Shear Wave Elastography to Assess Stiffness of the Human Ovary and Other Reproductive Tissues Across the Reproductive Lifespan in Health and Disease - Review

Sep 21, 2026

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The ovary shows early and progressive signs of aging, where age-related decline in ovarian function reduces gamete quantity and quality, links to infertility, and reshapes endocrine balance. With advancing age, the ovarian microenvironment becomes fibrotic and stiff while adopting a fibro-inflammatory state, affecting follicle growth, ovulation dynamics, ovarian physiology, and ovarian cancer risk. The review explains shear wave elastography as a quantitative, non-invasive ultrasound approach and summarizes its principles, current clinical uses, and emerging application to transvaginal assessment of ovarian stiffness.

LanguageEnglish

CategoryHealthcare

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Pages15

Reading Time38 min

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Shear wave elastography to assess stiffness of the human ovary and other reproductive tissues across the reproductive lifespan in health and disease† Emily J. Zaniker1 , Man Zhang2 , Lydia Hughes1 , Lizellen La Follette3 , Tomiris Atazhanova1 , Alexis Troﬁmchuk1 , Elnur Babayev1 , * and Francesca E. Duncan1 ,4 , * 1 Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA 2 Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA 3 Greenbrae, CA, USA 4 Center for Reproductive Longevity and Equality, Buck Institute for Research on Aging, Novato, CA, USA *Correspondence: Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 676 N. St.Clair, Suite 2310, Chicago, IL 60611, USA. Tel: 3129268868; E-mail: [elnur.babayev@northwestern.edu](elnur.babayev@northwestern.edu); Department of Obstetrics and Gynecology, Feinberg School of Medicine , Northwestern University, 303 E. Superior Street, Lurie 10-117, Chicago, IL 60611, USA. Tel: 3125032172; E-mail: [f-duncan@northwestern.edu](f-duncan@northwestern.edu) †Grant Support: The work described in this manuscript was supported by the Global Consortium for Reproductive Longevity and Equality (FED and EB), the Northwestern Department of Obstetrics and Gynecology Startup Funds (FED), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD093726 to FED) . Abstract The ovary is one of the ﬁrst organs to show overt signs of aging in the human body, and ovarian aging is associated with a loss of gamete quality and quantity. The age-dependent decline in ovarian function contributes to infertility and an altered endocrine milieu, which has ramiﬁcations for overall health. The aging ovarian microenvironment becomes ﬁbro-inﬂammatory and stiff with age, and this has implications for ovarian physiology and pathology, including follicle growth, gamete quality, ovulation dynamics, and ovarian cancer. Thus, developing a non-invasive tool to measure and monitor the stiffness of the human ovary would represent a major advance for female reproductive health and longevity. Shear wave elastography is a quantitative ultrasound imaging method for evaluation of soft tissue stiffness. Shear wave elastography has been used clinically in assessment of liver ﬁbrosis and characterization of tendinopathies and various neoplasms in thyroid, breast, prostate, and lymph nodes as a non-invasive diagnostic and prognostic tool. In this study, we review the underlying principles of shear wave elastography and its current clinical uses outside the reproductive tract as well as its successful application of shear wave elastography to reproductive tissues, including the uterus and cervix. We also describe an emerging use of this technology in evaluation of human ovarian stiffness via transvaginal ultrasound. Establishing ovarian stiffness as a clinical biomarker of ovarian aging may have implications for predicting the ovarian reserve and outcomes of Assisted Reproductive Technologies as well as for the assessment of the efﬁcacy of emerging therapeutics to extend reproductive longevity. This parameter may also have broad relevance in other conditions where ovarian stiffness and ﬁbrosis may be implicated, such as polycystic ovarian syndrome, late off target effects of chemotherapy and radiation, premature ovarian insufﬁciency, conditions of differences of sexual development, and ovarian cancer. Summary Sentence Shear Wave Elastography is a non-invasive technique to study human tissue stiffness, and here we review its clinical applications and implications for reproductive health and disease. Key words: ovary, aging, stiffness, ﬁbrosis, shear wave elastography Introduction The female reproductive system is one of the first organ systems to age in the human body with ovarian function decreasing in females beginning in their mid-thirties and ce

FAQs

Why is measuring human ovarian stiffness important for reproductive health?

Ovarian aging is linked to loss of gamete quality and quantity, infertility, and changes in endocrine function. Assessing stiffness could help track ovarian aging and related health and disease implications.

What is shear wave elastography and how is it used?

Shear wave elastography is a quantitative ultrasound imaging method that evaluates soft-tissue stiffness. It has been used clinically for other conditions, including liver fibrosis and characterization of tendinopathies and several neoplasms.

How does the review connect ovarian stiffness to reproductive outcomes and therapies?

Ovarian stiffness may serve as a clinical biomarker of ovarian aging, supporting prediction of ovarian reserve and Assisted Reproductive Technologies outcomes. It may also help assess the effectiveness of emerging therapeutics aimed at extending reproductive longevity.

Sep 21, 2026

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