Why is the follicle not growing? Causes and consequences of this problem. To stimulate the follicles in the ovaries, there are effective folk recipes

The female body is arranged in such a way that the birth of a new life depends on the quantity and quality of these small follicular elements in which the egg matures. Expectant mothers should know what processes are going on in their reproductive organs in order to contact a gynecologist in time for violations.

What are follicles

The process of the emergence of human life begins with the fertilization of the egg. What are follicles? These are the elements that protect her, the place where she matures until the moment of ovulation. The egg is securely surrounded by a layer of epithelium, a double layer of connective tissue. The possibility of pregnancy and bearing a child depends on high-quality protection. On ultrasound, it looks like a round formation. The second function of the elements is the production of the hormone estrogen.

Follicles on the ovaries go through their monthly cycle of evolution:

  • start developing a few small pieces;
  • one - antral - begins to increase in size;
  • the rest decrease and die off - atresia occurs;
  • the largest - dominant - continues to grow;
  • under the influence of hormones, it breaks through, ovulation occurs;
  • the egg enters the fallopian tubes;
  • during sexual intercourse at the time of the meeting with the sperm, fertilization occurs;
  • if this does not happen, during menstruation, the egg leaves the uterus along with the epithelium.

What is a dominant follicle

By the middle of the menstrual cycle, the follicular apparatus approaches the main stage of its activity. What is a dominant follicle? This is the largest and most mature element that protects the egg, which is already ready for fertilization. Before ovulation, it can grow up to two centimeters, more often located in the right ovary.

In a mature state, under the influence of hormones, it breaks - ovulation. The egg rushes to the fallopian tubes. If the maturation of the dominant element does not occur, ovulation does not occur. The causes of this condition are developmental disorders.

Persistent ovarian follicle - what is it

Due to hormonal changes that begin in adolescence, during menopause, there may be a violation of the activity of the follicular apparatus - persistence. This can cause delayed menstruation, bleeding. Persistent ovarian follicle - what is it? The situation means that the protective element:

  • matured;
  • reached a dominant state;
  • there was no rupture;
  • the egg did not come out;
  • fertilization did not follow;
  • pregnancy did not take place.

In this position, persistence occurs - the reverse development of the follicular formation, with further development of events from it, the formation of a cyst is possible. In order for the formation to burst, treatment with progesterone is prescribed in gynecology. What happens during persistence? The following process develops:

  • hormones continue to be produced;
  • thickening of the endometrial mucosa occurs;
  • the uterus is compressed;
  • the endometrium begins to shed;
  • bleeding occurs.

Primordial follicle

The reserve of eggs for the whole life of a woman is laid in the womb, it is called the ovarian reserve. The primordial follicle is the primary stage in the development of the protective element. The rudiments of germ cells - oogonia - are located on the periphery of the inner surface of the ovary, have dimensions that are not visible to the eye. They are protected by a layer of granulosa cells and are at rest.

This continues until the girl's puberty - the beginning of the menstrual cycle. The course of this period is characterized by:

  • the formation of follicle-stimulating hormone;
  • under its influence, the growth of the nucleus of the egg - the oocyte;
  • maturation of two layers of the outer protective shell;
  • monthly development of several follicular elements that protect the egg.

Antral follicles

At the next, secondary stage, the follicles in the ovaries continue their development. Around the seventh day of the cycle, there is an increase in the number of cells that produce follicular fluid. Structural processes of the structure take place:

  • antral follicles start producing estrogen on day 8;
  • theca cells of the outer layer synthesize androgens - testosterone, androstenedione;
  • the cavity containing the follicular fluid increases;
  • The epithelium differentiates and becomes two-layered.

Preovulatory follicle - what is it

At the last, tertiary stage of maturation, the egg takes its place on a special hill, it is ready for fertilization. Preovulatory follicle - what is it? At this point, it is called the Graaffian bubble and is almost completely filled with liquid. Its number has increased tenfold compared to the previous period. The day before ovulation, major changes begin to occur.

At this time, the production of estrogen increases, then:

  • it stimulates the release of luteinizing hormone, which triggers ovulation;
  • the Graafian bubble forms a stigma on the wall - a protrusion;
  • a breakthrough appears at this place - ovulation;
  • after that, a corpus luteum is formed, which prevents the rejection of the endometrium due to the production of progesterone;
  • after ovulation, it forms a pronounced network of blood vessels, helping the further formation of the placenta.

Solitary follicles in the ovary

How many tragedies happen because of the impossibility of conceiving a child. In some cases, ovarian impoverishment syndrome is observed. A woman is not able to become pregnant because their functioning stops. Single follicles in the ovary cannot develop to a normal size, there is a lack of ovulation, an early menopause occurs. The reasons for this situation may be:

  • active sports;
  • starvation diets;
  • menopause;
  • hormonal disorders;
  • obesity.

The norm of follicles in the ovary

If there is an abnormal development of the follicular apparatus, the woman undergoes a regular examination for ultrasound. Compare the real picture and the number of follicles in the norm. With deviations - increases or decreases - a pathology arises - the impossibility of conception, the woman begins to be treated. How many follicles should an ovary have? At reproductive age, it depends on the days of the cycle:

  • on the sixth, seventh - from 6 to 10 pieces;
  • from the eighth to the tenth - one dominant appears - the rest die off.

How many follicles should be for conception

In order for a woman to become pregnant, the full maturation of the egg is necessary. How many follicles should be for conception? At the stage before fertilization, it is necessary to have one - high-quality dominant development. He must be ready to ovulate. If two such formations are found during an ultrasound examination, and they both undergo fertilization, twins will be born.

Follicle maturation

Folliculogenesis - the process of growth and maturation of the follicle under favorable conditions ends with ovulation and fertilization. Things don't always go well. In case of developmental disorders, observation and analysis is carried out using ultrasound. Starting from the 10th day of the cycle, the growth of the dominant element is monitored. If slow maturation is observed, ovulation does not occur, treatment is prescribed. During the next cycle, monitor the results. So you can increase the rate of maturation, achieve the onset of a long-awaited pregnancy.

