1
|
Chung EH, Petishnok LC, Conyers JM, Schimer DA, Vitek WS, Harris AL, Brown MA, Jolin JA, Karmon A, Styer AK. Virtual Compared With In-Clinic Transvaginal Ultrasonography for Ovarian Reserve Assessment. Obstet Gynecol 2022; 139:561-570. [PMID: 35271530 PMCID: PMC8936158 DOI: 10.1097/aog.0000000000004698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/23/2021] [Accepted: 12/03/2021] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To evaluate noninferiority of virtual transvaginal ultrasonography compared with in-clinic ultrasonography for ovarian reserve assessment. METHODS We conducted a single-site, head-to-head crossover trial. Participants performed self-administered virtual transvaginal ultrasonography at home, guided by a remote-certified ultrasound technologist, then underwent transvaginal ultrasonography in-clinic with another ultrasound technologist. Participants were women in the greater Boston area interested in evaluating ovarian reserve and recruited through social media, health care referrals, and professional networks. The uterus and ovaries were captured in sagittal and transverse views. These randomized recordings were reviewed by two or three independent, blinded reproductive endocrinologists. The primary outcome was noninferiority of the rate of clinical quality imaging produced at home compared with in clinic. Sample size was selected for greater than 90% power, given the 18% noninferiority margin. Secondary outcomes included antral follicle count equivalency and net promoter score superiority. RESULTS Fifty-six women were enrolled from December 2020 to May 2021. Participants varied in age (19-35 years), BMI (19.5-33.9), and occupation. Ninety-six percent of virtual and 98% of in-clinic images met "clinical quality." The difference of -2.4% (97.5% CI lower bound -5.5%) was within the noninferiority margin (18%). Antral follicle counts were equivalent across settings, with a difference in follicles (0.23, 95% CI -0.36 to 0.82) within the equivalence margin (2.65). Virtual examinations had superior net promoter scores (58.1 points, 97.5% CI of difference 37.3-79.0, P<.01), indicating greater satisfaction with the virtual experience. CONCLUSION Virtual transvaginal ultrasonography remotely guided by an ultrasonography technologist is noninferior to in-clinic transvaginal ultrasonography for producing clinical quality images and is equivalent for estimating antral follicle count. Virtual transvaginal ultrasonography had superior patient satisfaction and has potential to significantly expand patient access to fertility care. FUNDING SOURCE This study was sponsored by Turtle Health. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT04687189.
Collapse
Affiliation(s)
- Esther H. Chung
- Duke University Medical Center, Durham, North Carolina; Boston Children's Hospital, Boston, Massachusetts; Emory University, Atlanta, Georgia; University of Rochester Medical Center, Rochester, New York; Wright State University, Wright-Patterson AFB, Ohio; Northwestern Medicine, Chicago, Illinois; Massachusetts General Hospital, Boston, Massachusetts; Hawaii Pacific Health, Honolulu, Hawaii; and CCRM Fertility, Boston, Massachusetts
| | - Laura C. Petishnok
- Duke University Medical Center, Durham, North Carolina; Boston Children's Hospital, Boston, Massachusetts; Emory University, Atlanta, Georgia; University of Rochester Medical Center, Rochester, New York; Wright State University, Wright-Patterson AFB, Ohio; Northwestern Medicine, Chicago, Illinois; Massachusetts General Hospital, Boston, Massachusetts; Hawaii Pacific Health, Honolulu, Hawaii; and CCRM Fertility, Boston, Massachusetts
| | - Jesse M. Conyers
- Duke University Medical Center, Durham, North Carolina; Boston Children's Hospital, Boston, Massachusetts; Emory University, Atlanta, Georgia; University of Rochester Medical Center, Rochester, New York; Wright State University, Wright-Patterson AFB, Ohio; Northwestern Medicine, Chicago, Illinois; Massachusetts General Hospital, Boston, Massachusetts; Hawaii Pacific Health, Honolulu, Hawaii; and CCRM Fertility, Boston, Massachusetts
| | - David A. Schimer
- Duke University Medical Center, Durham, North Carolina; Boston Children's Hospital, Boston, Massachusetts; Emory University, Atlanta, Georgia; University of Rochester Medical Center, Rochester, New York; Wright State University, Wright-Patterson AFB, Ohio; Northwestern Medicine, Chicago, Illinois; Massachusetts General Hospital, Boston, Massachusetts; Hawaii Pacific Health, Honolulu, Hawaii; and CCRM Fertility, Boston, Massachusetts
| | - Wendy S. Vitek
- Duke University Medical Center, Durham, North Carolina; Boston Children's Hospital, Boston, Massachusetts; Emory University, Atlanta, Georgia; University of Rochester Medical Center, Rochester, New York; Wright State University, Wright-Patterson AFB, Ohio; Northwestern Medicine, Chicago, Illinois; Massachusetts General Hospital, Boston, Massachusetts; Hawaii Pacific Health, Honolulu, Hawaii; and CCRM Fertility, Boston, Massachusetts
| | - Amy L. Harris
- Duke University Medical Center, Durham, North Carolina; Boston Children's Hospital, Boston, Massachusetts; Emory University, Atlanta, Georgia; University of Rochester Medical Center, Rochester, New York; Wright State University, Wright-Patterson AFB, Ohio; Northwestern Medicine, Chicago, Illinois; Massachusetts General Hospital, Boston, Massachusetts; Hawaii Pacific Health, Honolulu, Hawaii; and CCRM Fertility, Boston, Massachusetts
| | - Michelle A. Brown
- Duke University Medical Center, Durham, North Carolina; Boston Children's Hospital, Boston, Massachusetts; Emory University, Atlanta, Georgia; University of Rochester Medical Center, Rochester, New York; Wright State University, Wright-Patterson AFB, Ohio; Northwestern Medicine, Chicago, Illinois; Massachusetts General Hospital, Boston, Massachusetts; Hawaii Pacific Health, Honolulu, Hawaii; and CCRM Fertility, Boston, Massachusetts
| | - Julie A. Jolin
- Duke University Medical Center, Durham, North Carolina; Boston Children's Hospital, Boston, Massachusetts; Emory University, Atlanta, Georgia; University of Rochester Medical Center, Rochester, New York; Wright State University, Wright-Patterson AFB, Ohio; Northwestern Medicine, Chicago, Illinois; Massachusetts General Hospital, Boston, Massachusetts; Hawaii Pacific Health, Honolulu, Hawaii; and CCRM Fertility, Boston, Massachusetts
| | - Anatte Karmon
- Duke University Medical Center, Durham, North Carolina; Boston Children's Hospital, Boston, Massachusetts; Emory University, Atlanta, Georgia; University of Rochester Medical Center, Rochester, New York; Wright State University, Wright-Patterson AFB, Ohio; Northwestern Medicine, Chicago, Illinois; Massachusetts General Hospital, Boston, Massachusetts; Hawaii Pacific Health, Honolulu, Hawaii; and CCRM Fertility, Boston, Massachusetts
| | - Aaron K. Styer
- Duke University Medical Center, Durham, North Carolina; Boston Children's Hospital, Boston, Massachusetts; Emory University, Atlanta, Georgia; University of Rochester Medical Center, Rochester, New York; Wright State University, Wright-Patterson AFB, Ohio; Northwestern Medicine, Chicago, Illinois; Massachusetts General Hospital, Boston, Massachusetts; Hawaii Pacific Health, Honolulu, Hawaii; and CCRM Fertility, Boston, Massachusetts
| |
Collapse
|