What are ovarian follicles in women? The ovaries are paired organs of the female reproductive system. They monthly produce an egg suitable for fertilization by a spermatozoon. However, you can often hear from a doctor about the maturation of the follicle in the ovaries. What does it mean?
The fact is that the number of eggs is limited and is individual for each woman. Immature forms are in a special protective shell, a kind of bag. This is the follicle. It performs the following functions:
- Protection of the egg embryo from the effects of negative factors.
- Production of hormones. Participates in the synthesis of the female hormone estrogen.
- Ensuring the maturation of the egg. Inside the follicle, the egg ripens every month, and it is also ensured that it enters the fallopian tubes during the period of ovulation.
Note. It is impossible to say exactly how many follicles should be in the ovary. It is generally accepted that their number is from 50 to 200 thousand.
Features of the ripening cycle
The number of female germ cells is formed at the stage of embryonic development. They are evenly distributed over the body of the ovary and, with the onset of puberty, the girl begins their maturation.
The formation of follicles in the ovaries occurs during each menstrual cycle. Gradually, this sac increases in size, and by the middle of the cycle it breaks, which is accompanied by the release of a mature egg and, possibly, its subsequent fertilization. If conception does not occur, menstrual bleeding occurs. This process is repeated normally every cycle.
When the follicles in the ovary mature, a woman may feel slight discomfort. This is due to an increase in the size of the organ and the subsequent rupture of the sac. Initially, several follicles are formed in the ovaries. The quantity norm is up to 10 units per cycle.
By the middle of the cycle, single follicles remain in the ovary. Usually only 1 follicle reaches the end of the maturation cycle. It's called dominant. The remaining formations gradually resolve. If 2 follicles in one or each ovary mature at the same time, the chance of conceiving twins increases.
Important! With artificial insemination or egg donation, artificial stimulation of multiple maturation of follicles in the amount of 6-30 pieces is performed.
What can go wrong
Not always the process of egg development occurs normally. There may be such a situation when in a separate menstrual cycle there are no follicles in the ovaries. What does it mean? In this case, the maturation of the egg does not occur, which means that conception in a natural way becomes impossible. In addition, the menstrual cycle fails, there is a lack of menstruation on time.
The absence of follicles can be both temporary and a sign of infertility. It is also one of the symptoms of the onset of menopause, when the resource of germ cells, laid down in the prenatal period, is depleted, or their maturation fails.
Also, violations associated with the maturation of an empty follicle are often observed. In this case, pregnancy is also impossible.
A slightly different situation - the growing follicle in the ovary does not burst or does not fully open, that is, it becomes persistent. Such a violation also provokes cycle disorders, and the accumulated fluid in the sac can be converted into a follicular cyst. Over time, with the normalization of the process, the cyst resolves on its own, however, with frequent failures of this kind, polycystic ovary develops.
Causes of violations
To eliminate deviations, it is important to find out what specifically provoked their occurrence. The reason why the follicles in the ovaries do not ripen may be such factors:
- Diseases of the gynecological sphere. Most often we are talking about pathologies of the ovaries, for example, polycystic. Also, various inflammatory processes and oncology can have an impact.
- Hormonal fluctuations. It can affect any hormone. But the greatest influence is exerted by prolactin, which is involved in the process of stimulating lactation.
- Taking hormonal contraceptives. Especially if the funds were chosen incorrectly, or the procedure for taking birth control pills was violated.
- Diseases of the thyroid gland. Such pathologies of the endocrine system negatively affect the activity of the whole organism.
A sign of violations can be not only an increased menstrual cycle, but also its shortening. There may be pain and discharge at different periods of the cycle.
Diagnosis and treatment
For diagnosis in such cases, it is necessary to undergo a complex of laboratory and hardware studies. With their help, it is possible to identify follicles suitable for development in the ovaries or the causes of deviations of these processes. Diagnostics includes:
- blood tests (general and biochemical);
- thyroid hormone tests;
- analyzes for sex hormones;
- gynecological examination;
- Ultrasound of the ovaries.
The size of the follicles in the ovaries is normally about 6-8 mm at the beginning of the cycle. Gradually, their number decreases, and the size increases, and a large dominant formation can be considered.
Only a doctor can explain the situation, why there are no follicles in the ovaries, and give recommendations on how to eliminate this problem. Treatment is selected individually and is generally aimed at achieving the following goals:
- normalization of hormone levels;
- elimination of cystic formations;
- stimulation of ovulation;
- restoration of the menstrual cycle;
- elimination of diseases of the endocrine system;
- improvement of metabolic processes.
Most often, treatment is limited to the use of hormonal drugs. In severe cases, surgery may be required, in particular, a puncture in the formation of cysts that threaten the woman's ability to conceive and bear a child. With the accumulation of immature follicles, cauterization of the ovary is performed.
Prevention
In order to maintain the process of maturation of follicles in the ovaries in a normal way and in general to prevent the development of problems with women's health, it is recommended to follow a number of preventive measures. Their essence is as follows:
- maintaining an active lifestyle;
- rejection of bad habits;
- proper balanced nutrition;
- avoidance of excessive emotional and physical stress;
- maintaining a full sexual life;
- protection against sexual infections;
- prevention of abortion;
- control of hormone levels;
- selection of oral contraceptives together with a qualified doctor;
- timely treatment of diseases of any kind;
- regular medical examination by a gynecologist.
Important! Pregnancy to a certain extent is also a prevention of women's health problems.
If you experience menstrual irregularities, pain in the lower abdomen or other suspicious changes, you should immediately consult a doctor for advice. It is necessary to regularly be examined by a gynecologist in order to prevent the development of such health problems.
