Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : September | Volume : 17 | Issue : 9 | Page : AC01 - AC05 Full Version

Ultrasonographic Assessment of Ovarian Volume: A Cross-sectional Study to Evaluate Ovarian Reserve and Its Impact on Reproductive Potential


Published: September 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/66280.18269
Aruna Arya, Sushma Tomar, Nikhil Aggarwal, Sukriti Kumar, Amita Pandey, Punita Manik, Rakesh Kumar Diwan

1. Assistant Professor, Department of Anatomy, Muzaffarnagar Medical College, Uttar Pradesh, India. 2. Additional Professor, Department of Anatomy, King George’s Medical University, Uttar Pradesh, Lucknow, India. 3. Senior Resident, Department of Anatomy, King George’s Medical University, Uttar Pradesh, Lucknow, India. 4. Associate Professor, Department of Radiodiagnosis, King George’s Medical University, Uttar Pradesh, Lucknow, India. 5 Professor, Department of Obstetrics and Gynecology, King George’s Medical University, Uttar Pradesh, Lucknow, India. 6. Professor, Department of Anatomy, King George’s Medical University, Uttar Pradesh, Lucknow, India. 7 Professor, Department of Anatomy, King George’s Medical University, Uttar Pradesh, Lucknow, India.

Correspondence Address :
Dr. Sushma Tomar,
Additional Professor, Department of Anatomy, King George’s Medical University, Uttar Pradesh, Lucknow-226003, India.
E-mail: drsushmatomar@gmail.com

Abstract

Introduction: Ovarian Reserve (OR) serves as an important indicator of a female’s reproductive potential and remaining reproductive lifespan. With the societal shift towards delayed marriages and increased career focus among women, there is a growing need to understand the impact of age on fertility and the role of assisted reproductive techniques.

Aim: To evaluate the volume of both left and right ovaries in asymptomatic females using ultrasonographic measurement of various morphometric parameters.

Materials and Methods: This cross-sectional observational study was conducted in the Department of Anatomy, in association with the Department of Obstetrics and Gynaecology and Department of Radiodiagnosis, King George’s Medical University, Uttar Pradesh, Lucknow, India, from September 2016 to June 2017. Total 100 non pregnant females aged 19-49 years were included in the study. Ultrasonography was used to measure the Longitudinal Length (LL), Transverse Diameter (TD), and Anteroposterior Diameter (APD) of both ovaries (right and left). The volume of each ovary was calculated using the formula: 0.523×LL×TD×APD. Statistical Package for the Social Sciences (SPSS) software version 24.0 was used to assess the maximum, minimum, and mean±Standard Deviation (SD) for all the morphometric parameters of the right and left ovaries. A paired t-test was used to compare these morphometric parameters, and a p-value <0.05 was considered statistically significant.

Results: The mean±SD age of the study participants was 34.06±9.35 years. The mean±SD of LL, TD, APD, and volume for the right ovary were 3.12±0.29 cm, 2.37±0.24 cm, 1.76±0.19 cm, and 6.78±1.08 cm³, respectively. The mean±SD of LL, TD, APD, and volume for the left ovary were 3.08±0.45 cm, 2.32±0.25 cm, 1.76±0.18 cm, and 6.61±1.06 cm³, respectively. A comparison between these morphometric parameters of the right and left ovaries did not reveal any statistically significant differences.

Conclusion: The use of sonography is rapidly increasing nowadays in the field of gynaecology and reproductive medicine, and ovarian parameters are of great importance in diagnosing ovarian abnormalities in adolescents, PCOS, and ovarian cancer. In the field of reproductive medicine, ultrasound is helpful in serial follicular monitoring of females on ovulogens to assess their ovarian reserve.

