Posted on June 7th, 2017 by wombwithaviewblog.com

The Myth of Early Fetal Sex Determination

As a sonographer of many years, I know that ultrasound is subjective, but expectant moms seem to continue to be surprised by incorrect early fetal sex determination. And I seem to be receiving more and more emails about this ever-growing problem. Nothing makes me angrier than when another sonographer tries too early to hand out a sex guess! I get angrier still when some businesses make this promise as a marketing ploy.

It just isn’t fair to the patient or customer. I feel these facilities take advantage of pregnant anxious moms who have a desire to know the sex of their baby as soon as possible. After all, it is one of the most anticipated events in pregnancy! However, these mothers-to-be wouldn’t spend their money on an ultrasound if 3D non-medical businesses didn’t exploit that desire. They advertise a promise or guarantee for early fetal sex determination at 12+ Weeks! So, what is the public to believe except that they can deliver on that promise? The truth is they know it’s only a guess. If they guess right, they got lucky. If they guess wrong…oh, well. Here’s some of your money back.

I think developments in the technology have yielded a little too much ambitious guessing in the fetal sex department. Resolution has improved so greatly over the years that we see better than ever with the most modern equipment. But just because we can see “a little something” sticking out, in no way or shape or form, means you’ll be investing in blue paint.

I want to educate every fertile, human-growing woman or parent-to-be out there that even the best ultrasound equipment on the planet cannot differentiate a boy from a girl. To this day, determination of sex is still dependent on the experience and skill of the person holding that probe to your belly. But also know that a sonographer’s skill doesn’t mean squat when external genitalia has just begun to grow. It’s anyone’s guess!

We have all heard a similar story. A customer pays for an early scan and is told one sex. “Congratulations! I’m 100% sure!” Lo and behold! At the mid-pregnancy anatomy screen (or later), the penis has magically fallen off and now all the sailboat motif and cute suspenders have to go back. Or vice versa. The question I always get is, “How did this happen???”

 

Loads of Room for Error

So, just how DID this happen?

Easy. It’s the scanning observer’s opinion, but it’s still just a guess. You assume he or she is experienced in making this determination…maybe, maybe not. Especially when this person displays such confidence in his/her guess, you feel sure that they must be correct in their guess. But it doesn’t mean they are; they can still be very confidently and entirely…wrong.

This is why!

External genitalia is just starting to develop later in the first trimester, and it will continue to morph and change in appearance over the next several weeks. All babies have a little something sticking out at 12 Weeks. But if Baby is a girl, that tissue will shrink and become recognized as a clitoris later on, with labia seen on each side. If a boy, this part grows a little larger and becomes a penis. The scrotal sac develops over the next few weeks but is still quite small. And we cannot see testicles until somewhere around 28 Weeks (or maybe slightly earlier).

 

The Nub Theory?

early fetal sex determination

12 Week Fetus

Most readers ask if this test has any validity. The answer is “some.” If (and, again, subjectivity comes into play here), if an observer knows what fetal angle to obtain and how to read the angle of the nub, you might have a 70% accurate guess. But that’s a few IFs. The observer also has to know when the angle is equivocal, meaning the protruding part is not one way or the other but somewhere in-between. In these cases, a guess cannot be made. Keep in mind here that even if the angle is perfect, there is still a ~30% chance of an incorrect guess! In other words, it’s not a hugely reliable predictor.

 

So, What’s the Best Advice?

Later is better! Wait for your mid-pregnancy anatomy screen at 18 – 20 Weeks. Below are great images of typical and normal-appearing external genitalia of each sex at this age:

male gender, 2nd Trimester

Male Fetus

female gender, 2nd Trimester

Female Fetus

If Baby isn’t cooperating, don’t put the heat on your sonographer to guess anyway. Part of a good sonographer’s job is also to know when NOT to guess.

The truth is that no one should be providing a guess for sex determination much earlier than this in pregnancy, especially for a fee. And certainly not with a 100% positivity attached.

Just because someone says she is 100% sure, doesn’t mean she is right.

Business is business. As long as parents will pay for it, someone will take your money and offer a guess. This is the unfortunate bottom line in the non-medical ultrasound business. I’m not saying you shouldn’t go to one of these places. Maybe you just want to see a heartbeat and bond. This is understandable. But I caution you to pay for fetal sex determination earlier than 18 Weeks.

Advice Regarding Early Fetal Sex Determination

All you moms who are thinking about paying for an early scan at a strip mall near you (or anywhere!), please first consider the above info. It might just save you a few bucks and some disappointment later. Alternatively, if you are the kind of person who can remain entirely neutral about any sex guess and just want to have some fun watching Baby move, go for it. Have a blast.

The biggest issue here is our own nagging, relentless, compelling need to know as soon as possible. But more of the same will keep happening. Businesses won’t quit selling early fetal sex determination as long as pregnant moms are buying. Let’s pass the word around, ladies. Just don’t buy what they’re selling!

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Posted on April 11th, 2017 by wombwithaviewblog.com

OOPS! Not a Girl! – The Case of Mistaken Fetal Sex

Yep, it happens…the mistaken fetal sex guess. It can happen to anyone and sometimes does! We all have heard the story somewhere. A friend. Family member. Someone’s friend’s cousin’s sister-in-law… The truth is that the right conditions can make anyone susceptible to an incorrect guess. Consequently, the discovery of the opposite sex inevitably leads to a roller coaster of emotions! This is precisely why I have always been careful and cautious when throwing out a guess to any interested parent-to-be.

In the Eye of the Beholder

I have certainly been on the giving end of that conversation. Most of the time, it’s not pretty. The result usually accompanies shock and wonder at how this could have happened, especially with today’s technology. This is the typical feeling. However, still get the feeling that the general public thinks it’s the machine doing the guessing and not the observer. This would be an incorrect assumption. It always has been and always will be the observer who guesses. The machine does nothing without the operator making it happen. Other healthcare professionals are more experienced and better than others at scanning.