The process of ovulation is thoroughly studied. It completely depends on the development of follicles in the ovaries, what it is, every adult woman should know.
The functional state of such vesicles in the ovaries in women is important. If dysfunction is noted during folliculogenesis, infertility often occurs.
What are follicles (lat. folliculus ovaricus)? The development of human life begins with the fertilization of a mature female reproductive cell. This is a very complex mechanism.
Folliculus ovaricus ( ovarian follicle, Further FYa) - a container and shell of an immature egg, a structural component of the ovary.
The female germ cell, which is located in the FYA, develops in such a small vesicle. In the female body, changes constantly occur during the maturation of follicles in the ovaries.
Such a primary female cell is securely covered and surrounded by connective tissue and epithelial cells.
How does folliculogenesis occur?
How many follicles should be in the ovaries? Even at the stage of the embryo, a certain number of immature female cells are formed in a female child.
These are primordial (primary) follicles. There are approximately 1⁄2 million of them in the body of a girl in the womb.
At the age of about 12 years, antral female germ cells begin to develop rapidly and actively. Their diameter is approximately 8 mm.
How does the maturation of follicular elements occur:
- Ovulation is preceded by an extremely complex process - folliculogenesis.
In the female body, the egg matures every month, it is preparing for fertilization. Normally, antral follicles in the ovaries disappear over time.
Pathology is considered a deviation from normal indicators, when an excessive number of follicles are formed.
- The number of ovarian follicles decreases to 40,000 upon reaching puberty. This is the norm.
Only about 500 FJs mature completely during the entire female reproductive period.
- The totality of all folliculus ovaricus, maturing in 1 menstrual cycle in the ovaries, is the follicular apparatus.
A normal occurrence 3 days after menstruation is the presence of several follicles in the ovary.
- The remaining ovarian follicles in the body are destroyed.
The reasons for this process are natural. Gradually, fewer and fewer eggs remain in the woman's body.
It is impossible to increase this stock of follicles in an adult lady. In a geometric progression, the number of antral follicles rapidly decreases closer to menopause.
Menopause occurs closer to 50 years, when the supply of eggs in a woman's body ends.
How many eggs mature in one cycle? Under the influence of chemical active substances in the 1st phase of the monthly cycle, about 10 primary female cells simultaneously mature.
Estrogen production begins in the adnexa when the follicular vesicle matures. Different indicators of the size of the follicles on the days of the cycle are noted on different days of the monthly cycle.
The size of the eggs during ovulation gradually change. When the oocyte matures sufficiently, the follicular vesicle increases to 18 mm on day 11.
How does the dominant follicular element develop?
In both ovaries, the maturation of each follicle occurs during menstruation. More than 10 FIs mature in 1 monthly cycle, but only 1 of them is involved in the ovulation process.
Only he can fully mature and burst. The size of the follicle before ovulation can be determined by a specialist.
An ovum ready for fertilization comes out of the ruptured sac. The remaining ovarian follicles stop in their development at various stages, die and resolve.
From the very beginning of the menstrual cycle, the growth of follicles occurs, which is observed until the very ovulation.
This is the only FYa from which a mature sex cell will emerge, called dominant.
Specialists are able to visualize it already on the 10th day of the cycle.
In the middle of the formation phase, the most developed and largest is precisely the dominant follicle in the left ovary or right.
How does ovulation occur?
This is the process of rupture of the ovarian follicle. Normally, this procedure occurs during each menstrual cycle. When maturing, the female germ cell breaks out of the follicle.
However, without a dominant follicular element, ovulation cannot occur.
What size follicle is considered sufficient for ovulation? Normally, this figure is approximately 18-24 mm.
If this element of the ovary bursts, there is a possibility of pregnancy if the egg comes out of the bursting follicular vesicle. Now she can be fertilized.
Until the onset of menopause, ovulation in a healthy woman is repeated every month.
In the body of a woman capable of conception, the dominant follicle of the right ovary is most often formed. The completion of folliculogenesis is facilitated by a peak in estrogen levels.
Every woman should know exactly what day the folliculus ovaricus matures. The size of the follicle during ovulation should be between 20 and 25 mm.
However, in some cases, in one cycle, several dominant follicular elements are simultaneously fertilized, which are located in different ovaries.
This often becomes a consequence of artificial insemination, the action of the dominant follicular elements.
Several FIs at once often dominate if multifollicular properties are inherent in this receptacle of an immature ovum. In this case, the right ovary is often enlarged.
Often, as a result of hormonal stimulation, dominant ovarian follicles develop in both parts of the paired organ that produces female germ cells.
As a result, two eggs are released. This leads to an increase in the likelihood of conceiving twins.
In rare cases, there is a case when two dominant follicles develop in one ovary.
As a rule, there should be no delay in the maturation of the structural elements of the ovary, if everything is in order in the body.
For example, the size of the dominant follicle of about 6 mm is clearly visualized on ultrasound as early as a week after the start of the menstrual cycle. This diagnostic procedure allows you to reliably determine in which ovary ovulation occurs.
At what size can a follicle burst? Every day, on average, the size of the dominant follicular element increases by 3 mm.
An early onset of ovulation is possible when its diameter is about 21 mm. This occurs after its full maturation.
Normally, the egg is released in the middle of the cycle. You can accurately determine the size of the follicle by the days of the cycle.
With a regular cycle of menstruation, it is much easier to track the daily maturation of follicular elements. With the help of ultrasound of the appendages, you can find out the number of follicles in the ovaries.
