Ultrasound scanning is one of the most important investigations in fertility assessment. It provides detailed information about the uterus, ovaries and surrounding pelvic structures, helping identify factors that may affect fertility and guide treatment planning.
Our fertility specialists use ultrasound to assess ovarian reserve, monitor ovulation, evaluate the uterine lining and identify a range of gynaecological conditions that may influence conception or pregnancy outcomes.
A transvaginal fertility ultrasound provides a detailed assessment of the uterus, ovaries and endometrium. During the examination, we assess the appearance of the ovaries, perform an antral follicle count (AFC) to estimate ovarian reserve, and evaluate the thickness and appearance of the uterine lining.
The scan may also identify conditions such as fibroids, ovarian cysts, adenomyosis, polycystic ovarian morphology (PCOM) and other pelvic abnormalities.
A 3D ultrasound scan includes all elements of a standard fertility ultrasound and provides a detailed three-dimensional assessment of the uterine cavity and shape.
This additional information can be particularly valuable when investigating recurrent miscarriage, implantation failure or suspected abnormalities of the uterine cavity.
Most fertility ultrasounds are performed using a transvaginal ultrasound probe, which provides much greater detail than an abdominal scan.
You will usually be asked to empty your bladder before the examination. A slim ultrasound probe is gently inserted into the vagina, allowing detailed images of the pelvic organs to be obtained.
The procedure is safe, straightforward and typically takes between 10 and 20 minutes. Most patients experience little or no discomfort.
Why is an ultrasound scan part of a fertility investigation?
A fertility ultrasound is a transvaginal scan, meaning a small, smooth probe is gently placed inside the vagina to obtain detailed images of the pelvic organs. This approach gives a much clearer view of the uterus and ovaries than an external abdominal scan, and is the standard method used in fertility clinics. It is not painful, though some people find it mildly uncomfortable, and it takes around fifteen to twenty minutes.
No preparation is needed beforehand. Unlike some types of scan, you do not need a full bladder for a transvaginal ultrasound.
At Genus Fertility, the baseline ultrasound forms part of your initial fertility assessment and is usually carried out at your first consultation or shortly afterwards. The results are available immediately and discussed with you on the same visit. The scan provides a real-time picture of your reproductive anatomy that blood tests alone cannot, and it is one of the most informative single steps in a fertility investigation.
How is the ultrasound scan different from a blood test for ovarian reserve?
The ultrasound AFC and the AMH blood test are the two most widely used measures of ovarian reserve, and they work in complementary ways. Neither replaces the other, and the most accurate picture comes from using both together.
AMH is a blood test that measures a hormone produced by the small follicles in your ovaries. It gives a stable, cycle-independent reading that reflects the overall size of your follicle pool. Because it does not fluctuate significantly across the cycle, it can be done at any point and gives a consistent baseline.
The AFC gives a direct visual count of the follicles present at the start of a specific cycle. It is performed in real time and is immediately visible, so the result is available the moment the scan is complete. It can vary slightly from cycle to cycle, which is one reason it is most informative when interpreted alongside AMH rather than in isolation.
Blood tests, however detailed, cannot show the physical condition of the uterus or ovaries. Fibroids, polyps, endometriomas, and structural anomalies of the uterus are invisible to hormonal testing and can only be identified on ultrasound. This is why the scan is an essential step, regardless of your blood results.
What happens if the scan finds something unexpected?
Finding something on a fertility scan can feel alarming in the moment, but most findings are manageable and many are straightforward to treat. Discovering an issue at this stage is always preferable to finding it later, as it allows us to plan your treatment with a full picture.
Common findings and what they typically mean are as follows. Fibroids are extremely common, and the vast majority do not require treatment before IVF. Whether intervention is needed depends on the size and, crucially, the location of the fibroid and whether it is distorting the uterine cavity. Endometrial polyps are usually small and can be removed with a straightforward outpatient hysteroscopy before starting a treatment cycle. Ovarian cysts are assessed individually; simple cysts often resolve on their own, while endometriomas or complex cysts may require further investigation or treatment.
If the scan suggests Polyendocrine Metabolic Ovarian Syndrome (PMOS), this will inform the stimulation protocol we use for IVF, with lower medication doses and careful monitoring to reduce the risk of ovarian hyperstimulation. A very low antral follicle count allows us to have an early conversation about tailored protocols, embryo banking strategies, or, where appropriate, donor eggs.
Will I need more than one scan during the fertility investigation or treatment process?
Yes, and this is worth knowing from the outset so that the process feels less daunting when additional scan appointments are arranged. The baseline scan is the starting point, but ultrasound plays a role at several stages of a fertility journey.
If you proceed with ovulation induction, monitoring scans are used to track follicle development and confirm ovulation, allowing us to time any intervention at the most effective point in your cycle.
During an IVF stimulation cycle, you will have a series of monitoring scans, typically every two to three days, to track how your follicles are responding to medication. These scans allow us to adjust your medication dose in real time, assess the endometrial lining, and determine the optimal moment to trigger ovulation before egg collection.
Before a frozen embryo transfer, a scan is used to confirm the thickness and appearance of the uterine lining, ensuring the conditions are right.
Each scan is a brief outpatient appointment, and results are always discussed with you on the same visit. The frequency of monitoring varies depending on your protocol and how you are responding, and our team will always keep you informed about what is coming next.