.

Fertility patients have routine trans-vaginal ultrasound scans during their treatment cycles. For women planning a family naturally, regular scans are also worth having. Why struggle to conceive, only to have an ultrasound scan diagnose a problem you could have spotted months earlier?

How does an ultrasound scan of you uterus and ovaries work? A probe, lubricated with gel and covered by a condom, is inserted about three inches into your vagina. Harmless sound waves create computer-generated images of your pelvic organs. These photos are surprisingly clear – and they need to be to highlight problems. It’s all over in 15 minutes or less. The procedure is painless.

What precisely does a trans-vaginal ultrasound scan look for? Here’s a quick summary.

1. Find those fibroids.

Fibroids are benign growths in the uterus. 1 in 4 women have them, though they may not know it. Depending of their size and position, some fibroids make it harder to get pregnant. They they can increase the chance of a miscarriage or implantation problems. This is more likely when the fibroids grow into the uterine cavity. A trans-vaginal ultrasound spots fibroids a mile off.

2. See those cysts.

Ovarian cysts are fluid-filled structures. Most are harmless and won’t stop you conceiving. Many come and go. But if you have endometriomas (cysts resulting from endometriosis) or cysts due to PCOS, your fertility could be affected. Trans-vagina scans identify ovarian cysts with ease. And if they’re dodgy, there are things you can do.

3. Look at that lining.

TV scans love uterine linings. A trans-vaginal ultrasound scan, performed mid-cycle, measures your endometrium down to the last millimetre. If it’s too thin, at the point in your cycle where it should be optimally thick, this may be why you’re not getting pregnant. Scans can see polyps, too (though a hysteroscopy is even better for this).

If you’re having fertility treatment, a trans-vaginal scan (or scans) of your lining during stimulation is essential. Uterine receptivity is everything. And a 2017 study into trans-vaginal scans and IVF found that a TV scan (not just a trans-abdominal one) during embryo transfer improved success rates.

4. Follow those follicles.

For IVF patients, trans-vaginal ultrasound tracking is crucial. TV scans get up close and personal, enabling the sonographer to accurately measure the quantity and size of your developing follicles. A typical patient needs 1 to 3 scans before her hCG trigger shot and egg retrieval.

5. Conception checker.

Fertility patients should have an early (six-week) scan after a positive pregnancy test. This will check for an ectopic pregnancy, as the risk is higher following assisted reproduction. It can also spot other pregnancy problems, such as a blighted ovum.

A scan will also, of course, detect a fetal heartbeat. Trans-vaginal ultrasound is the optimal way to see it. We think all pregnant women should have a six-week scan, not just fertility patients. Early checks reduce stress and help manage pregnancies. Have a private scan if necessary. Use a specialist fertility sonographer.

6. Hit that hydrosalpinx.

A hydrosalpinx is a collection of fluid in the fallopian tube. It can severely hamper natural and assisted pregnancies. Leaky fluid and embryos are a bad combination. Hydrosalpinges are often seen by trans-vaginal ultrasound – though you’ll need an experienced fertility sonographer. A hysterosalpingogram can see them more clearly, so have an HSG too if you can.

7. Pounce on your PID.

Pelvic inflammatory disease (PID) is not nice. And it can cause infertility. Your doctor may diagnose it based on touch and swabs. But a trans-vaginal ultrasound is a pretty good PID-identifier too. Early diagnosis is key.

8. Cross off cancer.

A trans-vaginal scan can see female cancers of the lower organs better than an abdominal scan. Cancers of the uterus, vagina, ovaries, kidneys and bladder are not that common in your reproductive years. But check for them anyway.

In summary, a trans-vaginal ultrasound scan is an important procedure. If you’re thinking of starting a family, a pre-conception scan is a no-brainer. Shop around: we found prices ranging from £70 to £500 for exactly the same procedure. And remember the mantra: if you can, have the scan!