A healthy woman does not feel obvious signs when a follicle ruptures in the ovary.
About 7mm should be the thickness of the endometrium for conception. If there are deviations from the norm, the egg does not mature.
How does fertilization take place?
Almost 12 mm is the size of the dominant follicular element on the 8th day of the cycle. The diameter of this bubble increases to 24 mm on the 12th day.
Such a follicle gradually fills with fluid and then bursts in the second week of the menstrual cycle.
The size of this bubble may be different on day 12. When this sac breaks, the follicular fluid enters the peritoneal region.
The process of ovulation lasts approximately 2 days. It does not occur if the follicular vesicles do not burst.
When conception occurs, the embryo will be in the uterine cavity after 10 days.
If fertilization of a sexually mature egg does not occur, it dies in a day.
Experts noticed that if ovulation occurred in the right ovary, it is likely that a girl will be born.
Persistent follicle
Such causes of infertility are very common. The egg does not leave the follicle. As a result of such deviations from the norm, ovulation does not occur, and a cyst forms on the ovary.
This neoplasm may increase over time.
Failure of the menstrual cycle, pain during menstruation are clinical symptoms of the appearance of such a cyst, which can be detected by ultrasound.
Since the follicular elements do not grow, it occurs if she does not start the necessary treatment on time.
Pregnancy will not occur, since the follicle does not burst, the sexually mature female cell does not have the opportunity to meet with the sperm. There are many other complications.
Why do follicular vesicles not mature in pathology?
Women of all ages face the problem of infertility. This is female infertility.
Its common causes are violations of the maturation of follicular elements in the female body.
The follicular apparatus is depleted, there are no follicles in the body if the paired sex glands are depleted.
This means that the woman's follicular supply has dried up, a syndrome of exhausted ovaries has arisen.
A manifestation of this pathology is the appearance of single follicles in the ovary. It is required to check the condition of the endometrium to assess the work of these female organs.
In case of ovarian pathology, treatment is prescribed by a gynecologist. The follicles do not mature, a woman is not able to become pregnant with such a pathology, since mature germ cells are not formed.
The maturation of follicular vesicles is a prerequisite for the formation of a full-fledged egg.
With an accuracy of up to 100%, it is rarely possible to identify the exact cause if the follicular apparatus is not expressed.
The functional balance of the reproductive system can cause. A negative effect has a low level of progesterone and lutein.
Early menopause or dysfunction of the reproductive organs explains the absence of follicles in both ovaries.
The pathological state of the endometrium disrupts the process of folliculogenesis.
Diagnosis of disorders of folliculogenesis
In order to conceive a child, you can contact specialists who will conduct a diagnostic study. The most favorable days for conceiving a baby are determined according to the indicators of folliculogenesis.
The natural contraceptive method is also based on this information. can be diagnosed in a woman if the process of folliculogenesis in the body is impaired.
A specialist can observe this natural process using folliculometry. This is an ultrasound monitoring procedure. Based on its results, a table is compiled.
If you estimate the number of antral follicles, it becomes possible to estimate the chances of getting pregnant.
You should contact a gynecologist in time for violations of folliculogenesis. This will allow you to become happy parents of a healthy baby.
For the proper development of the egg, which directly affects the health of the unborn fetus and the course of pregnancy in general, nature has created a unique mechanism for its protection. Few people know that this task is performed by the follicles located in the ovaries in women.
A follicle in gynecology is a shell consisting of a group of cells formed by the body to protect and fully develop the egg.
In a healthy woman, a large number of follicles mature in the ovaries throughout life, according to the degree of development they are divided into:
- primordial;
- antral;
- dominant;
- preovulatory;
- persistent.
The main function of the follicle is to create a favorable environment until the full maturation of the egg and ensure its safety.
In the case of a well-functioning reproductive system, the follicle accompanies the egg during the growth period, after which, under the influence of estrogen and luteinizing hormone, its walls become thinner, the membrane ruptures and ovulation occurs.
The most common cause of female infertility is the depletion of the ovarian follicular apparatus. Thanks to the symbiosis of technology and medicine, specialists can now detect such a deviation as the formation of a follicle without an egg, which can only be detected by puncturing the follicular fluid.
The development of follicles without an egg, or even its absence in the ovary, can be a serious problem for a couple and threaten infertility.
Primordial follicle
Primordial are small follicles in the ovaries that are not visible on ultrasound and are in the initial stage of their development. Their number in a woman is laid in the womb even before birth. By birth, a girl's ovaries may contain 1-2 million of these follicles, and by the time menstruation appears, about 300-400 thousand.
Each new cycle, the pituitary gland produces the hormone FSH, which stimulates the maturation of 5 to 30 primordial follicles, which subsequently become preantral or primary.
Antral follicles
Antral (secondary) are called follicles that have passed the first stage of development and have undergone structural changes. Each of them has a high chance of full maturation before ovulation.
During this period, the follicles reach a size sufficient to determine their number using ultrasound.
dominant follicle
With the normal functioning of a woman's ovaries, one of the antral follicles stands out in larger, dominant sizes. It is one dominant follicle (rarely 2) that continues the development cycle and passes to the follow-up preovulatory stage, the rest regress.
Preovulatory follicle
In the preovulatory follicle, compared to the antral follicle, there is 100 times more liquid component, and the egg is attached to the oviduct.
The day before the expected ovulation, the theca cells of the follicle increase the level of estrogen, which stimulates an increase in the production of luteal hormone. The wall of the follicle at the site of the arcuate protrusion bursts, and the egg comes out of the follicle.
