The influence of ultrasound on embryonic development

Intrauterine effects of ultrasound: human epidemiology

Ultrasound imaging has been used clinically as an effective diagnostic tool over the past 30 years. In spite of literally millions of examinations, there is no verified documented evidence of adverse effects in patients caused by exposure to diagnostic ultrasound. A number of epidemiological studies of intrauterine ultrasound exposure have been conducted, including several case-control and prospective randomized control studies. In some studies, an association of one or another bioeffect was identified, such as low birth weight, delayed speech, or increased incidence of left-handedness. However, with the exception of low birth weight, these findings have never been duplicated, and the great majority of such studies have been completely negative.

Effect of prenatal ultrasound exposure on adult behavior in mice

Pregnant Swiss mice were exposed to diagnostic levels of ultrasound (3.5 MHz, Maximum acoustic output: ISPTP = 1 W/cm2 and ISATA = 240 mW/cm2, acoustic power = 65 mW) for 10 min on days 11.5 or 14.5 postcoitus (PC). At 3 and 6 months postpartum, offspring were subjected to the following behavioral tests: bright and dark arena test for locomotor/exploratory activity and passive avoidance test for learning and memory. Anxiolytic activity and latency in learning were noticed in the ultrasound-treated animals. The effect was more pronounced in the 14.5 days PC group than in the 11.5 days PC group. But memory was not affected in the ultrasound-exposed animals. There was a nonsignificant decrease in the total locomotor activity at 6 months of age in all the exposed animals. Thus, the present data demonstrate that exposure to diagnostic ultrasound during late organogenesis period or early fetal period in mice may cause changes in postnatal behavior as evidence by selected adult offspring behavioral tests. However, any conclusive statement in this regard should await results from more detailed investigations.

A teratologic evaluation of continuous-wave, daily ultrasound exposure in unanesthetized pregnant rats

Pregnant Sprague-Dawley rats were trained to remain immobile when placed in water in an ultrasound exposure tank and exposed to 0, 0.1, 2.0, or 30.0 W/cm2 ISPTA (spatial peak, temporal average), 3.0-MHz continuous wave (cw) ultrasound on embryonic (E) days 4-19 for approximately 15 min/day. On E20 fetuses were removed; weighed; examined for external, skeletal, and visceral malformations; and uteri were examined for resorptions. Analyses revealed no increase in pre-implantation loss and no effects on maternal body weight, food, or water consumption. No increase in skeletal or visceral malformations was found, in fact exposed groups had a lower incidence of defects than controls. A significant increase in resorptions in the lowest exposure group (0.1 W/cm2) was obtained, but the effect was isolated, non-dose dependent and not credible as a treatment-related effect. No reduction in fetal weight was obtained, in fact the lowest (0.1-W/cm2) and middle (2.0-W/cm2) exposure level groups weighed slightly more than controls. The immobility procedure succeeded in avoiding anesthetization or forced restraint of the dams, thereby eliminating these factors as potential confounders. The results demonstrated that in unanesthetized, unrestrained rats in utero exposure to incident intensities of ultrasound of up to 30.0 W/cm2 cw ultrasound (or estimated internal exposures of 4-21 W/cm2, depending on body orientation to the incident beam) produced no evidence of embryotoxicity based on fetal necropsy data.

Medical sonography: reproductive effects and risks

While it is clear that the levels and types of medical sonography that have been used in the past have no measurable risks, it would be inaccurate to label the modality of ultrasound as totally safe regardless of exposure. Most agents have reproductive risks and even teratogenic risks if the exposure is raised sufficiently. Thus the prudent use of sonography means that clinicians and designers of equipment have to maintain exposures far below the risks that have been demonstrated in animal studies and from the knowledge obtained about the physical changes that can be produced in humans as the absorbed dose is elevated. The reproductive risks were evaluated using five criteria: 1) human epidemiology, 2) secular trend data, 3) animal experiments, 4) dose response relationships, and 5) biologic plausibility. The analysis reveals that the human epidemiology does not indicate that diagnostic ultrasound presents a measurable risk to the developing embryo or fetus. Animal studies also indicate that diagnostic levels of ultrasound are safe and do not elevate the fetal temperature into the region where deleterious embryonic and fetal effects will occur. Because higher exposures of ultrasound can elevate the temperature of the embryo, the use of diagnostic procedures and the design of sonographic equipment should take into consideration the hyperthermic potential of higher exposures of ultrasound and the hypothetical additional risk of performing sonography on pregnant patients who are febrile. It would appear that if the embryonic temperature never exceeds 39 degrees C, then there is no measurable risk. We suggest that sonography (the field) and sonogram (the procedure) are the most appropriate and least anxiety provoking terms.

Reproductive performance in mares subjected to examination by diagnostic ultrasound

Mares were subjected to frequent examination by diagnostic ultrasound and data were compiled with respect to reproductive efficiency. The data were collected over a 3-yr period on 1032 light horse mares. The cummulative pregnancy rate at 35 d post-ovulation was 96.8% and the pregnancy rate per cycle was 76.0% as determined by ultrasound examination. The average number of cycles per conception was 1.43, with an average of 2.29 inseminations per cycle. The incidence of early embryonic death was 7.8%. Mares were subjected to an average of 5.04 scans during the follicular phase of the cycle. The average number of ultrasound examinations per mare (including pregnancy examinations) was 9.99. Although these data were obtained from an experiment that did not use both control and treated mares, there was no indication that preovulatory oocytes or embryos were damaged by routine ultrasound examination. Comparisons with existing data from commercial facilities are difficult to make concerning any improvement in reproductive efficiency resulting from the routine use of ultrasonography, but these data do suggest relative safety in equine reproductive management when ultrasound examinations are conscientiously used.