Keywords

Anteroposterior diameter, Infertility, Longitudinal length, Ultrasound

Ovarian reserve acts as a marker that can give the idea of reproductive potential of a female and her residual reproductive life span. It gives an estimate of number of primordial follicles/ oocytes remaining in the ovaries (1),(2). Our society is undergoing great socio-economic reforms. Females of the current era are more career-oriented, therefore they are getting married late. Late marriages result in delayed childbirth. The fertility of these females is significantly decreased compared to females who marry at a young age. This leads to an increased frequency of assisted reproductive techniques for pregnancy (3),(4). Extensive researches suggest that a reduction in ovarian volume is suggestive of a poor prognosis for assisted reproduction (5),(6),(7).

Female infants have approximately one to two million oocytes at the time of birth. Over time, the number of oocytes reduces due to ovulation, and it is approximately 300,000-400,000 at the age of menarche (8). A slow depletion of the number of oocytes continues as age advances, and this number reaches approximately 25,000 at the age of 37-38 years (9). The depletion of follicles continues until menopause, where a few hundred follicles are left in the ovaries (10). It is very difficult to count the non growing follicles (NGF), so OR can be tested by biochemical tests and ultrasound imaging of the ovaries. Biochemical tests include measurements of Follicle Stimulating Hormone (FSH), Estradiol (E2), Inhibin B, Anti-mullerian Hormone (AMH), and Clomiphene Citrate Challenge Test (CCCT). Sonographically, OR can be tested by measuring the ovarian volume. Ovarian functions and OR can be well predicted by sonographic estimation of AFCs (11).

Endocrine and metabolic disorders are affecting women of reproductive age globally. For the past few years, Polycystic Ovary Syndrome (PCOS) has become very common. It is negatively associated with the pregnancy rate because of elevated androgen levels. A few constraints were highlighted with the estimation of androgen levels, such as which androgen to be measured and also variations in laboratory methods for measuring androgen levels. To minimise this challenge, scientists advised having a non invasive measure that can accurately identify females with PCOS and androgen excess. Hence, sonography of ovaries has been included in the diagnostic work-up, as ovarian volume constitutes the best sonographic indicator for PCOS (12).

Ovarian cancer is diagnosed annually in nearly 250,000 females worldwide and leads to the death of approximately 140,000 females per year. Ovarian cancer has a high mortality rate because of non specific early symptoms. Sometimes, it is asymptomatic and diagnosed in the last stage. Hence, there is a need for a population-based screening program for females, of which sonography is most popularly used along with Cancer Antigen 125 (CA125) (13).

Ultrasound is an inexpensive, uncomplicated, and easily accessible method, and the quality of images produced by ultrasound is very much equivalent to that of other imaging techniques. Though Computerised Tomography (CT) and Magnetic Resonance Imaging (MRI) techniques are available for the location and morphometry of ovaries, they are high-priced and associated with more complications of ionising radiation (CT), in comparison to ultrasonography. In ultrasonography, there is no need for any contrast medium, and there is no risk of ionising radiations; therefore, the procedure can be repeated multiple times (14).

To the best of authors knowledge, very limited research studies are freely available in the online published literature of the English language on the morphometric parameters of ovaries in normal females of North India (15). As the authors did not find any research study on the morphometry of ovaries in normal females from the Eastern Uttar Pradesh region of India, the authors have measured this organ of utmost reproductive importance using the ultrasonographic method. The findings of the present study will supplement the normative data on ovarian parameters covering a wide age range (from 19-49 years) of North Indian females. The nomogram of ovarian morphometric parameters furnished by the present study will be immensely useful for gynecologists and infertility specialists.

Material and Methods

The present cross-sectional observational study was conducted in the Department of Anatomy, in association with the Department of Obstetrics and Gynecology and Department of Radiodiagnosis, King George’s Medical University, Uttar Pradesh, Lucknow, India, from September 2016 to June 2017. Study was conducted after obtaining approval from the Institutional Ethical Committee (Ref. no: 0046/Ethics/R.Cell-16). One hundred non pregnant females aged 19-49 years were included in the study.