Persistent ovarian follicle
One of the reasons for the lack of ovulation may be the persistence of the dominant follicle. The shell remains intact, preventing the egg from leaving the ovary, and the follicle continues to exist.
This situation requires medical supervision as it may be accompanied by a long delay in the cycle. A persistent follicle in most cases exists for no more than 10 days, but the risks of its development into a cyst should not be ruled out.
The norm of follicles in the ovary
Before saying that the follicular apparatus is depleted, it is necessary to know how many follicles should be in the ovary during normal functioning of the organs of the reproductive system.
Normally, for a successful pregnancy, each of the ovaries should have up to 25 antral follicles, which are determined by ultrasound.
In the process of maturation of each follicle on the days of the cycle, their number decreases. On the 8-10th day, the largest and most developed dominant one stands out from the total mass of the antral ones. If such a follicle appears in two different ovaries, a multiple pregnancy is possible.
Solitary follicles in the ovary
The consequences of disruption of the female genital organs may be the formation of a single follicle in the ovary.
This pathology almost completely deprives a woman of the possibility of conception without the help of specialists, and also threatens with the onset of early menopause and premature aging.
Follicle size by day of cycle
In the process of follicle development from primordial to preovulatory growth rates are constantly increasing. The size of the dominant follicle by day of the cycle is presented in the table.
With the growth of follicles on the days of the cycle, their size may differ from generally accepted norms, a decrease in indicators indicates violations in the reproductive system and requires the supervision of a gynecologist.
How much do you need to conceive
Despite the fact that one ovulated follicle is required for conception, women with 11-26 antral follicles develop in the ovaries at once have the highest chances. The presence of 6-10 is considered a low indicator, so specialists may suggest stimulation.
Often, only 5 follicles in the ovary are clearly visible on ultrasound - this is a low indicator for the possibility of conceiving a child.
To determine the ovarian follicular reserve, the following methods are used:
- ultrasound. It is carried out from 1 to 4 days of the monthly cycle to count the number and measure the size of antral follicles, which have a direct relationship with the number of primordial follicles.
- Measurement of the concentration of hormones in the blood. It is given on the 2-3rd day of the cycle, the ovarian reserve is inversely proportional to the concentration of FSH.
The most severe are the situations of maturation of only 4 follicles in the ovary. In this case, the normal development of the follicle and subsequent ovulation without the help of IVF specialists is almost impossible.
Deviations from the norm
The norms of the number of follicles and their sizes at different stages of maturation are average values. Despite the individual characteristics of the woman's reproductive system, deviations from the normative indicators, both up and down, require more careful medical supervision.
Among the most common deviations are:
- multiple follicles in the ovaries;
- a small number of follicles;
- immaturity of the follicle;
- follicle persistence.
Any of the above deviations reduces a woman's chances of conceiving a baby and can lead to irreversible consequences.
Many follicles in the ovary
On the one hand, it is good for a woman if there are many follicles in the ovaries, but there is always a risk of developing polycystic disease, and the sooner treatment begins, the greater the likelihood of maintaining reproductive function.
This pathology is characterized by the presence of a large number of follicular cysts, which prevents one of them from maturing to a dominant state. Ovulation does not occur, therefore, conception is impossible.
To treat a disease such as folliculosis (polycystic) of the ovaries begins with the use of combined oral contraceptives. Drugs regulate the amount of hormones, normalize the monthly cycle. At the same time, sports and a balanced diet are recommended, especially in cases of excess weight gain.
Few follicles in the ovaries
After the results of an ultrasound examination, a woman worries whether it is possible to become pregnant if there are few follicles in the ovaries.
A meager ovarian follicular apparatus is not yet a verdict. With the right choice of specialist, treatment and stimulation, the chances of pregnancy in a natural way increase.
Things are more complicated if the ovary is completely without follicles, which means that the direct function of the organ is lost. Reasons why follicles do not grow:
- genetic disorders (congenital);
- autoimmune processes;
- poisoning the body with chemotherapy, radiation;
- surgical interventions;
- inflammatory processes of a chronic nature;
- menopause.
During the onset of menopause, the number of follicles in the ovary decreases, the eggs practically do not form, and eventually disappear altogether.
If there are no follicles in the ovaries, the first thing a woman needs to do is undergo a complete examination to identify the causes, prescribe the correct treatment and prevent negative consequences.
The follicles existing in the ovaries can be grown in such a way as stimulation:
- Against the background of the abolition of oral contraceptives, temporarily suppressing the maturation of follicles, prescribed to the patient for 3-6 months. As a result, the ovaries begin to work in an enhanced mode after a long rest.
- Stimulation with stronger hormonal drugs, a number of which have serious side effects and cannot be used frequently.
You can increase the number of follicles in the ovaries with both medication and folk remedies. To stimulate the growth of germ cells in the first phase, a decoction of sage is used, and closer to the second - from a boron uterus containing phytohormones. Herbal drink is being prepared at the rate of 1 tbsp. for 200-250 ml. water, brought to a boil and cooled. It is recommended to drink in equal parts during the day.
Please note that before using decoctions or medications during the stimulation period, be sure to consult your doctor, make sure that there are no allergic reactions.
Two dominant follicles in one ovary
This situation differs from generally accepted norms, but despite the need for constant medical supervision, it is not a pathology.
In the case of full maturation and ovulation of two dominant follicles, a multiple pregnancy can most likely develop. This feature of the ovaries is mostly genetic and is inherited.
Why the follicle does not mature
Specialists in gynecology identify a number of reasons why follicles do not mature in the ovaries:
- diseases of the endocrine system;
- lifestyle (stress, smoking, heavy physical activity);
- deviations in the work of the pituitary and hypothalamus;
- early menopause.