Follicle size by day of cycle

Every month during menstruation, there is a gradual growth of follicles by day. The following process is observed:

  • until the seventh day, the size of the bubble is in the range from 2 to 6 millimeters;
  • starting from the eighth, there is an activation of the growth of the dominant formation up to 15 mm;
  • the rest shrink and die;
  • from 11 to 14 days of the cycle there is a daily increase;
  • the mature element can be up to 25 mm in size.

Many follicles in the ovary - what does it mean

Deviation from the norm in the direction of increase is considered a pathology. A large number of follicles in the ovaries - more than 10 pieces are called multifollicular. With ultrasound, a huge number of small vesicles are observed, which is called follicular ovaries or polyfollicularity. When their number increases several times, a diagnosis of polycystic disease is made.

This situation does not mean the formation of a cyst, it is characterized by the presence of multiple follicular elements along the periphery. This can interfere with the development of dominant education, ovulation and conception. Such problems can be caused by stress or nervous disorders, and can quickly return to normal. Requires treatment for a situation caused by:

  • improper selection of oral contraceptives;
  • endocrine problems;
  • weight gain;
  • drastic weight loss.

Few follicles in the ovaries

A woman cannot become pregnant, to find out the reason, she is prescribed an ultrasound scan. Such a study takes place during the antral phase of the activity of the follicular apparatus - on the seventh day of the menstruation cycle. When at the same time they find that there are very few follicles in the ovaries, it is possible that the situation was provoked by a decrease in hormone levels. The analysis is carried out using a vaginal probe. If, during the examination, the follicles in the ovaries are in the amount of:

  • from 7 to 16 - there is a chance of conception;
  • from 4 to 6 - the possibility of getting pregnant is small;
  • less than 4 - there is no chance of conception.

Two dominant follicles in one ovary

During the treatment of infertility with hormones, their concentration increases, instead of one, two dominant follicles mature in one ovary. It rarely happens on the left side. Those elements that should have stopped their development under the action of hormones begin to grow. Fertilization of two eggs can occur simultaneously or with a short time interval. This will lead to the birth of twins. If a woman has had sexual intercourse with different men in a short period, it is possible that the children will have different fathers.

Why the follicle does not mature - reasons

Developmental disorders have very serious problems - it leads to infertility. Why is the follicle not growing? There can be many reasons for this:

  • early menopause - natural or surgical;
  • disruption of the ovaries;
  • having problems with ovulation;
  • low estrogen production;
  • endocrine disorders;
  • inflammation in the pelvic organs;
  • pituitary pathology.

Interruptions in maturation cause: stressful situations, the presence of depression, nervous strain. An important role is played by the state of the follicular component itself, it can:

  • absent;
  • have a stop in development;
  • not reach the required dimensions;
  • be late with maturation;
  • not develop at all;
  • linger with the moment of formation.

Video: how the follicle grows

In order for the egg to reach a state ready for fertilization, it has several stages of maturation that occur in follicles - rounded formations with a membrane consisting of two layers of epithelium and a layer of connective tissue. By the time of puberty in the female ovaries, the number of follicles reaches five hundred. This is about a thousand times less than what is laid down in the girl's body at the stage of the embryo. In the process of maturation of the follicle, an egg is formed inside it. Even today, this process is not fully understood and is fraught with many dark spots.

Stages of follicle maturation

The maturation process is controlled by hormones, in particular, progesterone and lutein. If the balance of these hormones is disturbed, then this leads, first of all, to a violation of the menstrual cycle. In its first phase, with a normal hormonal background, the process of maturation of the follicle starts. Up to ten follicles can develop at the same time, but only the dominant one has a chance to reach the required size. The remaining formations should degrade if the hormonal balance is not disturbed. Otherwise, they continue to develop and inhibit the growth of the dominant follicle.

A normal menstrual cycle is a sign that there are no problems with maturation of the follicles. Before ovulation, women may feel pulling pains in the lower abdomen, overexcitation or irritability, mood swings; vaginal discharge may become more abundant and thick. One of the signs of follicle maturation is also a slight decrease in temperature a day or 12 hours before ovulation. Then the rectal temperature rises by a few tenths of a degree Celsius. You can also track the release of an egg from the follicle using hormonal tests: before ovulation, the level of progesterone rises.

Usually, the menstrual cycle is accompanied by the maturation of a single follicle, but there are cases when two or more mature at the same time. This is not a pathology, but the result of the maturation of several follicles is often a multiple pregnancy.

Ripening problems

Violations can be caused by many factors:

  • pathologies of the ovaries of various origins, leading to their dysfunction;
  • endocrine diseases leading to a deficiency of female sex hormones;
  • a malignant or benign tumor in the pituitary gland or hypothalamus;
  • inflammation or infection of the abdominal organs;
  • stress, depression;
  • underweight or overweight;
  • the onset of early menopause.

If, due to a violation of the reproductive function, the follicle does not mature, then it is necessary to consult a doctor who will establish the causes and prescribe an effective treatment.

Premature or delayed maturation of the follicle is also an abnormal phenomenon. If ultrasound detects a lot of vesicles, then this situation leads to difficulty in the maturation of the dominant follicle, which can be the cause of infertility.

Diagnosis and treatment

Ovulation is closely related to menstrual cycles. Even small delays can signal problems, meaning that the follicle does not mature in the time allotted for this by nature. The absence of pregnancy during a normal sexual life without contraception throughout the year suggests that the likelihood of infertility on the part of a woman in this case is high. But the examination must be completed by both partners, so the male factor can also serve as a cause.

There are many methods for diagnosing infertility. The examination strategy is chosen by the attending physician. He can prescribe hormone tests, ultrasound, as well as various studies, the results of which may indirectly indicate the causes of the malfunctioning of the female reproductive system.

