Ralf Menkhaus, M.D., of the Center for Fertility Treatment and Prenatal Diagnosis Minden in Germany, talks technology and highlights the ultrasound features that help him make faster, more confident clinical decisions in reproductive medicine.

Q: Many of your patients are over 35, and are coming to you for help because they can’t get pregnant. How important is ultrasound in evaluating these patients?A:Ultrasound is at the beginning of everything. Each one of my fertility patients has a 3D scan of the uterine cavity to see if there’s an anatomical reason—like a myoma or a septate uterus—why she can’t get pregnant. Ultrasound also helps me assess the ovarian reserve. Counting antral follicles in a 3D volume of the ovary is more exact than counting with 2D—and it’s more patient friendly. A volume can be taken quickly, and the counting can be done offline without the patient in the office.

Q: What is the advantage of ultrasound over hysteroscopy and laparoscopy—two procedures still utilized by many physicians to assess fertility in patients?
A:Ultrasound is the first choice to assess the uterus and the ovaries. The possibility of 3D reconstruction of the uterine cavity makes hysteroscopy partially redundant. Ultrasound is also much quicker and it doesn’t harm the patient. It isn’t painful and it’s more cost-effective. It is the same with tubal patency. Although laparoscopy is still the so-called “gold standard,” we will just do a sonohysterography, and in most cases that will be sufficient.

Q: What ultrasound technology do you use in your practice and how is it helpful in accessing fertility patients?
A:We use Volsuon™ and I believe they are the best machines and help us make the best diagnoses. The resolution is great—even in obese patients. I use many of the different features in my daily practice. I can look at any plane from a 3D volume using OmniView. It allows me to see irregularly shaped structures that can’t be seen in 2D. Another feature, Volume Contrast Imaging (VCI) provides better tissue differentiation so I can get a really good look at the uterine cavity.

Q: How does Voluson’s SonoAVC™ feature play a role in both evaluating patients who are struggling with infertility and those undergoing IVF treatment?
A:We use SonoAVC™antral to count the small follicles < 10mm to assess ovarian reserve. We take the volume of the whole ovary and then the calculation is automatic. SonoAVC™follicle is necessary to monitor a stimulation cycle. Using volume and automated 3D counting of all follicles is more exact than measuring only the biggest follicles with 2D, using only two planes. Utilizing SonoAVC™follicle is the most exact way to know when to induce ovulation because I want mature oocytes for the best possible outcome.

Q: What is the value of technology in your practice?A:Having new technology is important to me. I feel more confident, especially in malformation scans. I want things to be as exact as possible—and that depends a lot on image quality. I can really tell a difference between the new and old machines. The image quality has improved so much over the last several years. It’s incomparable. I also think it makes sense to buy high-tech equipment like Voluson because it’s good for your reputation. Patients will hear about the technology or even take note during an exam that it’s the best ultrasound equipment and want to see you.