Effects of ultrasound on ovulation in the mouse

In vitro fertilization and embryo transfer (IVF-ET) programs use ultrasound extensively for monitoring the growth of ovarian follicles and, subsequently, for confirming the presence of a fetal sac. There have been few reports of the effects of ultrasound on ovulation rates in mammals, and we report here that following exposure to continuous wave ultrasound at a spatial average intensity of 3.0 W/cm2 for five minutes, ovulation rates measured 10 days later were significantly reduced in mice. When temperature elevation of the exposed ovary was measured with a thermocouple, hyperthermia correlated with reduction in ovulation.

Evaluation of the bioeffects of prenatal ultrasound exposure in the cynomolgus macaque (Macaca fascicularis): II. Growth and behavior during the first year

The extensive use of ultrasonography for the prenatal assessment of growth and development continues to present questions regarding biological effects. We are currently evaluating a nonhuman primate model (Macaca fascicularis) exposed to ultrasound from gestational day (GD) 21 to 152 +/- 2. Exposures were performed with a commercial real-time sector scanner (ATL, MK 600); animals were scanned five times weekly on GD 21-35 +/- 2, three times weekly on GD 36-60 +/- 2, and once weekly on GD 61-150 +/- 2. The length of exposure was approximately the same as human exposure (GD 21-60 +/- 2 = 10 min/exam and GD 61-150 +/- 2 = 20 min/exam) although the frequency of the examinations was considerably greater. Initial reports indicated differences between control and treated animals including lower birth weight, higher simian Apgar scores, and changes in select hematologic parameters. Follow-up evaluations of growth during the first year included measurements of body weight, hand and foot lengths, humerus and femur lengths, biparietal and occipitofrontal diameters, head circumference, arm circumference, chest circumference, skinfold thickness, and crown-rump length. Results indicated a significant reduction in body weight in treated animals during the first three months, with nonsignificant differences during the following nine months. Hematologic analysis including complete blood counts (CBC) and clinical biochemistry at 6, 9, and 12 months of age were not significantly different. A series of behavioral evaluations including a neurobehavioral test battery (NBT) and tests assessing motor and cognitive skills were included. The NBT revealed increased muscle tone in treated animals at one, two, and four days. In an observation cage (week 1-14) more quiet activities were displayed by treated animals. Group differences in performance of motor and cognitive tasks were observed and may be attributable to agitation and difficulties in adjusting to test environments. There were no group differences observed in discrimination learning. When considering the possible implications to the human population, it is important to consider the amount of exposure these animals received, and the fact that most of the effects observed appeared to be transitory. Although human epidemiological studies have not revealed any significant bioeffects, the "prudent use" of diagnostic ultrasound should still be kept in mind. This is especially significant with the current rise in the use of endovaginal scanning and pulsed Doppler.

Evidence for an absence of deleterious effects of ultrasound on human oocytes

Animal and human data would suggest that ultrasound causes deleterious effects to oocytes during meiosis. We directly compared the fertilization rate and embryonic development following in vitro fertilization and embryo transfer of those oocytes exposed to ultrasound and those not exposed in the same patient. In 39 unscreened patients a combination of laparoscopy and ultrasound was used for oocyte recovery. Laparoscopy was performed first on the most accessible ovary (usually the right) and at least one oocyte was obtained. Ultrasound-guided oocyte recovery was successful in the other inaccessible ovary. To assess how oocytes obtained by ultrasound or laparoscopy related to the pregnancy rate, two groups of patients were evaluated in whom the embryos transferred either had been exposed to ultrasound or had not been. The fertilization and the embryo cleavage rates were not significantly different between the ultrasound-exposed and the unexposed groups. The pregnancy rate was also not significantly different [9 of 49 (18.4%) for ultrasound exposed versus 14 of 74 (18.9%) for unexposed]. There was one early spontaneous abortion in each group. Further analysis of a group of 40 patients, in whom the oocytes were exposed to ultrasound in situ, after the endogenous luteinizing hormone (LH) surge had begun 1-27 hr earlier, revealed that 6 became pregnant (15%). This preliminary study suggests that exposure of human oocytes to ultrasonic waves, either during the different phases of meiosis or after the completion of meiosis, did not significantly influence the developmental potential of the in vitro fertilized embryos.

Ultrasound study of the endometrium during in vitro fertilization cycles

Ultrasonography is a noninvasive technique for studying the characteristics of the endometrium. This method was used in our in vitro fertilization and embryo transfer program during the periovulatory period for determination of whether there exists a moment at which the uterine mucosa is most favorable for implantation of the ovum. The endometrial thickness was noted in the course of the periovulatory phase. No correlation was found between the ultrasound image and hormonal assays. The endometrial thickness was significantly greater (P less than 0.01) when the in vitro fertilization attempt resulted in a pregnancy, even when considering the number of embryos transferred. However, it was not possible to predict the probability of pregnancy with the use of endometrial thickness.

Embryotoxic and teratogenic effect of high intensity, low frequency ultrasonic vibration on chicken embryos

Controlled exposure of chicken embryos to continuous 30 W/cm2, 29 kHz ultrasonic vibration in a water medium produced, in proportion to exposure, progressively retarded growth or death. Analysis supports, and observation confirms, the presence of cavitation in the water medium. The effects reported here differ substantially from published observations of megaHertz insonation of chicken embryos at similar intensities. The experiments closely resemble in method of application, frequency and intensity the operation of several ultrasonic surgical and dental instruments.