Sample size calculation: Formula used to calculate sample size was, N={Zα/22×p×(1-p)}/d2

Where, Zα/2=critical value of the normal distribution at α/2=1.96~2 for a 95% confidence level, power 80%, and α is 0.05; p=sample proportion=0.50, i.e., 50% (considered for normative data amongst non pregnant females viz., an infinite population); d=margin of error=0.10, i.e., 10%. Hence, sample size (N)=22×0.5×0.5/(0.1)2=4×0.25/0.01=1.00/0.01=100.

Inclusion criteria: The females who were not pregnant at the time of the study and had a normal regular menstrual cycle were included in the study.

Exclusion criteria: Females taking Oral Contraceptive Pills (OCP) or using any intrauterine device, using oral or injectable ovulation induction drugs, taking Hormonal Replacement Therapy (HRT), suffering from carcinoma of the breast, ovary, or uterus, diagnosed with a pelvic mass, or operated for gynaecological/ obstetrical pathology were excluded from the study.

Study Procedure

In the Obstetrics and Gynecology Department, the GE Logiq 200 PRO Series ultrasound system with a 3.5 MHz frequency probe was used for sonography. In the Radiodiagnosis Department, the Philips Affiniti 70 ultrasound and colour Doppler system with a 1-5 MHz frequency C5-1 probe was used for sonography of females. The following parameters of both ovaries (right and left) were measured:

(i) Longitudinal length (LL);
(ii) Transverse Diameter (TD);
(iii) Anteroposterior Diameter (APD).

The volume of the ovary was calculated using the following formula (16): 0.523×LL×TD×APD.

The ultrasound scanning was carried out in the dorsal decubitus position. The urinary bladder was kept full for proper visualisation of the ovaries. Ultrasound conductive gel was applied to the skin 2and transducer so that the transducer can move smoothly on the skin. The ultrasound probe was placed in the suprapubic area along the midline with the probe indicator facing upward. The bladder was identified as an acoustic shadow. Now the probe was rotated 90° anticlockwise so that the indicator of the probe lies on the subject’s right side. By rocking the tail of the probe to the right and left side of the subject, the authors visualised the right and left ovaries, respectively. Usually, the ovaries are situated posterolateral to the uterus and anterior to the internal iliac artery and vein. The long axis of the ovary was directed downward and forward. The maximum LL and APD were assessed in the longitudinal plane, while the transverse plane was used for measuring TD (17).

Statistical Analysis

Statistical analysis was done using SPSS software version 24.0 (IBM, Chicago, Illinois, USA). A descriptive statistic showing the maximum, minimum, and mean±SD for all the morphometric parameters of the right and left ovaries was used. Also, a comparison between these morphometric parameters of the right and left ovaries was made using a paired t-test, and statistical inferences were drawn. The p-value <0.05 was regarded as statistically significant.

Results

The study involved ultrasonographic assessment of various morphometric parameters of the right and left ovaries among 100 non pregnant females aged 19-49 years (mean age: 34.06±9.35 years) (Table/Fig 1).

It was observed that the maximum and minimum LL of the right ovary were in females aged 32 years and 45 years, respectively. The maximum and minimum TD were found in females aged 45 years and 43 years, respectively. The maximum and minimum APD were seen in females aged 32 years and 45 years, respectively. The maximum LL and maximum AP diameter were observed in the same subject aged 32 years (Table/Fig 2).

Subsequently, the ovarian volume was calculated using the formula. The mean volume of the right ovary was 6.78±1.08 cm3 (Table/Fig 3). It was also observed that the maximum and minimum LL of the left ovary were in females aged 41 years and 45 years, respectively. The maximum and minimum TD were found in females aged 26 years and 45 years, respectively. The maximum and minimum APD were seen in females aged 32 years and 45 years, respectively (Table/Fig 4).

Subsequently, the ovarian volume was calculated using the formula. The mean volume of the left ovary was 6.61±1.06 cm³ (Table/Fig 5), and it was slightly lower than the mean volume of the right ovary as already mentioned above.

When the morphometric parameters of ovaries of right and left-side were compared, there was no statistically significant difference (Table/Fig 6).

