How common are 'hidden ovaries' in a transvaginal ultrasound?

June 29, 2015 12:23 AM

I had a transvaginal ultrasound a little while ago, and the tech couldn't find my ovaries. Is this a cause for concern?

I'm 32, and I've been temping/charting for the past two years, allegedly to avoid having sex during my fertile phase (my husband and I still use condoms), but really to reassure myself that I'm ovulating. Well, my temperatures fluctuate WILDLY, so it frequently looks like I have annovulatory cycles, despite my rigidly regular 28 day cycle and predictable cervical mucous. We are not trying for kids right now - we'd like a year or two more to ourselves - but obviously I'd like to know if I'm fertile or not.

This lead me to ask my flaky GP to investigate, just to make sure I am fertile. She sent me for a transvaginal ultrasound, and the tech kind of casually told me that my ovaries were 'hiding' and she couldn't see them. She seemed unconcerned. I talked to my GP, and my GP handwavily told me that ovaries hide sometimes.

My GP has written a referral to an OB/GYN at a local hospital, but it's actually quite expensive, and my healthcare practitioners seem really confused that I'm seeking this care when we're not actively trying to have a kid.

So here's my question: how common is it for ovaries to 'hide' on a transvaginal ultrasound? Will a follow up examination provide me with peace of mind (ie, tell me how many eggs are in my basket), or should I wait until we're actively trying for children?

posted by anonymous to Health & Fitness (10 answers total)

I know this isn't directly answering the question, but if you are 32 and sexually active you should have an OB/GYN who you see regularly anyway. Is this hospital-based one your only option? Can you talk to your insurance company about what sort of standard gynecological care is covered and whether you need a referral (I suspect you don't, they're not generally considered specialists the way like orthopedists are).

A good GYN should listen to you and believe you and answer your questions. Try to go find that good GYN.
posted by brainmouse at 4:52 AM on June 29, 2015

When I first started going through fertility treatments, the ultrasound techs always had trouble finding my ovaries too. They didn't seem concerned either. However, my doc went in to retrieve eggs as part of IVF, and had a devil of a time obtaining any eggs. The doc was sure I had fibroid cysts, and that they were preventing implantation/pregnancy. Sure enough, my uterus was riddled with growths, one the size of a fucking softball. Miraculously, my uterus was intact after removal, and I went on to have a successful (twin!) pregnancy. And with the fibroids gone, my ovaries popped off the screen at every transvaginal ultrasound.

Of course this is anecdotal, but a possibility to discuss with your doctor. I had normal periods and had no idea anything was happening. And yes, find yourself an OB/GYN. Good luck and take care of yourself. :-)
posted by killy willy at 6:45 AM on June 29, 2015

You don't say if you're in the US - the referral situation you're in is really unusual here, so maybe not and that's why it rings strange - but if you are you can check with your insurance company about going to a GYN of your choice, any of whom who will be more experienced in this.

But, yes, as a matter of fact, ovaries are kinda creepy and can go just about anywhere in your torso, if they really want to. If you're having pelvic radiation for treatment of a non-ovary-related disease, you can have your ovaries moved up out of the hot zone and put back later.

Fertility is a problem if they travel too far from your fallopian tubes, and you can't screen for cancer by the usual methods if they're way out of range. They could also just be missing or obscured by something, and those are things worth knowing too. It's worth following up with a gynecologist who probably has ultrasound resources they trust and have experience with, and if it gets complicated enough with insurance you could probably do it through Planned Parenthood for a reasonable cost and maybe a faster appointment than with a regular OB/GYN with a 4-6-month lead time on new patients.
posted by Lyn Never at 7:13 AM on June 29, 2015

I know this isn't directly answering the question, but if you are 32 and sexually active you should have an OB/GYN who you see regularly anyway.

This is the case in only some national healthcare models. I would guess the OP is in the UK, where she would only see an OB/GYN for non-routine sexual health or pregnancy care.

OP, if you are in the UK, take the referral now. If your healthcare practitioners are confused, try using the term "fertility workup" and see if the mystery lifts.
posted by DarlingBri at 7:20 AM on June 29, 2015 [1 favorite]

Like killy willy, when I had fibroids my ovaries were sometimes not visible on transvaginal ultrasound. After I had my GIANT fibroid removed (it filled my entire uterine cavity) my ovaries were visible every time. Your ovaries and ultrasound tech may vary.
posted by bedhead at 8:17 AM on June 29, 2015

I have endometriosis which has left adhesions all over my insides. One of these yanks my left ovary towards my rectum. Even my experienced tech (who I've now seen many times) can't find it. What we do is that I take control of the wand and move it around until I find a tender spot, which has resulted in the ovary being viewable.
posted by Riverine at 8:53 AM on June 29, 2015

I don't know about hidden ovaries, but my uterus has no desire to be seen even while carrying a baby. I miscarried at 3 months this year and had to go through an absurd series of ultrasounds during my pregnancy because my uterus is so tipped. I wouldn't be too worried about them not being seen.

Have you tried using ovulation predictor kits? I use the Clear Blue Easy ones that have the happy face or the empty face, and I think they work great. I have an odd cycle and they've been helpful and worth the $15/month cost.
posted by notjustthefish at 9:09 AM on June 29, 2015 [1 favorite]

Hey I know I'm a little late to this, but just to offer another point of view... I have pcos and a genetic disorder. When I was ttc, they couldn't find my ovaries because they were so shriveled. I got basically every blood test done and went to a geneticist who told me I had a birth defect similar to fragile x. I'm in my late 20's. Get a second opinion on your ultrasound, but special blood tests will tell you what's up. Good luck
posted by Kestrelxo at 3:49 PM on June 29, 2015

It's a little unnecessary to embark on a course of specialist referral and investigation based on a lack of evidence that there is a problem with your fertility. You do have ovaries - that is evidenced by the fact you have a menstrual cycle! They're in there! Fertility investigations are frequently invasive, unpleasant and expensive and I would question the professionalism of a doctor who would agree to perform them based on a (justifiable) curiosity rather than demonstrated sub-fertility (which is not being pregnant after a year of trying). How far are you willing to go to have this question settled? More tv ultrasounds? Blood tests? Surgery? Each of these steps offers the potential for further complication and finding non problems that then need further investigation.

I can understand why you'd be concerned - there's a lot of scare put out there about women's fertility - but I would prepare yourself for what may seem like a dismissive attitude from a gynecologist. Doctors are in the business of treating problems, and you do not have any evidence of having a problem of your fertility.

Disclaimer, I work in a public health system so the " rationing " of health services is slightly more of a priority. It may be different in other contexts. I would question the rationale for your original TV ultrasound in the first place - it would be a poor answer to the question of whether you have ovulated or not and it has clearly caused more anxiety with an equivocal result. I hope you find a doctor who can communicate clearly with you about your fertility and reassure you.

Yes, there are a laundry list of conditions that can contribute to sub fertility that people are offering, but unless you do have that problem it will not benefit you to go looking for them.
posted by chiquitita at 5:41 PM on June 29, 2015 [2 favorites]

On the other side of chiquitita, I spent several years going to different obgyn practices, all hand waves and dismissal before going to an endocrinologist who was finally able to help me. However, I did have signifiers that caused me to seek extra help, and my partner and I had been trying for years. If you try for over a year, that's cause to investigate further, but if you've been regular for your adult life and are still cycling, avoid my route if you can. It's expensive and heartbreaking.
posted by Kestrelxo at 8:54 AM on June 30, 2015