Most often, the delay or absence of the process of maturation of the follicle is due to hormonal disorders. An insufficient level of female hormones leads to the fact that communication between the follicles and the body practically disappears. They do not seem to receive a command to act. That is why this problem can be solved in particular by introducing the missing hormones.

But pregnancy with stimulation of the maturation of the follicle can occur. Future women in labor who underwent a course of hormonal therapy, doctors lead the entire period of gestation, as well as postpartum.

Watch a video about follicle maturation and ovulation

Married couples who turn to specialists in time due to the impossibility of conceiving a child with regular sexual activity for one year are sent for examination. Doctors prescribe standard tests to detect the true cause of infertility. One of the mandatory studies is folliculometry. During this procedure, it is possible to observe folliculogenesis and track the moment of ovulation, if it occurs. In the case of ovulation, folliculometry allows you to designate the menstrual cycle and determine the most favorable days for conception.

Observation of folliculogenesis as part of the diagnosis of infertility makes it possible to track the behavior of the dominant follicle and give an overall assessment of the reproductive abilities of a woman.

In the absence of ovulation, determined during folliculometry, a number of tests are prescribed, including hormonal. Do not despair if there is no ovulation. Hormone therapy very often helps the maturation of the follicle and the release of an egg ready for fertilization. But the reasons may be not only in the lack of hormones. A number of different diseases, and many of them are not gynecological, can inhibit the maturation of the follicle. Even a common cold very often leads to disruption of the normal menstrual cycle. The attending physician takes into account all factors related to folliculogenesis.

The psychological state, in particular nervousness and fear of not getting pregnant, almost always affect the maturation of the follicles negatively. The vast majority of women who seek help at the Reproductive Medicine Clinic come with their own fears. And there is nothing reprehensible in this, because for a woman there is nothing more important than to be realized as a mother. Insolvency in terms of childbearing for them is the strongest psychological problem.

The task of the doctor already at the examination stage is to remove the fear of not being pregnant as much as possible in women. This is helped by a friendly atmosphere in the clinic, as well as communication with grateful clients, who, thanks to the qualified doctors of the clinic, succeeded.

It should be noted that modern reproductive science has advanced enormously over the past decade. Today, if a doctor believes that there are chances for motherhood, then this means a really high probability of success.

A large number of tests that are prescribed for the diagnosis of infertility is by no means a medical whim, but professional actions. To discover the true causes of non-ripening of the follicles, the entire spectrum of the examination prescribed is necessary. This will give a complete picture of the state of the reproductive functions of a woman and help determine the possibility of a particular treatment.

One of the most common types of examination of the follicle is ultrasound. Ultrasonic sensors are able to fix the dominant follicle. If it is fixed constantly (regardless of the phase of the menstrual cycle), then persistence is diagnosed. This disease is curable in most cases. But at the same time, there is a considerable probability of the Graafian vesicle turning into a cystic formation.

Since the behavior of follicles is shaped by hormones, it is endocrine disorders in a woman's body that most often cause a lack of ovulation. The second most common cause is a cyst, into which a follicle has transformed, from which an egg has not been released. If the bubble counts exceed 25 mm in diameter, then the doctor has every reason to suspect a cystic formation. If the diameter is less than the above, then we are talking about persistence or the so-called luteinization. Such cysts with a diameter of up to 50 mm resolve without any treatment from one to four months. More large cysts require hormone therapy or surgery.

In the body of a woman, complex processes are constantly repeated that help the birth of a new life in her. The egg grows inside a special capsule that protects the organ from negative external influences. The development of the follicle helps to understand whether successful fertilization can occur, what changes await the hormonal background and prevent the occurrence of possible diseases.

Follicles are small sacs that contain immature eggs. Each woman has her own supply of the latter, which is laid down at the stage of the embryo's conception. This happens around the sixth week. The development of follicles in the ovaries is completed at the time of the birth of a person. According to scientific research, the number of such bags sometimes reaches 500 thousand. All of them will play their role for 35 years, because that is how long the reproductive period usually lasts. If they did not have time to ripen, then death awaits them.

The so-called sacs are present in the body for the purpose of performing two functions:

  • estrogen production;
  • damage protection.

follicle maturation process

In the first phase of the menstrual cycle, the hormone that stimulates the development of follicles (FSH) is active in the body. Under its influence, their increase begins. Over time, the volume of fluid in the capsule is constantly growing, and its walls are prone to stretching. On the day of the onset of possible fertilization, the latter bursts, and the formed one moves into the uterine tube, where it can actively interact with the spermatozoon.

At full maturity, in each cycle, the follicle matures, but only one. As for the rest, they are engaged in the production of estrogen, which is responsible for the endometrium. In most cases, it is the dominant follicle that matures.

The fluid present in it contains salts, proteins and other compounds that help the egg grow.

In medical practice, there are three main types of follicles:

  • dominant (main). It is he who stretches on the day of the possible onset of pregnancy. Rarely do two appear at once. If this happens, then there is a chance of twins being born.
  • persistent. Doctors begin to talk about its formation if the capsule has not burst, and the egg has died inside it. Then there is an anovulatory cycle.
  • antral. It grows at the beginning of the cycle under the influence of FSH. One of them with development passes into the category of the main ones, and the rest die.

The maturation of the follicle is a very complex process from a biological point of view. It is influenced by many factors. When the menstrual cycle is regular, around day 7, an ultrasound will show the size of a follicle measuring a few millimeters. If further studies are carried out, then the growth trend of the shell will be monitored.

There is an increase of about 2 mm per day. The maximum size can reach 20 mm. When it comes to high rates, it is worth waiting for the rupture of the follicle into ovulation. It is often accompanied by the following sensations:

  • pain in the lower abdomen;
  • the presence of mucous secretions;
  • an increase in LH in the blood.

The most optimal follicle size for the release of an egg and the onset of ovulation is 20-24 mm.

