January 24, 2018

The baseline ultrasound scan

Before starting a stimulated treatment cycle with clomiphene citrate (Clomid), with injectables or with a combination of both, we customarily do a baseline ultrasound sometime around day #1 to day # 5. What are we looking for with this? Actually, it’s more of what we’re NOT looking for. We’re specifically looking to see that there are no cysts. In other words, we’re looking to see that there are no follicles that are beyond a certain size. For clarification of these terms, you may consult this post.

Remember that this early in the cycle, all the follicles for that month should be very small. I tend to use 13mm as a cutoff, but I have colleagues who have a slightly smaller or slightly larger cutoff. The rationale is that if we already see something larger in size, then the cycle will be suboptimal because that cyst can grow and disrupt the course of development of any new upcoming follicles.

Another purpose of this visit is to discuss the exact formula or protocol to use for the upcoming cycle. There have been times when a patient came in to start injectables and after discussion relating to her particular case, we change our minds and decide to do Clomid-only or a combination of Clomid with injectables. We may make our final decision regarding doing IUI or just timed intercourse. We might have some adjustments regarding the dosage, as well.

By the way, sometimes for the sake of convenience, we can actually do the baseline scan a few days BEFORE the period starts. Let’s say for example that the patient is here to pick up some medications or settle her account and hasn’t started her period yet. However, she is expecting it to come any day now. We can do the baseline ultrasound today; then she can call with her period and get instructions on when to start her meds.