A transvaginal ultrasound gives a close view of the uterus and ovaries, and can show fibroids, polyps and cysts. Early in the cycle it can also count small follicles, the antral follicle count, which is a rough guide to egg reserve but says nothing about egg quality.
What the scan is
An ultrasound uses sound waves to make a picture. There are no X-rays. For a fertility check, the scan is usually transvaginal: a slim probe, covered with a sterile sheath and gel, is placed a short way into the vagina. Because it sits close to the uterus and ovaries, the pictures are much clearer than a scan through the tummy.
A scan through the tummy (abdominal scan) can be used instead or as well, for example if you have never had sex or find a vaginal examination too difficult. It is reasonable to ask for this.
What it looks at
| Area | What the scan can show |
|---|---|
| Uterus | Its size and shape, and fibroids (non-cancerous growths of muscle) |
| Lining of the uterus (endometrium) | Its thickness, and sometimes polyps (small growths in the lining) |
| Ovaries | Their size, cysts, and the number of small follicles |
| Tubes | Usually not visible, unless a tube is swollen with fluid (hydrosalpinx) |
The scan can also show signs that suggest endometriosis cysts in the ovary (endometriomas) or adenomyosis, where lining-type tissue grows into the muscle of the uterus. It cannot rule out endometriosis completely, because small patches often don't show on a scan.
Ovaries with many small follicles can be one sign of PCOS. On its own, this appearance does not mean you have PCOS.
The antral follicle count
Each month, a group of small follicles starts to grow in the ovaries. These early follicles are called antral follicles. Early in the cycle, usually around day 2 to 5, the sonographer can count them in both ovaries. The total is the antral follicle count (AFC).
Like the AMH blood test, the AFC gives a rough idea of ovarian reserve, that is, how many eggs remain. Doctors mainly use it to:
- predict how the ovaries may respond to stimulation medicines in IVF or egg freezing
- help plan medicine doses and treatment
- add context, alongside age, when someone is thinking about timing or egg freezing
Good to know. Like AMH, the AFC is about the quantity of eggs, not their quality. A low count does not mean you can't get pregnant, and a high count does not mean you will. Egg quality is closely linked to age.
Limits of the AFC
- The count can differ slightly between scans, machines and the person doing the scan.
- It is a snapshot of one cycle.
- Hormonal contraception can lower the count for a while, so tell the team if you are taking it or recently stopped.
- In people who are not having fertility treatment, it has not been shown to predict natural conception within a given time.
That is why the AFC is read together with your age, AMH and history, rather than on its own.
What it feels like
Most people find a transvaginal scan uncomfortable rather than painful. You may feel pressure as the probe moves, especially if the sonographer presses to see an ovary more clearly. It usually takes around 10 to 20 minutes.
Some things that can help:
- You will usually be asked to empty your bladder first. For an abdominal scan, you may be asked to have a full bladder instead, so check the instructions.
- You can scan during your period. Bleeding does not affect the scan.
- You can ask for a chaperone, or for a female sonographer where one is available.
- You can ask the sonographer to explain what they are doing, or to pause at any time.
Scans in India
Ultrasound centres in India must be registered under the PCPNDT Act. That law makes sex selection, and telling anyone the sex of a fetus, illegal. You may be asked to fill in a form before a scan; this is routine.
Celova does not offer scans itself. A doctor can explain what a scan report says and whether any further tests make sense.
When to see a doctor
- You have a scan report and you are unsure what it means for you. Our appointment question builder can help you prepare.
- You have very heavy periods, bleeding between periods, or pelvic pain that is getting worse.
- You have pain during sex, or periods painful enough to stop daily life.
Call 112 or go to the nearest hospital for sudden severe pelvic pain, heavy bleeding, or fainting.
Sources
This is general information, not medical advice. It can't account for your history. Please talk to a doctor about your own situation. Medical disclaimer
Severe pain, heavy bleeding or fainting? Call 112 or go to the nearest hospital.