If the follicle is not mature

Today, the problem of infertility is quite common. The reason for unsuccessful conception is often an unripe shell with an egg. The doctor will help solve this problem. It's usually about:

  • ovarian dysfunction;
  • the presence of a tumor;
  • frequent stress;
  • improper functioning of the endocrine system;
  • early menopause.

Delayed or premature formation of an egg is also considered a deviation. An additional examination will help to identify the problem.

What happens after ovulation

After the end of this phase, the production of the important hormone progesterone begins. The latter contributes to the preparation for the arrival of the fertilized cell. The empty shell, in turn, begins to contract. If conception has not occurred, the level of progesterone and estrogen decreases markedly. In this case, the mucous membrane of the uterus exfoliates. This situation indicates the beginning of a new cycle.

What to do if maturation has occurred, but there is no ovulation?

To understand how the follicle bursts, it is necessary to observe what happens earlier. It happens that nothing comes out of the capsule. Then there is the possibility of the existence of a follicular cyst. The reasons for its formation are as follows:

  • oversaturation of the body with estrogen;
  • gynecological diseases;
  • constant change of sexual partners;
  • excessive alcohol consumption;
  • unbalanced diet, including debilitating diets;
  • abortions;
  • stress.

Sometimes, in order for the egg to be released, it is enough to rest and include healthy foods in your diet. To maintain a balanced amount of hormones, medications are prescribed. In particular, in the second half of the cycle, doctors prescribe progesterone. By the way, it is not canceled in case of successful fertilization.

According to doctors, the growth of the follicle can already be considered good news. However, for the egg to be released, the space must be helped to open. There are specific mechanisms for this. Sometimes you have to resort to the use of medications.

Ultrasound monitoring

This method of analysis is called folliculometry. It helps to track changes in dynamics.
Positive aspects of this method:

  • it becomes possible to assess the condition of the uterus as a whole;
  • you can track the growth of the sacs;
  • potential violations are identified.

By the way, if an ultrasound is performed by an unqualified specialist, it does not make sense to use this method. A computer study does not help to assess the patency of the pipes.

If a woman has a 28-day cycle, then the first ultrasound can be done on day 8, when the bleeding has ended. Further, it is recommended to repeat the study in a couple of days. The next visit to the hospital is regulated by the doctor, based on the results of the previous examination.

It is worth noting that a clear visualization of 15 mm dots on the screen does not indicate the exact onset of ovulation. Also, this will not be confirmed by a single ultrasound.

conclusions

The development of the follicle helps determine if everything is normal with fertility. Violation of this process indicates the presence of failures in the normal functioning of the female body. When the development of one follicle has occurred, and the capsule has not ruptured, this is the wire to contact a specialist.

Almost every woman who has had an ultrasound at least once could hear the phrase “You have polycystic ovaries” or "You have PCOS." As a rule, this diagnosis is followed by a very confusing explanation, in which there are phrases about high levels of male sex hormones and possible problems with pregnancy. What is "polycystosis" and why does this phrase sound so often from doctors? Let's figure it out! The lack of a clear explanation from doctors is due to the fact that there are still disputes around this “condition” and there is no unequivocal opinion, but the main meaning of this pathological condition is clear. This topic is very complex, but without explaining some of the mechanisms of the ovary, you will not be able to understand the essence of this disease or condition.

HOW NORMAL OVARY LOOK AND WHAT THEY CONSIST OF

The ovary is a slightly elongated formation with an average size of 3x2 cm - the shape and size of the ovaries may vary from woman to woman. Inside, the ovary is made up of connective tissue and blood vessels that feed the ovary. In the outer layer of the ovary, follicles grow and the rudiments of future follicles are located.

Follicle - outwardly, it is a vial filled with a transparent liquid, inside of which there is an egg. In fact, this is the "house" of the egg. At birth, about 2 million follicles are laid in the ovary, but by puberty there are about 400 thousand of them - the rest regress.
If we look at the ovaries of an adult woman, then we can see only a few follicles of various sizes, since all the other follicles are initially so small that they are absolutely invisible.
What does the doctor see on the ultrasound? When the doctor sees an ovary on an ultrasound, he pays attention to its size, the number and size of follicles, the location of the follicles, and the correspondence of what he sees in the ovaries to the day of your menstrual cycle.
Normally, the doctor should see:

· AT early cycle (the first days after menstruation) - several small (6-8 mm) follicles

· In with in the middle cycle - one (rarely 2) large follicle (dominant) and several smaller follicles

· After the middle cycle before menstruation - the corpus luteum (temporary gland, which is formed from a follicle bursting in the middle of the cycle).


WHEN THE DOCTOR SAYS THE WORD "POLYCYSTOSIS"

If he sees an enlarged ovary and many small follicles (such as at the beginning of the cycle) more than 10-12 pieces. Moreover, the ovaries have this type at the beginning of the cycle and in the middle and at the end of the cycle.


At the same time, the doctor can see other changes, but in order not to get confused, more on that later.

There are several medical terms for the condition I'm talking about.
“Polycystic (hereinafter the option: morphology, structure, degeneration, change, transformation, rebirth, etc.) of the ovaries” - “poly” - translates as a lot; cysts in this name are called small follicles that did not grow further, but remained at the initial stage.
Here are three definitions of cysts from different dictionaries:

· a cavity that occurs in the tissues and organs of the body due to various pathological processes

· a tumor in the form of a closed cavity filled with liquid or mushy contents

· an abnormal cavity filled with a liquid or semi-liquid substance and separated from the surrounding tissues by a membrane or capsule.

