RESUMEN
Antral follicle Count (AFC) is a non-invasive biomarker used to assess ovarian reserves through transvaginal ultrasound (TVUS) imaging. Antral follicles' diameter is usually in the range of 2-10 mm. The primary aim of ovarian reserve monitoring is to measure the size of ovarian follicles and the number of antral follicles. Manual follicle measurement is inhibited by operator time, expertise and the subjectivity of delineating the two axes of the follicles. This necessitates an automated framework capable of quantifying follicle size and count in a clinical setting. This paper proposes a novel Harmonic Attention-based U-Net network, HaTU-Net, to precisely segment the ovary and follicles in ultrasound images. We replace the standard convolution operation with a harmonic block that convolves the features with a window-based discrete cosine transform (DCT). Additionally, we proposed a harmonic attention mechanism that helps to promote the extraction of rich features. The suggested technique allows for capturing the most relevant features, such as boundaries, shape, and textural patterns, in the presence of various noise sources (i.e., shadows, poor contrast between tissues, and speckle noise). We evaluated the proposed model on our in-house private dataset of 197 patients undergoing TransVaginal UltraSound (TVUS) exam. The experimental results on an independent test set confirm that HaTU-Net achieved a Dice coefficient score of 90% for ovaries and 81% for antral follicles, an improvement of 2% and 10%, respectively, when compared to a standard U-Net. Further, we accurately measure the follicle size, yielding the recall, and precision rates of 91.01% and 76.49%, respectively.
RESUMEN
Women with primary ovarian insufficiency rarely ovulate and even more rarely achieve a spontaneous pregnancy. A patient with primary ovarian insufficiency who had only 13 follicle development cycles during 13 years, but had 2 live births resulting from intrauterine inseminations is reported. She was diagnosed with primary ovarian insufficiency at 19 years of age and started infertility treatment at 23 years of age. During 10 of the 13 years that she was not pregnant and not breastfeeding, she underwent cyclic estrogen and progestin therapy with biweekly monitoring of follicle development. She delivered the first and second child at 30 and 37 years of age, respectively. This case report suggests that continuous follicle monitoring may increase the probability of having a child in a subset of patients with primary ovarian insufficiency and desired fertility, although the validity and efficacy of such management has not been established.