The problem is that at a certain stage of development, for one or more of the above reasons, growth stops. All follicles regress, including the preovulatory one, the shell of which remained intact.
Why did the follicle not burst
Taking certain medications, hormonal disruptions, early menopause and pregnancy can cause the persistence of the follicle.
You can find out that the follicle has burst by the following symptoms and signs:
- aching pain in the lower abdomen;
- increased mucous secretions, discoloration;
- increased sexual desire;
- increase in basal temperature.
To confirm the result, you can use a special test that reacts to the release of luteinizing hormone.
In some cases, remaining intact, the follicle develops into a cyst. Do not let the situation take its course - this can lead to serious complications.
If you are attentive to your reproductive health, planning a pregnancy, or just interested in the processes taking place in the female body, then you should read this article - here you will find the most complete information about the role of follicles in the female body.
Follicles in the ovaries - why are they needed?
Today, many women are thinking about planning a pregnancy after they have crossed the 30-year mark, having achieved some success, both in the professional and social spheres.
However, it is impossible to go against the body's settings - the biological clock is set in such a way that just by this age, a decrease in the natural fertility of women begins.
It means limited ovarian reserve. That is, we are talking about the ability of the ovaries to mature a healthy follicle with a full-fledged egg.
It is important to emphasize here that immature germ cells (oogonia) are laid down by about the 20th week of intrauterine development of the fetus, and over time their number decreases. The formation of new germ cells throughout life does not occur.
However, do not forget that for a woman’s fertility, not only the number of “combat-ready” eggs is important.
Thus, the ovarian reserve is the cumulative number follicles located in the ovaries, and directly depends on a variety of physiological factors.
Video: Development of follicles and release of an egg from a dominant follicle
One of the most important factors affecting the number of follicles in a woman's ovaries is primordial pool. In short, this is the number of follicles that the girl has left by the time the menstrual function becomes established (on average, it is about 200-300 thousand).
In order to present an approximate consumption of the ovarian reserve, it is important to understand that folliculogenesis process happens constantly and non-stop. The follicles grow up to - or undergo atresia(reverse development).
It is in the follicles that reach ovulation that the maturation of eggs occurs, the fertilization of which leads to a long-awaited pregnancy.
With each menstrual cycle, the number of follicles decreases, and when full-fledged follicles are no longer determined - or single ones are determined (a very small number of follicles) - we can talk about the onset of menopause. During this period, a woman loses the ability to conceive.
How does the follicle grow and develop?
Folliculogenesis consists from three periods:
- Development primordial follicle before secondary— lasts for several months. The longest, hormone-independent process
- development of the secondary follicle greater antral. The process occurs under the influence of the hormone FSH (follicle-stimulating), lasts for 3-4 menstrual cycles.
- Follicle growth requires high doses of FSH. This stage lasts approximately 7 days. There is a selection dominant follicle, then its transformation into preovular, then ovulation occurs.
Follicle growth rates - follicle sizes by cycle days
Approximate table of follicle growth for a woman aged 29-32, with a regular cycle duration 28 days, not using oral contraceptives
Dominant follicle size at ovulation is from 20 to 22 mm. It is in it that the development of the egg occurs during the first (preovulatory) half of the cycle. Such a follicle develops if the menstrual cycle proceeds normally, without pathologies.
With the correct development of the dominant follicle, ovulation occurs when, under the influence of luteotropic hormone, it ruptures, and a mature follicle comes out of it into the abdominal cavity. egg.
How the follicle bursts - symptoms that the follicle has burst
By the way, a woman can feel the moment when the follicle is torn. It is characterized aching pain in the lower abdomen right or left - depends on which ovary the follicle has matured and burst. In its place, a corpus luteum is formed that produces progesterone.
However, events may develop differently.
Pathology of follicle development
It is important to note that the menstrual cycle, like all processes in a woman's body, is under the influence of hormones. First of all, these are LH (luteotropic hormone), FSH (follicle-stimulating hormone), as well as progesterone and estrogen.
If the hormonal background of a woman is disturbed - there is a lack of LH and progesterone, it may develop persistent follicle.
This condition is characterized by the impossibility of ovulation due to the fact that during persistence, the dominant follicle is not able to break and release the egg.
Accordingly, the dominant follicle continues to remain in the ovary.
In order to make an accurate diagnosis, you need to contact a gynecologist and undergo an ultrasound procedure.
The doctor in the diagnosis will focus on the following indicators:
- Low progesterone, high estrogen.
- Absence of the main signs of ovulation.
- Irregularity of the menstrual cycle.
Monitoring the presence of the follicle during the ultrasound procedure on different days of the menstrual cycle
Why does the follicle not "burst", but turns into a follicular ovarian cyst?
Follicular ovarian cyst- a benign formation formed from a dominant follicle in the absence of ovulation with continued growth of the follicle.
It occurs due to hormonal abnormalities in the body of a woman, namely, violations of the function of the cerebral cortex.
Also, a problematic hormonal background increases the likelihood of the formation of a corpus luteum cyst in the ovary. After the follicle bursts, excess fluid can accumulate in its place, sometimes containing blood - as a result, a cyst forms, since the corpus luteum does not regress.
Most often, this condition does not require special treatment and goes away on its own after several cycles, and during pregnancy - in the second trimester.
The appearance of a corpus luteum cyst, a follicular cyst, and a persistent follicle is often associated with inflammatory diseases of the pelvic organs, stress, and the consequences of abortion.