It is quite obvious that in the case of our condition of the ovaries, it is not entirely correct to use the term "polycystic", since the ovaries do not re-form cavities and tumors, but simply normal structural elements (follicles) - they begin to grow and stop at the initial stage. Such a follicle cannot be considered as a cyst, because if you start stimulating its growth, this follicle can mature before ovulation and produce a normal egg (more on that later).
Therefore, the most appropriate name to describe such ovaries is "polyfollicular" or "multifollicular". These terms are also used during the description of ultrasound, but less often.
There are several ultrasound classifications of this condition of the ovaries and various authors describe the differences between "polycystic" and "polyfollicular" ovaries (with polycystic - the follicles are located along the periphery of the ovary in the form of a "necklace", and the central part of the ovary is thickened; with "polyfollicular" - many follicles along throughout the ovary, the central part is not thickened).
In my opinion - use the term « polycystic" in this case is not entirely acceptable - primarily because it is very scary for patients.
Hearing the word "polycystic" - the patient most often imagines that her ovary is filled with cysts, and they inevitably need to be removed. In fact, this is absolutely not true.
Something is preventing the follicles in the ovary from growing. Because of this, many follicles accumulate in the ovaries at the initial stage of development. This is what the doctor sees on an ultrasound scan and says that it is “polycystic”. The term "cyst" is not entirely correct to use in this name, since a "cyst" is something that appears in tissue where it was not, as a result of a pathological process, and follicles normally exist in the ovary and are its structural element.
The ovaries are a dynamically changing organ. Therefore, each cycle it looks different. During the year, even in a healthy woman, each menstrual cycle is different from the previous one. It is perfectly normal that several menstrual cycles a year can be without ovulation. In addition, stress, climate change and general diseases can also change the course of the menstrual cycle, and this will be reflected in the "appearance" of the ovary.
Now it will be clear to you why the “polycystic” type of ovaries is detected on ultrasound in every 4th healthy woman in the absence of any reproductive system disorders (regular menstrual cycle, absence of infertility, and other signs).
Thus, the ultrasound conclusion - "polycystic ovaries" can correspond to the ovaries of perfectly healthy women.

WHAT HINDS FOLLICLES TO GROW?

Follicles can be prevented from growing by many factors. For example, if you are taking hormonal contraceptives, then your ovaries on ultrasound can be characterized as "polycystic" or "multifollicular". This is due to the fact that one of the mechanisms of action of hormonal contraceptives is to prevent the growth of follicles at their early stage of development.
A number of diseases and conditions can cause follicle growth disorders - these are thyroid diseases, increased production of the hormone prolactin, endocrine disorders, prolonged stress and the period of breastfeeding.
Thus, as soon as conditions arise that do not allow the follicles to grow, the ovaries begin to take on a "polycystic" appearance. At the same time, stopping the growth of follicles can be either a permanent phenomenon (against the background of a disease) or a temporary one (stress, taking contraceptives, breastfeeding).
In some women, the ovary may just look “polycystic” and at the same time the growth of follicles before ovulation occurs. That is, against the background of many follicles that do not grow beyond the initial stage, follicles are formed that grow in the middle of the cycle to the desired size and ovulation occurs.

Main conclusion! The presence of an ultrasound picture of "polycystic ovaries" in the absence of other signs of the disease does not mean anything and can be either a temporary condition of the ovaries or variant of the norm.

Polycystic ovary syndrome or Stein-Leventhal disease
The very concept of "polycystic ovaries" appeared at the beginning of the last century, when this is how the appearance of the ovaries was described in women who are obese, lack of menstruation and excessive growth of unwanted body hair.
In 1934, Stein and Leventhal immortalized their names by first describing 7 patients with no menstruation and polycystic ovarian characteristics. The failure of medical treatment of these women necessitated surgery, during which enlarged ovaries with a thickened capsule and many small follicles were found. It has been suggested that a thickened ovarian capsule underlies this disease, which was indirectly confirmed by the effectiveness of resection of three quarters of the affected ovaries.
Subsequently, this disease was called "polycystic ovary syndrome"

This syndrome is one of the most controversial in modern gynecology, since there are still controversies regarding the criteria for making this diagnosis. Two definitions of this syndrome have already been adopted (one in 1990, the other in 2003), but even the latest clarifications made in 2003 in Rotterdam do not put an end to this issue.
According to the latest definition, polycystic ovary syndrome is diagnosed when any two of the three conditions are present:

1. Lack of ovulation or very rare ovulation (this is manifested in menstrual irregularities - very long delays, menstruation is rare, as a result, such patients suffer from infertility)

2. Signs of increased production of male sex hormones (either in the results of tests, or by external signs - excessive growth of hair on the body, acne, greasiness of the skin)

3. The picture of "polycystic" ovaries on ultrasound, the criteria are as follows: more than 12 follicles ranging in size from 2 to 9 mm or an increase in ovarian volume of more than 10 in 3 degrees. Criteria such as: the location of the follicles strictly along the periphery of the ovary in the form of a "pearl necklace" and the growth of the inner layer of the ovary are regarded as optional.


Since similar clinical signs can be in other diseases (adrenogenital syndrome, Cushing's syndrome, increased prolactin levels, decreased thyroid function, etc.), for the diagnosis of "polycystic ovary syndrome" it is necessary to exclude the presence of these diseases.
Given such strict criteria for making this diagnosis, polycystic ovary syndrome is not a very common disease. The frequency of occurrence is about 4-6%.
It is very important to understand that the true polycystic ovary syndrome is a disease rare(4-7%), and the picture of polycystic ovaries on ultrasound occurs in every 4th woman. That is, I repeat once again - just an ultrasound of the signs of polycystic ovaries is not enough to make such a diagnosis, polycystic ovaries can be in the absence of a disease, be the result of another disease.
In addition, to describe the ovaries as “polycystic”, there must be not only a subjective assessment of the doctor (something like: the ovaries are enlarged, many small follicles), but the appearance of the ovaries must meet the established criteria: more than 12 follicles from 2 to 9 mm or an increase in ovarian volume of more than 10 to 3 degrees.

What is polycystic ovary syndrome characterized by?
This syndrome has common characteristics, however, the degree of their severity can vary significantly.

