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Counting ovarian antral follicles by ultrasound.

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eMediNexus    02 November 2017

A new article published in Ultrasound in Obstetrics Gynecology summarized the main aspects of several available techniques to perform ovarian antral follicle count AFC in order to propose a standardized report and to draw perspectives for future research on this subject. This consensus was drawn by a group of clinicians and sonologists. It was stated that AFC should be performed by transvaginal ultrasound using probes with frequency 8805 7 MHz. A minimum training of at least 20 40 supervised exams was proposed such that the operator should be able to adjust machine settings to achieve the best contrast between follicular fluid and ovarian stroma. The article elaborated that follicle count might be evaluated by real time two dimensional ultrasound 2D US by stored 2D US cine loops and by stored three dimensional ultrasound 3D US data sets. Real time 2D US has the advantage of permitting extra maneuvers to ensure whether an anechoic structure is a follicle as the patient is present but may require longer scanning time particularly when there is a large number of follicles resulting in more discomfort to the patients. Cine loop has the advantages of reducing scanning time and also allows other observers to count the ovarian follicles. 3D US imaging requires special ultrasound machines and extra training for acquisition analysis but has the same advantages of the cine loop and also allows employing different imaging techniques as volume contrast imaging VCI inversion mode and the use of semi automated techniques as sonography based automated volume calculation SonoAVC . Although recommendations were made based on available evidence it was acknowledged that there is no strong evidence that one method is better than the others. Hence it was stated that an operator should choose a method for counting ovarian follicles based either on availability preference or skills. It was suggested that more studies evaluating how to improve the reliability of AFC should be encouraged.

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