Some docs, nurse midwives, or other healthcare professionals are better than their counterparts at scanning. But I believe all of them in the field would agree that none of them have the skill of a seasoned sonographer. Unfortunately (and unbeknownst to you), some holding that probe are not formally trained in ultrasound at all! Some in the 3D business who are taking a crack at your baby’s sex don’t even come from the medical field. Scary, right?

Factors That Interfere With Fetal Sex Guesses

That said, a whole world of other issues can interfere with the guess of someone who is more than qualified to make it. Factors like fetal position and patient size can both make visualization limited. The laws of Ultrasound Physics dictate how well we will or won’t see a particular object. The more tissue the sound waves have to penetrate, the more limited the image will be once they make their long trek back to the monitor. That said, I could see very well in a few of my heavier patients over the years and definitely struggled in some thinner ones. This is also because air and gas are not our friends in ultrasound. If your intestines are full, it can get in the way of what we need to see…even in the thinnest of people! Yep, poop is a problem.

A Case of Mistaken Fetal Sex

Readers from all over the world email me with their images for a second opinion on fetal sex. This can be very difficult when the image isn’t a great one to start. I always like to play it cautious with my patients and readers. Especially when I’m examining one frozen image, the ability to see from all angles is taken out of the equation and a real disadvantage. The image has to be technically great, or it is simply a wild card.You’ll find one reader’s story below who wanted my opinion, but I was clueless. This baby didn’t look like a boy or girl!

You’ll find one reader’s story below who wanted my opinion, but I was a bit hesitant with this one. She wrote initially expressing her confusion. She was 20 Weeks but couldn’t make out typical girl or boy parts. This was the image below. Same for me, confused mama! The image below is not “textbook” for either sex, though I think most any sonographer would guess “girl” based on this one image alone. Hmm…

fetal sex, mistaken fetal sex

I wrote her back saying this:

Hi, this is not a very clear image but does seem to be a good angle. I don’t see anything sticking out, so I would have to guess girl based on that alone. Maybe a future ultrasound may be more clear? I’m sorry I couldn’t help more!

Best,
wwavblogger, RDMS

She wrote me back a couple of weeks later with a correction:

Everyone said it’s a girl again. I was a little disappointed, but now he is here. Blessed with a baby boy. The family is complete now. Wanted to share this happiness with you. Thank you.

I have to say I was a bit shocked that this was a boy, however, I was so happy for her that she got what she wanted. My reply to her:

Oh, congratulations!! This is precisely why I don’t like to try to confirm sex with other sonographer’s images! Sometimes they just aren’t very good and depend on angle and experience. A lack of something in one shot is not a definite girl! Many blessings to you!

Now, obviously, we all look different from one another and abnormally developing parts can cause confusion on sonography. I surely can’t say her baby didn’t have normal genitalia, but it just goes to show that angle and skill are everything!

I certainly and regrettably have had my share of patients get angry with me for not making a guess, but I’d rather play it safe any day. And this case is exactly why!

Have a great day, Moms, and feel free to email me at wombviewerblog@gmail.com!

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Posted on November 19th, 2015 by wombwithaviewblog.com

Baby Gender Ultrasound – Guessing Fetal Sex

“How sure are you?” I’ve heard this question probably more than any other in my career during the baby gender ultrasound! Sometimes, guessing fetal sex is a big risk and a real guess. Patients want percentages; I just want to be right!

Every sonographer is different. One’s sure is another’s iffy. I’ve seen images where a person was told one sex and the sonographer had “no doubts” only for me to scan later, confirming the opposite gender. The fact is that as long as expectant parents remain interested in guessing fetal sex by ultrasound, there will always be challenges surrounding the task.

How Sure Are We When Guessing Fetal Sex?

Are we sure or is it a guess? Honestly, they are all guesses. No sonographer should tell you her guess is 100% accurate. Even genetic tests like 1st Trimester DNA and amniocentesis can brag of 99+% accuracy! We, as humans, sure can’t surpass those odds!

Who we have making all those guesses are new sonographers right out of training, observers with little training, and those who are not formally trained in ultrasound at all (some of the keepsake video places). And because reading the scan is so subjective, there will be always be incorrect guesses during the baby gender ultrasound. Even all us experienced sonographers practice a little differently. There will always be those who feel more confident to guess earlier than me. Others are more cautious, examining from every angle but still hesitant to commit if Baby’s legs are partially closed.

I’m more of the latter persuasion. I want to be VERY sure, super-duper sure before delivering a guess to my patients! I need great views in more than one angle and textbook imaging. After all, moms and grandmas want to shop! I would crawl under a rock to know I guessed incorrectly. Mostly, I would feel simply horrible for my patient, knowing it was because of me that she invested (both emotionally and financially!) in one sex vs the other! 😵😣

What’s the Answer?

Those who are new graduates or with limited experience could consult a more-experienced sonographer for a second opinion. And if a patient decides to visit an elective ultrasound business, make sure your sonographer has had formal training!

Patients should not pressure their sonographers for a percentage but also be understanding if she says she cannot determine their baby’s gender. I know! It sure stinks when this happens, but guessing fetal sex is something we can do if we have time and if Baby cooperates! Last but not least, Moms, don’t trust a fetal sex guess from anyone in a non-medical ultrasound facility that does not carry sonographer credentials! RDMS for those who are certified and DMS for those with formal training but who have not yet passed a registry examination. Experience in OB is preferable!

*And a final word of caution! Save your money during Weeks 14-16! Waiting until 17-18 Weeks is always better!*

Here’s hoping you get pics like this for your next scan!

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