· Menstrual irregularity - a tendency to delay or even a complete absence of menstruation (there is even a diagnostic criterion - less than 6 menstruation per year).
Lack of ovulation or very rare ovulation - ovulation is the release of an egg from a mature follicle, usually occurs in the middle of the cycle. Without ovulation, it is impossible to become pregnant, therefore, the result of the lack of ovulation is infertility in such patients. Since in some patients ovulation can sometimes happen - they become pregnant by chance (after a long period of infertility)

· Signs of excess male sex hormones - increased growth of unwanted hair (above the upper lip, on the back, around the nipples, in the lower abdomen, on the inner surface of the thighs), acne, greasiness of the skin, hair loss on the head. Important! The severity of these signs is different. Some patients may not have them at all, or may have only mild manifestations, and some patients may have all these signs, expressed to a large extent.

o This syndrome is also characterized by an increase in the level of male sex hormones in the blood (free testosterone and DHEAS). However, this symptom is also not constant, and in some patients, the indicators of male sex hormones may be normal. There are situations when there are external signs of an excess of male sex hormones, for example, increased hair growth, and blood hormones are normal, or vice versa - male hormones are elevated in the blood, but outwardly this does not manifest itself in any way. Therefore, either external signs or laboratory parameters are used as a diagnostic criterion for this syndrome.

· Obesity This is a very non-permanent symptom. Only half of women with this syndrome are overweight. This syndrome can occur in completely thin women. The classic syndrome was described precisely in combination with obesity, but later it was found that weight gain is completely optional.

Metabolic disorders are a whole complex of metabolic disorders, which is regarded as a stage preceding diabetes mellitus. The essence of these disorders is that insulin (a hormone that regulates blood sugar and performs other important functions) stops working properly in the body, its amount increases and this begins to have an adverse effect on both reproductive function and other organs. and systems. This condition is also called "impaired glucose tolerance"
Against the background of metabolic changes in women with this syndrome, the risk of cardiovascular diseases and the development of diabetes mellitus increases.

Important! The severity of these changes differs among women with this syndrome - metabolic disorders may be mild.

The clinical features presented above do not necessarily occur in all patients with the syndrome. There may be only some of these signs, and their severity may be different. Therefore, it is not necessary to focus on this list of symptoms and try to find all these manifestations in yourself. I repeat once again - polycystic ovary syndrome is very diverse and it has many variations and combinations of clinical manifestations.

What causes polycystic ovary syndrome?
There is still no answer to this question, but there are already quite understandable theories that, although not completely, can explain why this condition occurs.
This block may seem a little difficult to understand, so you can skip it, although the theory of the occurrence of this disease is quite interesting.
It all starts with adolescence.

In the process of puberty, the girl goes through several consecutive stages, each of which has its own name: adrenarche(activation of the adrenal glands), pubarche(the beginning of hair growth on the pubic and armpits), thelarche(the beginning of the growth of the mammary glands), menarche (the first menstruation).
So, the puberty of a girl begins with the activation of the adrenal glands (adrenarche). During this period, male sex hormones prevail in the girl's body, and there are very few female sex hormones.
Male sex hormones, they are also called androgens, are responsible for the growth of the girl, the appearance of hair on the pubis and in the armpits, and they also set up and launch that cyclic system, which will subsequently manage the menstrual cycle.

Important! Female sex hormones appear in the body only due to the transformation of male sex hormones. That is, without male sex hormones, a woman cannot form her, female hormones. This is very important to understand, since it is a violation in this link that leads to the development of polycystic ovary syndrome.

Male sex hormones are also called "a necessary evil for the female body" since without them it is impossible to create female sex hormones, and exceeding their number blocks the creation of female hormones.
The main source of female sex hormones (estrogens) are the ovaries. Estrogens are produced by the follicles during their growth. Around each follicle there is a special "shell" which consists of cells that produce male sex hormones. In other words, the follicle is a factory, and the shell is a warehouse of blanks. Male sex hormones enter the follicle and there they turn into female hormones.

Using the example of a factory and a warehouse, I will try to explain what happens during puberty and why polycystic ovary syndrome is formed.
In order to start the production cycle, you must first create a sufficient number of blanks. So during puberty, during the period of "adrenarche", the girl's body is saturated with androgens (male sex hormones, which are "blanks" for the creation of female sex hormones). Androgens are predominantly synthesized in the ovaries and adrenal glands. The increasing amount of androgens stimulates the girl's growth, hair growth and finally creates certain incentives for the cyclical system of menstruation to work. That is, when there are enough blanks, a signal is given to start the factory.
The start of the factory - the receipt of blanks in the workshop, and in the ovaries - the beginning of the growth of follicles is stimulated by androgens, but then everything depends on how the factory itself will work - it must begin to produce a product from the blanks.
A factory without leadership cannot exist. The factory is run by two bosses - the first is responsible for the supply of blanks (but he has one more function, about it later), the second - manages production.
In the beginning, in the ovaries, the first chief is LH - this hormone is produced in the brain and stimulates the formation of androgens in the follicle membrane, the second chief is FSH - it stimulates the conversion of androgens into estrogens. FSH is a strict boss, when little estrogen is produced - its amount increases proportionally, that is, it stimulates their formation, and when a certain threshold is reached, estrogens begin to suppress FSH. This is essential for ovulation to occur.
But back to the very beginning. How does the normal formation of the menstrual cycle occur in the process of maturation. There comes a time when the production of androgens (blanks) begins to increase in the girl's body, they are produced in the adrenal glands and ovaries. Under their influence, the girl begins to grow actively, her first hair growth appears, and a signal is sent to the "first boss" of LH that it is time to increase the number of blanks directly at the factory - that is, LH begins to actively stimulate the formation of androgens in the follicle membrane. The follicles in a girl's ovary are small and not yet growing.
Under the influence of accumulated androgens in the membranes of the follicles, they begin their first growth. Then the “second boss” of FSH is turned on, which begins to manage the production process - to convert androgens into estrogens. It is the resulting estrogens that make the follicles grow further.
Of course, not all follicles begin to grow, but several, then only one breaks forward, it grows to 20 mm and bursts - this is ovulation. In place of the bursting follicle, a corpus luteum forms, which prepares the uterus for the implantation of a fertilized egg, and if this does not happen, the corpus luteum regresses and menstruation begins.
Under the influence of estrogens, the mucous membrane in the uterus (endometrium) grows, which is then rejected, which is menstruation.
This is how the menstrual cycle starts. It usually takes a girl half a year to set up this whole system, that is, the first menstruation may be irregular, as these two bosses and the new factory are only adapting to work harmoniously and not interfere with each other.

