When Do I Need a Pelvic Ultrasound?

If you have been trying to get pregnant and haven’t been able to, it’s time to have a pelvic ultrasound. Information gained during a pelvic ultrasound can tell you what the problem may be. The uterus is a pear-shaped organ that sits on top of the vagina. Embryos attach to the inside (also known as the uterine cavity) of the uterus and grow. A pelvic ultrasound may tell you if you have a growth inside your cavity that is affecting the ability of a pregnancy to either attach and/or grow.

What are the different types of abnormalities picked up by a pelvic ultrasound?

uterine liningWith a pelvic ultrasound, we can potentially see abnormalities of the uterine lining, or uterine cavity, and the uterus itself. While a pelvic ultrasound can help us investigate the uterus and uterine cavity, sometimes we may not be able to see inside the uterine cavity unless we first fill the uterus with fluid. Imagine a collapsed balloon. You won’t be able to see if there is something blocking the inside the balloon unless you try and blow the balloon up first. Along the same lines, if there is a blockage or abnormality inside the uterine cavity, we will be able to see it better if we fill the cavity first. In addition to the routine pelvic ultrasound, we can assess the uterine cavity with a saline infusion sonogram, or water ultrasound. Both of these procedures can be done in the office.

Fibroids are very common noncancerous growths and depending on their size or location, may cause problems with conceiving. As a result, evaluating the uterus and uterine cavity with a pelvic ultrasound and/or saline infusion sonogram can help us identify fibroids affecting the uterus and uterine cavity. A uterine polyp is a noncancerous growth of the uterine lining inside the uterine cavity that can also affect your chances of achieving a pregnancy. One common sign of a fibroid or polyp inside the cavity is spotting in between menstrual cycles.

The pelvic ultrasound is also be used to look at your ovaries and can also give your doctor an idea of your ovarian aging. Abnormal growths or tumors of the ovary are easily seen on an ultrasound. In addition, your doctor can count the number of follicles (cysts that potentially contain an egg) on each ovary that she sees and use this information to pick the appropriate treatment and infertility drug doses for you should you need help with fertility treatments for getting pregnant. Finally, the pelvic ultrasound can also determine if you have a fluid-filled fallopian tube, or hydrosalpinx. If there is fluid in the fallopian tube, this can affect fertiization of the egg by the sperm, thus preventing a successful pregnancy.

How is the pelvic ultrasound used if I am undergoing fertility treatments?

When you are in a fertility treatment cycle we will use the pelvic ultrasound to look at your uterus and obtain a measurement of the thickness of the tissue that lines the uterine cavity, or uterine lining. Your lining changes thickness and appearance as your menstrual cycle progresses and as you undergo fertility treatments. If your lining isn’t thick enough, this may be a sign that additional testing needs to be done.

The image below is an example of what a woman’s uterine lining would look like right before ovulation.

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We will also look at your ovaries in order to measure the size of your follicles during fertility treatments. Depending on the type of treatment your are having, we may want you to have one mature follicle or many more. A mature follicle means that it is ready to ovulate and produce an egg. This image seen below is of an ovary. You can see black circles which represent follicles. When a follicle is close to 2 cm, we think that the egg inside the follicle is mature.

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What questions should I ask if I am having a pelvic ultrasound?

Do I have any fibroids or polyps?

What is my antral follicle count? Assessing the antral follicle count allows us to evaluate a your ovarian reserve, or supply of eggs for the future. This only measures the quantity of eggs available.

What is the thickness of my uterine lining? Is this what is expected for this time in my cycle?

How many mature follicles do I have? Or, how many eggs do you expect me to ovulate?

Is this what you expected to see on ultrasound today? Why or why not?


Every fertility clinic operates differently. There may be many people involved with your care, whether or not you are undergoing fertility treatments. It is best that you personally keep track of your care so that you are equally as involved with your treatment planning as your doctors and nurses.