Fertility ultrasound: follicle count, uterus and ovaries

A fertility ultrasound is a transvaginal scan of the uterus and ovaries. It counts the small antral follicles that help estimate ovarian reserve, and looks for fibroids, polyps, cysts or a differently shaped uterus. In Gala Fertility a clinician orders it after reading your intake, and the imaging team books it for her at a center near home, with no extra cost for tests.

Start together

For male-female couples, both partners 18 or older.

What the scan looks at

The antral follicle count: the number of follicles measuring 2 to 10 mm across both ovaries, counted early in the cycle. ASRM notes that the count varies little from cycle to cycle and is reliable in experienced hands.
The uterus: ASRM describes transvaginal ultrasound as able to show most uterine problems that may affect fertility, such as fibroids, polyps and adenomyosis.
The ovaries themselves, including cysts.

What it cannot show

A standard pelvic ultrasound does not show whether the fallopian tubes are open. NIH lists an X-ray hysterosalpingogram or laparoscopy for that, and notes that a saline sonohysterogram can show that at least one tube is open. These are clinic procedures. If your history points to a tubal problem, your clinician refers you to a fertility clinic.

A couple on a video visit, going over her ultrasound results with their clinician

What to expect

NIH describes the scan simply: a wand placed in the vagina uses sound waves to give a clear view of the uterus and ovaries. In Gala Fertility nothing has to be arranged by you: once a clinician has reviewed your intake and ordered the scan, the imaging team contacts her to schedule it at a location near you.

When a scan leads to more imaging

A pelvic ultrasound is the first look, not always the last. ASRM's committee opinion describes three-dimensional ultrasound and pelvic MRI as ways to characterize a finding from a first scan more closely, and a hysterosalpingogram as the test that defines the size and shape of the uterine cavity, including developmental differences such as a septate, bicornuate or unicornuate uterus. NIH adds hysteroscopy, a thin camera passed into the uterus, and the saline sonohysterogram, which fills the cavity with sterile saline so its lining is easier to see.

One measure you may read about matters less than it sounds. ASRM notes that ovarian volume shrinks with age but is rarely used to predict anything, because it varies a lot within and between cycles. The follicle count is the number to look at.

Read together with AMH

The follicle count and AMH measure the same thing in two ways, and ASRM says neither predicts the chance of natural pregnancy independently of age. Your clinician reads the scan with her AMH, FSH and estradiol, and with his semen analysis, then explains it on your video visit. If the scan shows low reserve or a change in the uterus that needs in-person care, your clinician refers you and explains why. More on the blood side in AMH and ovarian reserve testing.

Questions, answered

What does a fertility ultrasound check?

The number of small antral follicles in both ovaries, the uterus for fibroids, polyps or shape differences, and the ovaries for cysts.

Is a fertility ultrasound transvaginal?

Yes. A wand placed in the vagina gives the clearest view of the uterus and ovaries.

Can an ultrasound show if my tubes are blocked?

Not a standard pelvic ultrasound. Tubal patency needs a hysterosalpingogram, a saline sonohysterogram or laparoscopy at a fertility clinic.

Why is an ultrasound part of a fertility workup?

ASRM calls ultrasound the best imaging tool for the uterus, because it shows the uterine wall, the cavity and the ovaries at the same time. It also gives the follicle count, a second measure of ovarian reserve next to AMH.

How is the ultrasound booked?

A clinician orders it after reviewing your intake, and the imaging team contacts her to schedule it at a center near you.

Is the ultrasound included in Gala Fertility?

Yes. Her pelvic ultrasound is part of the plan, with no extra cost for tests.

How to start

A $29.99 first step

Book an introductory video meeting with our care team. If you both agree to start, your plan begins and the $29.99 is credited to your first cycle. After that, your plan is one all-inclusive price per cycle, shown before you commit: medication if prescribed, a check-in after every cycle, your video visits, messages with your care team and all program tests for both of you. See what the program includes.