What happens when polycystic ovary syndrome develops.
The problem is that the initial process of accumulation of blanks (androgens during adrenarche) occurs in excess. It is still not very clear why, but it is assumed that insulin and similar substances are to blame. Insulin is not only responsible for blood sugar levels, but it also plays an important role in the growth process of the entire body.
When the process of active growth of a teenager is underway, its activity is increased, in particular, it stimulates an increase in androgen production during the onset of maturation.
So, it is insulin that can be responsible for a number of errors in this process.
His excessive activity not only increases the number of “blanks”, but he also disrupts the work of two bosses, but very selectively - to the “first boss” - LH - he gives excessive powers and does not allow him to stop in the process of creating and storing blanks (the synthesis of androgens in ovaries). "Second boss" - it blocks access to information about what is happening in the factory - that is, FSH does not begin to be produced in the proper amount, as it becomes less sensitive to stimuli that trigger its production.

What is going on: the factory is filled with blanks, which by their quantity block the production itself - production freezes, since the second boss is inactive, the blanks do not go into production - there is no product.

Many small follicles are formed in the ovaries, which have just begun to grow and have stopped, since under the influence of androgens it is only possible to begin growth. Androgens are actively synthesized in their membranes (under the influence of LH), which do not turn into estrogens, since there is not enough FSH. The size of the ovaries gradually increases, they become filled with small follicles. Since very little estrogen is produced, the uterus lags behind in development and remains small.

Clinically, this manifests itself as follows: a girl may have only a few periods and then completely stop or come with very long delays and not regularly.

Since the ovaries produce a lot of male sex hormones and few female sex hormones, excessive hair growth, acne (pimples), skin greasiness and hair loss may appear.

Disruption of insulin function may not manifest itself in any way (reflected only in the results of studies) or give a complete picture of metabolic disorders with the development of obesity.

In other words, the beginning of a girl's puberty (adrenarche) in all its characteristics corresponds to the state that causes the development of polycystic ovary syndrome, only normally the girl leaves this state in the process of further maturation. Those who have the disorders described above (improper functioning of insulin) remain in this state and it begins to form the development of polycystic ovary syndrome.

As I wrote above, the severity of polycystic ovary syndrome is different. Someone has a complete picture of the disease - an early violation of menstruation, external signs of an increase in male sex hormones, obesity. Others may simply have delays, a long cycle, little hair, normal body weight, there may be only one problem - infertility.

Such a variety in the severity of this syndrome is due to the fact that the body has great opportunities to compensate for the violations that occur, or the violations themselves do not have time to develop fully. Therefore, in patients with this syndrome, despite the many follicles in the ovaries, the increased level of androgens and the malfunction of the two bosses (LH and FSH), ovulation still sometimes occurs and such patients spontaneously become pregnant.

Inheritance

It has been found that polycystic ovary syndrome can be inherited from mother to daughter. It was also revealed that the fathers of girls with this syndrome have certain disorders. It is only important to understand that this syndrome is not inherited in the same way as “usually”, that is, it is “tied” to one gene, but it is inherited through a combination of several genes, which causes inconstancy of inheritance and different severity of disorders in this syndrome.

Now let's analyze the most common situation at a gynecologist's appointment: violation of the menstrual cycle and increased levels of androgens (male sex hormones) + "polycystic ovaries" on ultrasound.

1. The "polycystic" type of ovaries can be a variant of the norm if there are no violations (why the ovaries acquire this appearance is not known, it can be assumed that at the very beginning of maturation there were prerequisites for the development of the syndrome, but the body compensated everything in time). Therefore, only an ultrasound picture of "polycystic" ovaries does not mean anything.

2. It is important to understand that menstrual irregularities can be caused by a variety of reasons (stress, weight loss and a strict diet, illness, sports, elevated prolactin levels, thyroid problems, etc.), that is, there are many factors that can disrupt the work of "two bosses". » LH and FSH. At the same time, follicles will not mature in the ovaries, which means that the production of estrogen (female hormones) will be reduced, the production of male hormones will prevail, since they will not turn into estrogens, they will accumulate. As a result, their amount in the blood will begin to increase. A very important point! In this situation, one should not confuse cause and effect (a common misconception) - an increase in the level of male sex hormones will be a consequence of menstrual dysfunction, and not a cause !!!

Of course, the accumulation of male sex hormones in the ovaries after a while will begin to play an independent role, exacerbating the current situation.

Against the background of this stress for the body and the lack of adipose tissue (in which estrogens are also produced), the work of the “two bosses” of FSH and LH is disrupted - follicles stop growing in the ovaries, androgens do not turn into estrogens, accumulate in the body and the doctor fixes their increase in the blood .

On ultrasound, such a girl will have a picture of "polycystic ovaries", as there are many small follicles that have stopped at the beginning of their growth. In this situation, the diagnosis of "polycystic ovary syndrome" is erroneous.

3. There are separate diseases: Cushing's disease, adrenogenital syndrome, increased production of prolactin, decreased thyroid function, androgen-producing tumors, etc. In these diseases, the clinical picture may be the same as in polycystic ovary syndrome, but there will be some nuances, therefore, according to definition, all of these diseases must be excluded, as they are treated separately.