Treatment, if necessary, must in all cases be carried out under medical supervision!
Why does the egg not come out of the follicle?
Women of childbearing age may also face the problem anovulation - menstrual cycles with no ovulation.
- This may be due to a violation of the growth and maturation of the follicle - therefore, the egg is missing (empty follicle).
- The egg cannot be released due to the fact that the shell of the ovary is too dense.
The doctor should deal with the reasons that led to this condition. If periodically even a healthy woman can experience anovulatory cycles, then with a systematic absence of ovulation, we can talk about a pathology that is one of the main causes of infertility in women.
Often, this indicates the existence of problems with the internal genital organs, a malfunction of the endocrine glands (hormonal imbalance), or the presence of chronic inflammatory diseases of the small pelvis (for example, polycystic ovaries).
With problems in the reproductive system, the follicles in the ovaries may stop maturing.
Why there may be no dominant follicle in the ovaries - all the reasons why the follicles do not mature.
One of the main reasons infertility is the problem of maturation of the dominant follicle and the impossibility of ovulation.
This is often due to:
- Follicles do not develop at all, or there are single follicles (a small number) - the so-called "sleeping" ovary syndrome.
- The follicle develops abnormally reaches a certain phase and regresses.
- The follicle does not develop to the required size.
Doctors identify the following reasons why follicles in the ovaries do not ripen:
- Achievement by a woman of a critical age for reproduction - 37.5 years;
- Chronic diseases of the pelvic organs;
- Toxic effects
- Syndrome of premature exhaustion of ovaries;
- Surgical interventions on the pelvic organs;
- An unfavorable environment that provokes the emergence of a situation of stress.
Thus, under the influence of a number of circumstances, healthy follicles with a full-fledged egg may be absent in the ovaries of a woman - or only single instances are observed.
Summarizing the above, it is worth emphasizing that the most important thing in violations of folliculogenesis is to adequately determine the causes of their occurrence.
If you have any concerns about your reproductive health - be sure to undergo a comprehensive diagnosis by a gynecologist!
A woman's ability to procreate is determined by the well-coordinated work of her reproductive system. And in it a very important role is given to the ovarian follicles. It depends on the small formations in the sex glands of a woman whether she will be able to conceive a child, whether her female health will be strong and long.
What it is?
A follicle is a formation inside the ovary, it is a structural component of the female gonad, which consists of an immature egg and three layers of membranes (one - epithelial and two of connective tissue). The egg inside the follicle is called the first-order oocyte.
The reproductive cell until its maturation is carefully surrounded by a layer of glycoproteins and granulosa cells, which, in turn, are protected by an extracellular matrix - the basement membrane. Around it are the theca cells.
The structure and structure of the follicle are such that all elements carry only one functional meaning - to preserve and protect the female germ cells, and when the time comes, to provide them with optimal conditions for maturation.
The ovaries in female fetuses are formed even during fetal development; at 9-10 weeks of gestation, there are millions of follicles in the ovaries of the crumbs with a huge supply of first-order oocytes. Some cells die for natural reasons under the influence of a wide variety of external factors. At birth, a girl's ovaries have about 500,000 follicles.
They doze, do not act until the moment when puberty starts. By this period, the girl has about 250 thousand germ cells. But they die, and these processes are affected by ecology, nutrition, and diseases. Thus, from the numerous ovarian reserve given to the girl by nature at birth, only 450-500 germ cells are allocated for her reproductive period.
The follicles in the ovaries are in a constant process of maturation. This process sets the cyclical work of the female body, so every month one or two follicles mature in the gonads, which release a mature and fertile egg from their internal cavity on the day of ovulation. With age, when a woman acquires bad habits, chronic diseases, the depletion of the ovarian reserve becomes rapid. And already after 35 years, both the quantity and quality of follicles and oocytes leave much to be desired. By the age of 40, a woman has no more than 3% of her original ovarian reserve.
That is why experts do not recommend that women put off having a baby for too long, arranging their careers and settling other life circumstances. The reserve cannot be replenished, new primary follicles with first-order oocytes are not formed in the ovaries.
When the reserve is exhausted, menopause will come, that is, menopause. This means that you need to use your follicular reserve carefully and wisely.
Maturing process and cycle
The process that takes place every month in the female body, metamorphoses concerning the follicles, is called folliculogenesis. The process of maturation of these bubble sacs is very complex, regulated at the hormonal level by the body itself. It proceeds continuously and breaks are possible only during pregnancy. Folliculogenesis ends during menopause - with a depleted ovarian reserve, new follicles do not mature, there is no menstruation.
Multiple primary follicles are very small (no more than 50 microns), they cannot be seen without a microscope, they were laid before the birth of a girl and are called primordial. They originate in the ovaries at the 6th week of pregnancy. And the process of formation of new primordial follicles is completely completed by late pregnancy.
When a girl enters puberty, her anterior pituitary gland begins to produce a special substance - follicle-stimulating hormone (FSH). Under the influence of this active substance, every month immediately after the start of the next menstruation in the right and left ovaries, the formation and growth of 5-15 follicles from the reserve simultaneously begins. As soon as they begin to grow, their status changes - they become preantral, and their size is about 200 microns.
In the process of growth, many cellular processes take place, inside the vesicle-follicle a cavity with a liquid is formed, in which there is a first-order oocyte. Such follicles can already be assessed on ultrasound, they are called antral. Their dimensions are already equal to 3-4 millimeters.
