FAQ: Scan frequency post RE care

[u/Secret_Yam_4680]

NOTE: This post is for the Wiki/FAQ section. Please stick to answers based on facts and your own experience. This post and it's responses do not constitute medical advice; always consult your medical professional!

One of the hardest changes to accept, while transitioning from a RE patient to an OB patient, is in the number of ultrasounds one will receive. While auditory doppler checks are usually performed at each routine office visit from 2nd trimester onward, majority of non-high risk ART folks typically receive just 2-3 ultrasounds after graduating from their reproductive endocrinologist...NT (nuchal translucency) scan around 12 weeks gestation, a level 1 or level 2 anatomy scan around 20 weeks and maybe a fetal growth scan mid 3rd tri. Just because one did ART that does not automatically make them high risk.

Depending on your healthcare provider & diagnosis, you may also be offered a specialized cardiac ultrasound (fetal echocardiogram) weeks after your anatomy scan. Previous FAQ & links on echo's can be found here.

According to the SMFM (Society for Maternal-Fetal Medicine) “Although most IVF pregnancies are uncomplicated, there is an association with increased risks of maternal, fetal, and perinatal outcomes. Some of these risks are affected by specific IVF techniques.” SOURCE

Depending on history and diagnosis, the ACOG (American College of Obstetricians and Gynecologists) suggests weekly antenatal surveillance beginning at 32 0/7 weeks gestation or at time of diagnosis. For non complicated IVF pregnancies, recommendation is to begin at 36 0/7wks then if needed, increase to twice weekly and so forth. SOURCE

How many ultrasounds did you receive while pregnant? How many is your OB/midwife/MFM recommending? NOTE: PLEASE DO NOT COUNT # OF SCANS RECEIVED WHILE STILL UNDER THE CARE OF YOUR RE.

Factors that may influence feedback but are not limited to:

• ART method that helped you conceive? IUI, traditional IVF, ICSI, etc.
• If you did IVF, did you do PGT-A testing? Transfer an untested embryo, mosaic embryo, etc?
• Age conceived.
• Diagnosis/conditions such as GD, IUGR, elevated BMI, APS, etc.
• Country in which you reside.
• Singleton, multiple gestation?
• What kind of scan & frequency was recommended by your healthcare provider? BPP w/ NST, traditional growth scan, etc.
• Were/are you under the care of a specialist like a MFM?

Resources:

Ultrasonography 101

FAQ wiki: NT scan

FAQ wiki: anatomy scan

NST (non stress test)

BPP (biophysical profile)%20in%20the%20uterus.&text=The%20biophysical%20profile%20helps%20practitioners%20observe%20the,fluid%20surrounding%20the%20fetus%20in%20the%20uterus)

[u/Bananafish115]

With my son(in 2023) I had TONS of ultrasounds because of bleeding and previa. This was an FET pregnancy. 11 weeks bedside ultrasound, two 14 week ultrasounds at the ER bc of bleeding, 15,16,17 week bedside ultrasounds with obgyn. I had a 20 week ultrasound with MFM. They found placenta previa and (thankfully misdiagnosed) accreta, so MFM did a 24 week(previa resolved) and 28 week ultrasound. Also did an MRI to further rule out accreta at 28 weeks. Weekly biophysicals starting at 36 weeks.

Current pregnancy, also FET. We moved to a rural location and the care has been much less “hands on”. There is only one practice up here and it’s mostly comprised of midwives. — 12 week ultrasound at imaging center connected to the obgyn(per my request) 20 week anatomy scan at obgyn office 24 week scan at obgyn due to previa and MCI 29 week scan/MRI at mfm/specialist in city to rule out accreta again 33 week growth/previa check scan at obgyn As of now, they plan to do weekly NST starting at 36 weeks. I’m anxious about this since I had biophysicals at my old practice and was close to failing once or twice.

[u/S4mm1]

Making this comment to remind myself to edit this eventually. I just don’t have the spoons to talk about this right now. The quick and the short is, I had two scans at my fertility clinic before graduating one regular scan at my MFM and then I had abnormal testing results and ended up getting something like 12 to 15 ultrasounds throughout my pregnancy once I hit the second and third trimester and then because I hemorrhage, I actually ended up having an additional five ultrasounds postpartum.

[u/CaramelOrdinary9434]

• IVF with ICSI, PGT-A tested embryo. I was 38 at egg retrieval/fertilization, 39 at transfer, and turned 40 the day before baby was born.

• Singleton pregnancy in the USA, no complications.

• I was under the care of my OB, who did send me to the MFM for the anatomy scan and fetal echo. They erred on the side of caution and I had more scans than usual, simply because of my age and IVF. I liked having the extra information.

• I had ultrasounds with the OB at 9 and 15 weeks, anatomy scan with the MFM at 20 weeks, fetal echo and growth scan with the MFM at 24 weeks. Due to a potential anomaly found at the fetal echo, I had a few extra scans with the MFM and a pediatric cardiologist, and baby had another echo after birth. Starting at 30 weeks, I went to the OB twice a week for NST and a BPP (they do these on different days).

[u/reebs___]

• IVF singleton euploid pregnancy

• age at conception: 32

• diagnoses: MFI and DOR. During pregnancy, no complications other than low iron, needed infusions.