Conclusion:

1. "Polycystic ovaries" on ultrasound may be a variant of the norm and are not always a sign of the disease

2. Any conditions and diseases that turn off or disrupt the functioning of the ovaries can create a picture of "polycystic" in the ovaries, such conditions may include: taking contraceptives, stress (with the cessation of menstruation), sudden weight loss, breastfeeding, adolescence (after the onset of menstruation) , increased prolactin levels, thyroid dysfunction, endocrine diseases, obesity, etc.

3. Polycytosis - does not mean that there are many "cysts" in the ovaries - this term means that there are many small follicles in the ovaries (they are present there normally), which began to grow, but stopped at the very beginning of their growth

4. True polycystic ovary syndrome is relatively rare - 4-7%, there are certain diagnostic criteria for it.

5. Polycystic ovary syndrome develops at the beginning of a girl's puberty and is associated with excessive action of male sex hormones during their natural activation. These disorders are based on excessive activity of insulin.

6. The fact of inheritance of this disease has been proven

7. Most often, women with this syndrome have complaints of infrequent menstruation, infertility, overweight, acne, greasiness of the skin and unwanted hair growth, while some of these symptoms may be absent. The syndrome apparently has a different degree of severity, which is determined both by the compensatory capabilities of the body, as well as by the nature of the violations.

8. Women with polycystic ovary syndrome have metabolic disorders that increase the risk of developing cardiovascular disease and diabetes.

Like

The rest begin to gradually regress. With a hormonal failure, they do not die off, but begin to interfere with the normal development of the dominant follicle.

ATTENTION: If the menstrual cycle is regular, the woman can determine the period of maturation of the follicle herself. In this case, you need to focus on the indicators of basal therapy and your own feelings. If carried out, this process is controlled by ultrasound. The study is carried out on different days.

The following signs indicate the maturation of the bubble and the imminent onset of ovulation:

  1. Drawing pains localized in the abdomen.
  2. The appearance of vaginal whitish discharge in a larger amount than usual.
  3. Decrease in rectal temperature about a day before ovulation.
  4. An increase in the level of the hormone progesterone in the blood.
  5. Mood changes, irritability, increased sensitivity.

If it ripens in one cycle, this is the norm and indicates that chance of multiple pregnancy large enough.

Reasons why it does not mature?

When the bubble in the ovary does not grow, women experience anxiety. There are many reasons for this state of affairs. As a result, the follicle does not form at all or it is empty.

If the woman is young this indicates that she has some problems, for the elderly, this condition is practically the norm.

Pass without. They are considered the period of rest of the ovaries. In young healthy women such cycles occur 2-3 times a year, after 33 years - up to 4 times a year.

From lack of ovulation lean women are more likely to suffer constantly on strict diets. They have a deficiency of estrogen, and over time, not only ovulation disappears, but also menstruation.

If the bubbles do not grow, the woman is diagnosed with infertility. To fix the problem, it is important to identify the cause of the pathology.

The following factors can disrupt the maturation processes:

  1. Ovarian dysfunction resulting from trauma, inflammatory disease, after surgery.
  2. Disruptions in the endocrine system, when there is a deficiency of progesterone and estrogen.
  3. Brain dysfunction, provoked by inflammation of the membranes of this organ or its injury.
  4. A benign or cancerous neoplasm in the pituitary or hypothalamus.
  5. Infectious diseases that affect organs located in the abdominal cavity.
  6. Depression, severe stress.
  7. The development of menopause at the age of less than 45 years.
  8. Obesity or prolonged adherence to a strict diet.

ATTENTION: If there are malfunctions in the functioning of the genital organs, the bubble does not form at all, so a woman should definitely visit a gynecologist.

What to do?

In order for the doctor to diagnose infertility due to the presence of undeveloped follicles, you need to undergo ultrasound diagnostics. It is carried out at the beginning of the cycle, on days 8-10. After receiving the results of the study, the doctor tells the patient about his characteristics.

Diagnostics can detect:

  1. normal ovulation.
  2. Persistence.
  3. Regression of the dominant bubble.
  4. Follicular cyst.
  5. luteinization.
  6. The fact that the bubble for some reason does not burst.

Ultrasound makes it possible to identify several reasons at once that do not allow a woman to become pregnant. After that, the doctor selects the appropriate method of treatment.

Treatment

In the complete absence doctor often finds ovarian dysfunction or early menopause, which occurred in a woman younger than 45 years. Such patients are shown hormonal treatment.

The length of the menstrual cycle may indicate difficulties with ovulation if it is more than 35 days or less than 21 days. In this case, the risk of forming a non-viable or immature egg increases significantly.

ATTENTION: If the menstrual cycle is normal and regular, the time of bubble maturation can be determined independently, for example, by measuring the basal temperature. After artificial stimulation of the ovaries, women undergo ultrasound diagnostics on different days so as not to miss this period.

To identify the causes of deviations, you need to:

  1. Make a blood test.
  2. Examine the hormones secreted by the thyroid gland, as well as sex hormones.
  3. Get checked out by a gynecologist.
  4. Make an ultrasound of the ovaries.

Only an experienced doctor can explain why the follicle does not grow and how to deal with it. Treatment is aimed at achieving the following results:

  1. Normalization of hormonal levels.
  2. Elimination of cysts, if they were found.
  3. Normalization of the menstrual cycle.
  4. Elimination of diseases of the endocrine system.
  5. Improvement of exchange processes.

As a rule, it is enough for a woman to take hormonal medications to restore her health. In especially severe cases recommend surgery. It may be required that prevent the patient from conceiving a child. If an accumulation of immature follicles is detected, cauterization of the ovary is performed.

ATTENTION: Pregnancy itself is an excellent prevention of female diseases.

Doesn't get pregnant

In order for a woman to become pregnant, the egg must fully mature. For conception, one quality dominant follicle ready for ovulation. If two such bubbles form, then twins will be born.

If you can't get pregnant, need to be examined by a doctor and find out the cause of the problem. The sooner a woman undergoes treatment, the sooner she can become a mother, so in this case it is not worth delaying a visit to a gynecologist.

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