For a study, researchers sought to compare the noninferiority of virtual transvaginal ultrasonography to in-clinic ultrasonography for assessing ovarian reserve. A single-site, head-to-head crossover study was carried out. Participants self-administered virtual transvaginal ultrasonography at home while being coached by a remote-certified ultrasound technician, then transvaginal ultrasonography in-clinic with another ultrasound technologist. Women who were interested in evaluating their ovarian reserve were recruited using social media, health care referrals, and professional networks. Sagittal and transverse images of the uterus and ovaries were taken. Two or three independent, blinded reproductive endocrinologists assessed these randomized recordings. The primary outcome was noninferiority of clinical quality imaging performed at home vs in the clinic. Given the 18% non-inferiority margin, the sample size was chosen to have higher than 90% power. Secondary results were antral follicle count equivalence and superiority in net promoter score.
From December 2020 to May 2021, 56 ladies were enrolled. Age (19–35 years), BMI (19.5–33.9), and employment were all different among the participants. 96% of virtual pictures and 98% of in-clinic photos were of “clinical quality.” The difference was within the non-inferiority margin of 2.4% (97.5% CI lower bound -5.5%) (18%). The number of antral follicles was comparable among settings, with a difference in follicles (0.23, 95% CI 0.36 to 0.82) within the equivalence margin (2.65). Virtual exams had higher net promoter scores (58.1 points, 97.5% CI of difference 37.3–79.0, P<.01), indicating that the virtual experience was more enjoyable.
Virtual transvaginal ultrasonography, directed remotely by an ultrasonography technician, was non-inferior to in-clinic transvaginal ultrasonography in terms of creating clinical-quality pictures and was equal in terms of determining antral follicle count. Virtual transvaginal ultrasonography provides higher levels of patient satisfaction and has the potential to dramatically increase patient access to reproductive therapy.