Discussion

The ovary provides oocytes and sex hormones, estrogen and progesterone; therefore plays a crucial role in the establishment of pregnancy and the development of secondary sexual characteristics in females (18). Kelsey TW and Wallace WHB (2012) stated that growing and non growing follicles (NGFs) and the stromal tissues constitute the important components of the ovary. They found a very strong and positive correlation between the mean ovarian volume and the mean NGFs population in females aged 25-51 years. They hypothesised that there is a lesser number of non growing follicles in small ovaries. According to their calculation, a population of 1000 NGFs corresponds to 3.01 cm³ of ovarian volume at any age (3). Lass A et al. suggested that there is a >50% risk of abandonment of IVF cycle prior to the recovery of oocytes in females having small ovaries of <3 cm3 (19). Sharma N et al. also supported this statement by saying that the ovarian volume at a cut-off of 3 cm3 is a highly specific predictor for cycle cancellation and non pregnancy in 92-93% of cases of assisted reproduction (20). In the present study, the minimum value for the volume of the right ovary is 3.78 cm3, which is higher than the cut-off value of 3 cm3. Therefore, it can be infered that the females in the present study have good reproductive potential.

Primordial follicles or NGFs constitute the functional unit of reproduction, and their aggregate forms the ovarian reserve (OR) (21). Wallace WH and Kelsey TW hypothesised that ovarian volume helps in the determination of reproductive age and OR in females. They said that the age of menopause can be predicted using ovarian volume, but this prediction will only be applicable to women who have no history of ovarian pathology and who are not utilising hormonal contraceptive methods (22).

Ovarian volume constitutes a useful indirect criterion of OR. According to some studies, poor outcomes in assisted conception can be fairly predicted by reduced ovarian volume (3). It has been observed by various authors that ovarian volume is a good indicator for predicting OR and clinical pregnancy rate in combination with antral follicle count (AFC) (23),(24).

Ovarian volume is the principal factor in diagnosing various pathological entities of the ovaries (16). By adding the volumes of both ovaries, the Total Basal Ovarian Volume (TBOV) can be derived (20). In female neonates, the ovarian volume is around 1 cm3. Prepubertal ovarian volume is less than 2 cm3, and both the size and morphology remain relatively stable between the ages of two and nine years. Premenarchal ovarian volume ranges from 2-4 cm3. Postmenarchal ovarian volume is more than 4 cm3 (25). Ovarian volume does not change much during the reproductive years of a female until menopause. A decrease in ovarian size is seen in menstruating women around the age of 40 years (19). According to the first normative model of ovarian volume, which was generated and robustly validated by Kelsey TW et al., age is the only factor that causes 69% of the variations in ovarian volume. They observed a peak of ovarian volume at the age of 20 years (26). In the present study, we also found that the maximum right ovarian volume occurred at the age of 20 years. According to a three-parameter cumulative Lorentzian normative model of ovarian volume, the volume starts to decline rapidly around the age of 33 years, and the rate of decline slows around the age of 47 years. It is worth noting that the rate of decline of ovarian volume changes substantially with ethnicity (20).

The findings of Korsholm AS et al. are in concordance with the report of Kelsey TW and Wallace WHB, which demonstrates a positive correlation between ovarian volume and the count of NGFs (antral follicles). They found that the right ovary had 8.1% more antral follicles and a 10.7% larger volume compared to the left ovary (3),(27). In the present study as well, we observed that the mean volume of the right ovary was greater than the mean volume of the left ovary. This association may be explained by the establishment of a larger pool of primordial follicles in the right ovary during foetal life. Different studies have reported conflicting results regarding the volume of the right and left ovaries. Some authors reported a higher volume of the right ovary (28),(29). While others reported a larger volume of the left ovary (30),(31),(32). Upadhyaya RP et al. also found larger volume in the left ovaries, and no significant variation was observed in the volumes of the right and left ovaries (16). Additionally, Veena M and Banerjee C found equal volumes of both ovaries (33). In our study, we did not find any statistically significant difference between the volumes of the right and left ovaries. The ovarian volumes reported in different studies have been tabulated in (Table/Fig 7) (16),(28),(29),(30),(31),(32),(33).

