Automated Folliculometry Using Five-Dimensional Ultrasound in Women With Unexplained Infertility (pilot study)

Abstract

SUMMARY T wo-dimensional ultrasound is used to monitor follicular development during ovulation induction or IVF cycles. Follicular assessment is performed to assess follicular size and growth ,the follicle is imaged and the largest x and y or x, y, and z diameters are obtained ,these diameters are then averaged to obtain the mean follicular diameter (MFD). The MFD is a surrogate for the size of the ovarian follicle. This method of follicular assessment is often inaccurate, because the follicular borders are irregular. 2D Ultrasound is basically an axial image and 3D Ultrasound is a volume and 4D Ultrasound is a volume with time and the fifth dimension is how do you bring a level of workflow into ultrasound, and it is basically bordering on the sense of automation. 5D technology is a form of automation where you go through and do a scan and you get the results autopopulated for you. Five-Dimensional Ultrasound included features like 5D-LB (fetal long-bone) and 5D-NT (nuchal translucency), 5D (fetal echo-cardiography), 5D-CNS(central nervous system)and 5D follicle monitor. Sonography-based Automated Volume Count is a new software, which automatically identifies the follicles in a captured ovarian volume, and provides estimates of their dimensions. Previous studies have demonstrated that SonoAVC accurately measures follicular volume. Aim of the study To evaluate trans-vaginal Five-Dimensional Ultrasound in automated measurement of ovarian follicles with controlled ovarian stimulation in contrast to the conventional 2D ultrasound. This study was performed at the Fetal Care Unit at Ain Shams University Maternity Hospital. 67 women were recruited from the Fetal Care Unit who fulfilled the inclusion criteria. Verbal consent was obtained from participants who were included into the study. All women would be receiving ovarian stimulation using clomiphene citrate (clomid 50 mg) once daily for 5 days starting from 2nd day of the cycle then they will be scanned at 10th day by the same physician using 2D U/S then 5D U/S will be done. Results: In this study, Inter-method agreement for the estimation of follicle size by 2D US or 5D US was assessed using the Bland and Altman method. The mean difference between 2D US and 5D US (bias) was -0.14 mm with a 95% CI of -0.11 mm to -0.004 mm. The limits of agreement between the two methods ranged from a lower limit of -1.32 mm (95% CI, -1.3 mm to -1.96 mm) to an upper limit of 1.04 mm (9%% CI, 1.04 to 1.96). There was no statistically significant difference found between size of follicles when measured by 2D or by 5D with p-value > 0.05 meaning that 5D result are highly comparable to the gold standard 2D U/S.

The maximum limit of difference between 5d rather than 2d was 1.04 mm in 95 % of visualized follicles and the minimum difference between 5d and 2d was -1.32mm. The rather narrow limits of agreement denote that both methods may be used interchangeably. 2D US could estimate the follicle diameter with an accuracy of ±0.93 mm of that estimated by 5D US.