But all antral follicles must survive until ovulation, only one remains - the dominant one. Its growth rate is more intense. The remaining antral counterparts undergo reverse development and are stored by the body for future menstrual cycles. The development of the next follicle is delayed at the hormonal level. The dominant follicle grows rapidly, an egg matures inside it - before ovulation, the size of the follicle reaches 20-22 mm (sometimes 24 mm). Active production of estrogen and luteinizing hormone begins.
The LH hormone acts on the follicular membrane, thinning it. A mature egg is located on a tubercle and protrudes above the surface of the ovary. The follicle is now tertiary or preovulatory. It is also called the Graaffian bubble. Under the action of LH, a stigma is formed - a protrusion in the wall of the follicle. At the site of the stigma, the membranes rupture and the mature egg is released.
First, the egg enters the abdominal cavity, from where it is captured by the fallopian tube. Once in the fallopian tube, the oocyte retains the ability to be fertilized for 24-36 hours. If conception does not occur, the egg dies.
Ovulation Calculator
Cycle duration
duration of menstruation
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Enter the first day of your last menstrual period
Ovulation occurs 14 days before the start of the menstrual cycle (with a 28-day cycle - on the 14th day). Deviation from the mean value is frequent, so the calculation is approximate.
Also, along with the calendar method, you can measure basal temperature, examine cervical mucus, use special tests or mini-microscopes, take tests for FSH, LH, estrogen and progesterone.
You can definitely set the day of ovulation through folliculometry (ultrasound).
Sources:
- Losos, Jonathan B.; Raven, Peter H.; Johnson, George B.; Singer, Susan R. Biology. New York: McGraw-Hill. pp. 1207-1209.
- Campbell N. A., Reece J. B., Urry L. A. e. a. Biology. 9th ed. - Benjamin Cummings, 2011. - p. 1263
- Tkachenko B. I., Brin V. B., Zakharov Yu. M., Nedospasov V. O., Pyatin V. F. Human Physiology. Compendium / Ed. B. I. TKACHENKO. - M.: GEOTAR-Media, 2009. - 496 p.
- https://en.wikipedia.org/wiki/Ovulation
But after an increase in growth, that is, after the follicle, in fact, has fulfilled its role and ensured the maturation and release of the egg, matured and burst, development does not end. From the remnants of the shells, a new formation is grouped - the corpus luteum. This is a temporary gland that produces shock doses of progesterone. This hormone prevents the rejection of the endometrium and the onset of menstruation, the layer of the inner lining in the uterus grows under its influence and prepares to accept the fetal egg.
Implantation, if a woman has conceived a baby in the current cycle, usually occurs 6-8 days after ovulation. And in this case, in a day, the production of another hormone well-known to women, hCG, starts (it is he who makes the pregnancy tests “strip”). This hormone maintains the corpus luteum in working condition until 12-14 weeks of pregnancy, until all endocrine functions are taken over by the young placenta.
If there was no conception or the embryo for some reason could not implant, the corpus luteum dies 10-12 days after ovulation, progesterone production stops, estrogen concentration rises, which leads to the onset of menstrual bleeding, in which endometrial rejection occurs. And already in the first days of the cycle, everything starts from the very beginning - the growth of primordial follicles.
The entire female cycle is divided into two phases - follicular and luteal. In the first, the follicle matures, and the luteal phase begins after ovulation. Typically, the luteal phase in women of different ages and different health conditions lasts about 14 days. It helps to determine the estimated day of ovulation - 14 is subtracted from the duration of the menstrual cycle.
Examination methods
The only way to track the processes associated with the maturation of follicles is folliculometry. This is the name of a type of ultrasound. The ovaries are examined, the examination is carried out in dynamics several times in one cycle with a break of several days during the cycle. Ultrasound examination allows you to establish how consistent the ovarian follicular reserve is (antral follicles are counted), as well as to determine the fact that ovulation is approaching, the size of the dominant follicle and to state the fact of completed ovulation.
Especially folliculometry is indicated in preparation for IVF, in search of the cause of female infertility, in preparation for intrauterine insemination. This study in some cases helps to find the cause of the disorder of the female cycle.
The first procedure should be carried out after the end of menstruation. On the 5-7th day of the cycle, the doctor can count the number of antral follicles. Further, the procedure is repeated every 2-3 days (at the discretion of the doctor). The study can be carried out both with an abdominal sensor (through the anterior abdominal wall) and intravaginally. In the first case, it is important that the woman comes to the ultrasound diagnostic room with a full bladder. With a vaginal ultrasound, on the contrary, it is recommended to visit the toilet on the eve of the examination, since the bladder must be empty.
A quantitative indicator of antral follicles is a way to assess the reproductive capabilities of a woman (there are options in the table):
- over 26- this is too much, which is regarded as a manifestation of polycystic disease, the cause of which often lies in a serious endocrine disorder, usually pregnancy cannot occur until the causes of the failure are eliminated;
- 11-25 - a norm indicating that a woman should not have problems with independent conception;
- 6-10 - reduced ovarian reserve; in some cases, hormonal stimulation of ovulation may be recommended;
- less than 5(single follicle, absence of follicles) - infertility, in which even stimulation does not make much sense.
Follicles do not mature during menopause. In turn, the probability of depletion of the reserve is at any age. So, often the reason that there are too few antral follicles can be a woman undergoing chemotherapy or radiation treatment, exposure to radiation, poisons and toxins, severe hormonal disruptions caused by abortions, long-term use of hormonal drugs.
Important! When calculating according to the world standard, doctors take into account only those antral follicles that are well visualized, have clear boundaries and are at least 2 mm in size.
