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Follicle measurements using a computerized 3D ultrasound system (SonoAVC)

Research presentation by Dr. Richard Sherbahn at the 2009 Annual Meeting of the American Society for Reproductive Medicine

Sherbahn R, Deutch: T Follicle measurements using a computerized 3D ultrasound system (SonoAVC) is effective and efficient. Presented at the 65th Annual Meeting of the American Society for Reproductive Medicine in Atlanta, GA, in October, 2009.

SonoAVC 3D follicle ultrasound picture
SonoAVC ultrasound picture shows 3 planes in a volume of data from an ovary
Colored tracings of follicle borders are seen - as detected by SonoAVC software
At lower right is a 3-D computer-constructed view of the follicles


The size of the leading follicles in conjunction with serum hormone levels are used to determine the optimal time for giving the HCG trigger for IVF. Follicles have traditionally been measured manually with two-dimensional (2D) ultrasound by calculating the mean of the 2 largest follicle diameters.

Because follicles are often quite irregular in shape, measuring the follicles in the traditional fashion can result in significant inaccuracy. Another issue with manual measurements is that it is time consuming for the staff and the patients.

General Electric (GE) has software (Automated Volume Count, SonoAVC) for three-dimensional (3D) ultrasound machines that can identify follicles and automatically calculate their volumes. It then converts the measured volumes to diameters by using the sphere formula.

It is possible that this technology could give more accurate follicle measurements and also could increase the efficiency of the ultrasound monitoring process.

Materials and Methods

  • This study was a retrospective review of ultrasound follicle measurements during ovarian stimulation for IVF and the outcome parameters for those cycles.

  • The purpose was to study effectiveness and efficiency of 3D ultrasound assessment of follicle size during ovarian stimulation for IVF using SonoAVC.

  • Clinical pregnancy rates, total number of eggs retrieved, mature eggs retrieved and percentage of mature eggs were compared in 2 groups.

  • Group 1 included all women using own eggs under age 35 having egg retrievals during the 9 month period of October 2007 through June 2008. Almost all patients in Group 1 had follicles measured manually (2D) with a GE Voluson 730 ProV machine by averaging 2 diameters.

  • Group 2 included all women using own eggs under age 35 that had egg retrievals in the next 9 months (July 2008 through March 2009). Almost all of the patients in Group 2 had follicles measured using the SonoAVC software (3D) and a GE Voluson E8 Expert machine.

  • 23 patients were scanned with both methods (back to back) and the duration of time for scanning and entering data into the chart recorded for each method.

  • Statistical analysis utilized Student's t-test and chi-square.


  • The average time required to do a scan, analyze data and record it in the chart was slightly less with the 3D SonoAVC method (5.6 vs. 6.2 minutes).

  • There were no significant differences in clinical pregnancy rates per egg retrieval or other outcome parameters between the 2 groups. See Table:


Group 1 (2D)

Group 2 (3D)

P Value

Egg Retrievals




Mean # Oocytes




Mean # Metaphase II Oocytes




% Metaphase II Oocytes




Clinical Pregnancy Rate Per Retrieval




NS = not statistically significant


  • Follicular size determination during ovarian stimulation for IVF using the SonoAVC system is both effective and efficient.

  • Because the 3D volumetric method of measuring follicles could be more accurate and can give different diameters compared to manual measurements, studies should be done with SonoAVC (or similar software) to further evaluate the ideal leading follicle size for HCG trigger in order to optimize IVF success rates.

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