Ovarian volume is a helpful predictor of the success of in vitro fertilisation (IVF) along with the total antral follicular count. Lass A et al., in their study on infertile females with a mean age of 35.8 years, observed that females with an ovarian volume of less than 3 cm3 were poor responders to Human Menopausal Gonadotropins (HMG), which is a combination of FSH and Luteinising Hormone (LH). These individuals required a higher dose of HMG for oocyte retrieval. Therefore, measuring ovarian volume has clinical importance as a decrease in ovarian volume indicates a reduction in ovarian follicles and aging of the ovaries. Furthermore, they observed that the risk of Ovarian Hyper Stimulation Syndrome (OHSS) is very high in females with an ovarian volume exceeding 7.25 cm3. Females with ovarian volume less than 7.25 cm3 required a lesser quantity of FSH and fewer days of stimulation, and they expressed a higher ovulation rate (19). In the present study, the females had an ovarian volume less than 7.25 cm3. Therefore, if ovulation induction occurs in the current studied population group, OHSS will not be evident in the North Indian population.

Limitation(s)

In the present study, the authors could not take into consideration the menstrual cycle history of the studied female population. Moreover, the ultrasonography method used in the present study was transabdominal rather than a transvaginal scan, which could have been a better approach. Additionally, various anthropometric parameters were not considered in the current study, which could have provided a more specific nomogram for our region.

Conclusion

This study establishes normative data for the morphometric parameters of ovaries in asymptomatic females ranging from 19-49 years. The mean volume of the left ovary was slightly lower than the mean volume of the right ovary, but the results revealed no statistically significant differences between the morphometric parameters of the right and left ovaries. These findings provide essential insights for gynecologists and infertility specialists in understanding ovarian reserve and its implications for assisted reproductive techniques.

