Dr Heather Garthwaite – use of ultrasound in fertility treatment

Dr Heather Garthwaite, University of Sunderland, long term goal is to assess the need for ultrasound monitoring during fertility treatment to reduce risk of multiple pregnancy.

Fertility issues affect 1 in 7 couples at some point in their lifetime. Around a quarter of cases can be treated with a medication called clomifene, which triggers the release of an egg, or eggs, from the female’s ovary (ovulation).

Guidelines state that a vaginal ultrasound scan should be used after clomifene is first given, to assess how many eggs have developed. Where there are multiple eggs, there may be an increased likelihood of multiple pregnancy (more than one fetus), and the couple would be advised to avoid unprotected intercourse that month. This is because multiple pregnancies carry extra risks to mother and babies.

The guidance to use ultrasound for this purpose is not based on any research evidence because there is currently none available. Ultrasound may not accurately predict multiple pregnancy and we do not know that it reduces risk.

The long-term goal of this study is to assess the need for ultrasound monitoring during treatment with clomifene. We will be looking at data from medical records of patients who have completed their treatment.  The patients will be split into two groups (those who were monitored with ultrasound and those who were not monitored with ultrasound), then the pregnancy outcomes (not pregnant, single pregnancy or multiple pregnancy) will be compared.

If this study finds that ultrasound scanning in this context is beneficial, this will provide a much-needed evidence base for the guideline and will increase its uptake.  Conversely, if the study challenges the need for ultrasound, this would benefit women in negating the need for invasive testing (or even a hospital referral). It would also likely lead to significant cost savings for the NHS.

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