• scan frequency: 8 weeks, 13 weeks (early anatomy scan at MFM), 18 weeks (anatomy scan at MFM), 22 weeks (fetal echocardiogram at MFM), 32 weeks (growth scan), 36 weeks (growth scan), 37 weeks (BPP), 38 weeks (BPP)

The MFM did the three major scans (13,18,22) just bc of IVF as a risk factor.

[u/bench_slap]

In the US; singleton; untested frozen embryo. NIPT in first tri indicated low risk.

How many ultrasounds did you receive while pregnant? 2 through OB (confirmation at start of pregnancy; anatomy scan at 20 weeks); multiple via MFM How many is your OB/midwife/MFM recommending? MFM recommended the most due to IVF pregnancy, advanced maternal age, gestational diabetes, risk of severe preeclampsia (which I did eventually get) MFM did what was essentially an anatomy scan at my first appt at 12 weeks, the growth ultrasounds once per month starting after 20 weeks; added BPPs once monthly and NSTs twice weekly at start of third trimester. Also had a fetal echo with anatomy scan ordered concurrently from MFM and RE.

Side note: I was able to receive additional first and second trimester ultrasounds not included in counts above bc I enrolled in a research study (my care team is through a large health system and research university).

[u/partygnarl]

Conception background: Living in the US. Used IVF with ICSI, did PGT-A, had FET when I was 36 which resulted in a singleton pregnancy. No significant risk factors or diagnoses that impacted pregnancy care plan. Age and IVF did not risk me out of midwifery care and I was considered low-risk until the very end, when things took a turn!

• 9w dating scan at first appt

• 11w NT scan. I wanted the NT as early as possible because my first baby had a NTD that can be detected by then. However, the skull doesn't fully ossify until after 12 weeks, and I had travel planned, so my midwives offered me a scan a few weeks later to confirm baby's head was okay.

• 14w early anatomy scan. Was supposed to be a quick check of baby's skull, but because so many more structures are visible by 14w, our lovely sonographer pretty much covered everything.

• 19w full anatomy scan. Everything was great, though we learned I had a partial marginal cord insertion.

• 24w no ultrasound at this appointment, but I was grapplying with a lot of anxiety at this point, so my midwives offered to schedule me an extra growth scan, on top of the one I was supposed to get at 28w. Because I had that partial MCI, insurance covered it.

• "28w" growth scan to check on the marginal cord, done at 27w for scheduling purposes.

• "32w" extra growth scan, done at 30+change due to schedule changes at my provider's office.

• bedside ultrasounds at 32w and 34w appointments because my midwife those days had a student shadowing her and said I was a fun patient to practice ultrasounds with, lol.

• At 37+1, I developed severe pre-e and HELLP and risked out of my midwives' practice and straight into the hospital OR. Had I not developed any complications, I was to have my first NST at 37+3, which we were going to do weekly until baby made his entrance. The best laid plans!

ETA: I had a lot more scans than a typical low risk pregnancy, and I'm so grateful to my midwives. They really understood my history of loss, and wanted me to feel extra supported throughout this time. It's my hope that anyone who's experienced loss/infertility can feel so cared for and held by their provider(s).

[u/rbecg]

I received three scans: anatomy (18 weeks), follow-up anatomy (~21 weeks), and a growth scan (34 weeks). This was under the care of a midwifery collective.

We live in Canada and conceived at 29 years old via ICSI and transferred one untested embryo for our successful pregnancy, which was a singleton. We also used donor sperm because my husband is trans.

[u/LZ318]

I am in Germany and it is normal here to get an ultrasound at every appointment, performed by your OB. Techs don’t normally do ultrasounds here. So starting at intake appt at 8 weeks, it’s an appointment every 4 weeks until 28 weeks, then every 2 weeks until 36 weeks, then weekly thereafter. Most scans last about 2-3 minutes, only the NT scan at 12 weeks and the anatomy scan at 20 weeks are longer. I had these two scans at an MFM due to AMA and IVF.

[u/[deleted] → u/LZ318]

[u/E-as-in-elephant]

Conceived via IUI at age 33. Multiple gestation - twins. High BMI. First pregnancy. In the USA. Considered high risk. Unexplained infertility diagnosis, gestation hypertension diagnosed at 34 weeks.

Discharged from RE at 10 weeks, first OB visit was 12 weeks. Was immediately referred to MFM. Due to a multiples gestation my OB told me I would get an ultrasound at every visit to confirm heartbeats were not confused. My OB basically told me she would be my dr and MFM would be the babies dr and he would handle all of the growth scans. I had a monthly visit with my OB and a monthly growth scan with my MFM. First visit with MFM was at 16 weeks. So two ultrasounds a month (one for heartbeat check at the OB and one growth scan with the MFM) until around 28 weeks when baby A was diagnosed with IUGR. At that point I had twice monthly visits for a growth scan with my MFM as well as an NST at each of those visits. At 32 weeks I also went twice monthly to my OB, so twice a month growth scans and twice a month US for heartbeat check between MFM and OB. By 32 weeks, baby A was no longer measuring growth restricted and my next MFM visit was then made for 36 weeks. At my 34 weeks visit with my OB, I told her I had two BP readings of 140/90 and she sent me to L&D for a BPP. At that point, I saw my OB weekly (US for heartbeat check) and also had a BPP weekly. At my 36 weeks visit, it was discovered both babies had low fluid from my BPP. I was admitted and went into spontaneous labor overnight which was not discovered until morning when I finally started to feel contractions. C-section was that morning at 36+1.