References

1.
Findlay JK, Hutt KJ, Hickey M, Anderson RA. How is the number of primordial follicles in the ovarian reserve established? Biol Reprod. 2015;93(5):1-7. https://doi.org/10.1095/BIOLREPROD.115.133652. [crossref][PubMed]
2.
Rasool S, Shah D. Fertility with early reduction of ovarian reserve: the last straw that breaks the Camel’s back. Fertil Res Pract. 2017;3:15-26. https://doi.org/10.1186/S40738-017-0041-1. [crossref][PubMed]
3.
Kelsey TW, Wallace WHB. Ovarian volume correlates strongly with the number of nongrowing follicles in the human ovary. Obstet Gynecol Int. 2012;2012:305025. https://doi.org/10.1155/2012/305025. [crossref][PubMed]
4.
Pierce N, Mocanu E. Female age and assisted reproductive technology. Glob Reprod Health. 2018;3(2):e9-e9. https://doi.org/10.1097/GRH.0000000000000009. [crossref]
5.
Bishop LA, Richter KS, Patounakis G, Andriani L, Moon K, Devine K. Diminished ovarian reserve as measured by means of baseline follicle-stimulating hormone and antral follicle count is not associated with pregnancy loss in younger in vitro fertilization patients. Fertil Steril. 2017;108(6):980-87. https://doi.org/10.1016/J.FERTNSTERT.2017.09.011. [crossref][PubMed]
6.
Chang Y, Li J, Li X, Liu H, Liang X. Egg quality and pregnancy outcome in young infertile women with diminished ovarian reserve. Med Sci Monit. 2018;24:7279-84. https://doi.org/10.12659/MSM.910410. [crossref][PubMed]
7.
Yin J, Chang HM, Li R, Leung PCK. Recent progress in the treatment of women with diminished ovarian reserve. Gynecology and Obstetrics Clinical Medicine. 2021;1(4):186-89. https://doi.org/10.1016/J.GOCM.2021.10.004. [crossref]
8.
Forman MR, Mangini LD, Thelus-Jean R, Hayward MD. Life-course origins of the ages at menarche and menopause. Adolesc Health Med Ther. 2013;4:1-21. https://doi.org/10.2147/AHMT.S15946. [crossref][PubMed]
9.
American College of Obstetricians and Gynecologists. Female age-related fertility decline. Committee Opinion No. 589. Fertil Steril. 2014;101(3):633-4. https://doi.org/10.1016/J.FERTNSTERT.2013.12.032. [crossref][PubMed]
10.
Sarraj MA, Drummond AE. Mammalian foetal ovarian development: consequences for health and disease. Reproduction. 2012;143(2):151-63. https://doi.org/10.1530/REP-11-0247. [crossref][PubMed]
11.
Coelho Neto MA, Ludwin A, Borrell A, Benacerraf B, Dewailly D, da Silva Costa F, et al. Counting ovarian antral follicles by ultrasound: a practical guide. Ultrasound Obstet Gynecol. 2018;51(1):10-20. https://doi.org/10.1002/UOG.18945. [crossref][PubMed]
12.
Mansour A, Hashemi Taheri AP, Moradi B, Mohajeri-Tehrani MR, Qorbani M, Ghorbani Pashakolaee S, et al. Ovarian volume, not follicle count, is independently associated with androgens in patients with polycystic ovary syndrome. BMC Endocr Disord. 2022;22(1):298-306. https://doi.org/10.1186/S12902-022-01224-Y/TABLES/2. [crossref][PubMed]
13.
Kamal R, Hamed S, Mansour S, Mounir Y, Sallam SA. Ovarian cancer screening-ultrasound; impact on ovarian cancer mortality. Br J Radiol. 2018;91(1090): 20170571. https://doi.org/10.1259/BJR.20170571. [crossref][PubMed]
14.
Busse RM. Imaging modalities in gynecology. Donald School Journal of Ultrasound in Obstetrics and Gynecology. 2010;4:01-12. [crossref]
15.
Dixit M, Jaiswal V, Usmani Y, Chaudhary R. Uterine and ovarian parameters in healthy North Indian girls from 5 to 16 years by ultrasonography. Pediatr Endocrinol Diabetes Metab. 2021;27(1):37-41. https://doi.org/10.5114/PEDM.2020.103112. [crossref][PubMed]
16.
Upadhyaya RP, Ansari MA, Jha A, Kayastha P, Paudel S. Sonographic quantification of ovarian volume in adults attending general health check-up and general out patient Department in Tribhuvan University Teaching Hospital. Kathmandu University Medical Journal. 2020;18(3):275-78. https://doi.org/10.3126/KUMJ.V18I3.49223. [crossref]
17.
Karena ZV, Mehta AD. Sonography female pelvic pathology assessment, protocols, and interpretation. StatPearls Publishing, Treasure Island (FL); 2022.
18.
Cui J, Shen Y, Li R. Estrogen synthesis and signaling pathways during ageing: from periphery to brain. Trends Mol Med. 2013;19(3):197-209. https://doi.org/10.1016/J.MOLMED.2012.12.007. [crossref][PubMed]
19.
Lass A, Skull J, McVeigh E, Margara R, Winston RML. Measurement of ovarian volume by transvaginal sonography before ovulation induction with human menopausal gonadotrophin for in-vitro fertilization can predict poor response. Hum Reprod. 1997;12(2):294-97. https://doi.org/10.1093/HUMREP/12.2.294.[crossref][PubMed]
20.
Sharma N, Chakrabarti S, Barak Y, Ellenbogen A, Sharma N, Chakrabarti S, et al. Innovations in assisted reproduction technology. Innovations in Assisted Reproduction Technology. 2020. https://doi.org/10.5772/ INTECHOPEN.77538. [crossref]
21.
Pelosi E, Forabosco A, Schlessinger D. Genetics of the ovarian reserve. Front Genet. 2015;6:1-20. https://doi.org/10.3389/FGENE.2015.00308. [crossref][PubMed]
22.
Wallace WH, Kelsey TW. Ovarian reserve and reproductive age may be determined from measurement of ovarian volume by transvaginal sonography. Hum Reprod. 2004;19(4):1612-17. https://doi.org/10.1093/HUMREP/DEH285. [crossref][PubMed]
23.
Kwee J, Elting ME, Schats R, McDonnell J, Lambalk CB. Ovarian volume and antral follicle count for the prediction of low and hyper responders with in vitro fertilization. Reprod Biol Endocrinol 2007;5:9. https://doi.org/10.1186/1477- 7827-5-9. [crossref][PubMed]
24.
Broekmans FJ, Kwee J, Hendriks DJ, Mol BW, Lambalk CB. A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod Update. 2006;12(6):685-718. https://doi.org/10.1093/HUMUPD/DML034. [crossref][PubMed]
25.
Ziereisen F, Guissard G, Damry N, Avni EF. Sonographic imaging of the paediatric female pelvis. Eur Radiol. 2005;15(7):1296-309. https://doi.org/10.1007/ S00330-005-2648-6. [crossref][PubMed]
26.
Kelsey TW, Dodwell SK, Wilkinson AG, Greve T, Andersen CY, Anderson RA, et al. Ovarian volume throughout life: a validated normative model. PLoS One. 2013;8(9):e71465. https://doi.org/10.1371/JOURNAL.PONE.0071465. [crossref][PubMed]
27.
Korsholm AS, Hvidman HW, Bentzen JG, Nyboe Andersen A, Birch Petersen K. Left-right differences in ovarian volume and antral follicle count in 1423 women of reproductive age. Gynecol Endocrinol. 2017;33(4):320-23. https://doi.org/10. 1080/09513590.2016.1259406. [crossref][PubMed]
28.
Wehba S, Fernandes CE, Ferreira JA, Azevedo LH, Machado RB, Lunardelli JL, et al. Transvaginal ultrasonography assessment of ovarian volumes in postmenopausal women. Sao Paulo Med J. 1996;114(3):1152-55. https://doi. org/10.1590/S1516-31801996000300002. [crossref][PubMed]
29.
Qasim R, Naushaba H, Ullah E, Hena H, Ara Perven H, Nagor A, et al. A postmortem study-age related change of ovarian volume in Bangladeshi female. Update Dental College Journal. 2012;2(2):08-12. https://doi.org/10.3329/ UPDCJ.V2I2.15482. [crossref]
30.
Nwankwo NC, Maduforo CO. Transvaginal ultrasound measurement of ovarian volume in Port Harcourt. Journal of Medicine and Medical Science 2011;2(9):1080-84. https://www.interesjournals.org/articles/transvaginal-ultrasound-measurement-of-ovarian-volume-in-port-harcourt.pdf.
31.
Mohammad H, Ngwan SD, Utoo BT, Swende TZ. Transvaginal ultrasound evaluation of ovarian volume among normal adults in Makurdi, North-Central Nigeria. J Reprod Biol Health. 2013;50(14):6-8. https://doi.org/10.7243/2054- 0841-1-1. [crossref]
32.
Joseph E, Chukwuka UA, Christian N. Sonographic quantification of ovarian volumes in an adult Nigeria population. Internet Journal of Medical Update. 2009;4(1):15-18. [crossref]
33.
Veena M, Banerjee C. Comparative evaluation of ovarian morphology of women with PCOS versus those of normal women in tertiary care hospital. Int J Med Res Prof. 2020;6(4):90-93. https://doi.org/10.21276/ijmrp.2020.6.4.020.

DOI and Others

DOI: 10.7860/JCDR/2023/66280.18269

Date of Submission: Jun 28, 2023
Date of Peer Review: Jul 19, 2023
Date of Acceptance: Aug 01, 2023
Date of Publishing: Sep 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 29, 2023
• Manual Googling: Jul 01, 2023
• iThenticate Software: Jul 25, 2023 (12%)

ETYMOLOGY: Author Origin

EMENDATIONS: 5

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