- 4-5 day of the cycle- antral follicles from 2 to 4 mm in diameter;
- 6-7 day of the cycle- sizes increase up to 5 mm, follicles remain antral, there is a decrease in the number due to natural regression and involution;
- day 8 of the cycle- the dominant follicle is determined with a size of about 9-11 mm;
- 9-10 days of the cycle- the size of the follicle is 13-15 mm, a liquid cavity with an egg is visualized inside. Two follicles in one ovary during this period means that ovulation can be double, which increases the likelihood of multiple pregnancy;
- Day 11- the follicle reaches a size of 17 mm;
- 12-13 day- the cavity inside the dominant follicle grows and expands, its diameter reaches 19-20 mm, the stigma is clearly visible on the surface.
In order for a woman to become pregnant, there must be at least 1 follicle. In the absence of follicles, pregnancy is not possible.
If a woman is preparing for an in vitro fertilization procedure, then the maximum size of the follicle is not expected. It is necessary to obtain eggs for fertilization in the laboratory, and therefore, when the follicles (in the plural, since there are several dominant ones, which was caused by hormone therapy) reach a size of 17-18 mm, a follicle puncture procedure is prescribed.
In the second half of the menstrual cycle, a woman can find out from the results of an ultrasound whether she has ovulated. This will help the detection of the corpus luteum in the ovary. To confirm the fact of ovulation, it is better to contact the diagnostic room 3-4 days after the expected day of ovulation, so that the size of the corpus luteum allows the doctor to visually determine and measure it.
The fact that ovulation has taken place is indicated by the absence of a follicle, the presence of a corpus luteum and the presence of a small amount of free fluid in the abdominal cavity. If ovulation was double, that is, two follicles burst, then two corpus luteum are determined, which can be located both in one ovary and in different ones. If for some reason there was no rupture of the follicle, there was no maturation, ovulation does not occur, the woman in this cycle is not capable of conception, the cycle itself is called anovulatory.
Such cycles occur from time to time in any perfectly healthy woman. Normally, in young women and girls - up to 1-2 times a year, after 35 years - up to 5-6 times a year. And this is another answer to the question why it becomes more difficult to get pregnant with age, even if the woman is healthy.
In addition to folliculometry, laboratory blood tests for sex hormones are used (the level of FSH, LH, estradiol, progesterone and testosterone can tell a lot). Analyzes are referred to as clarifying methods that help to more accurately understand the causes of disruption in the process of maturation of follicles, if any.
Possible problems - symptoms and treatment
An examination can reveal a wide variety of folliculogenesis disorders, and in most cases they all lead to one degree or another that a woman cannot conceive a child, menstrual cycle failures occur. Consider the most common pathologies.
persistence
They speak of a persistent follicle when the process of maturation of the follicles proceeded at a normal pace, the dominant one was clearly fixed, but its membrane did not break. The egg does not come out, it is overripe and dies inside the follicular cavity. There is no ovulation, conception is impossible. Most often, such a follicle appears with a reduced level of the LH hormone. It still exists on the surface of the ovary for about 10 days, and then it transforms into a follicular cyst or resolves.
Most often, persistence is found in girls in adolescence and in women in the period of premenopausal changes. There are two types of persistence:
- rhythmic- a non-bursting follicle exists from 20 to 40 days, and then menstrual-like bleeding begins, the cycle is restored in 95% of cases;
- Schroeder's disease- this is a prolonged persistence, which often develops in older women, when a persistent follicle can exist for several months, producing estrogen, until heavy uterine bleeding occurs due to atresia of the follicle.
In most reproductive women, it is the rhythmic form of pathology that occurs. Symptoms of persistence are not characteristic and bright. This is usually manifested by a delay in menstruation. New follicles do not mature during the delay, the woman cannot conceive, there are no periods. Some note small pulling pains in the lower abdomen on the right or left side.
Persistence itself is not dangerous, but it is possible that high concentrations of estrogen can lead to the degeneration of the endometrium into malignant cells, and the risk of breast cancer also increases.
And it is for this reason that it is important to consult a doctor in time with a delay in menstruation in order to receive qualified help in a timely manner.
Most commonly used for persistence hormone therapy aimed at normalizing the cycle. A woman who does not plan to conceive may be recommended modern oral contraceptives. In some cases, therapy is carried out in phases of the cycle with the intake of replacement hormones - estrogens and hCG before ovulation and progestins - after.
Atresia
With such an ovulatory disorder, the follicle grows and develops at a normal pace, but at the stage of growth of the dominant vesicle, a sudden stop in growth occurs and involution starts. Ovulation does not occur with atresia, in some cases, when the development of the vesicle stops at the stage of the tertiary follicle, a cyst may form.
Symptoms also lie in the violation of the cycle - women experience quite long periods of amenorrhea (absence of menstruation), spotting is possible, which is long in time, but not abundant in quantity.
Treatment is also mainly based on hormone therapy to normalize ovulatory processes.
Cyst
Cystic ovarian formations are different: there is a corpus luteum cyst, there is a follicular cyst, a retention type, there are cysts that appear before pregnancy and are present for quite a long time, there are formations that first appear during pregnancy. They are cavities filled with fluid, sometimes interspersed with blood or pus.
A cyst may be indicated by a significant excess in the size of the follicle. In the vast majority of cases, you should not be afraid, since the cystic formations of the follicles are physiological in nature, that is, they are prone to self-involution within two to three menstrual cycles. But even if the cyst did not resolve before pregnancy, it often happens in women already in an “interesting position”.
With such a diagnosis, it is important to visit the doctor more often, since it is not the cyst that is dangerous, but its possible complications, although they do not happen often. These include torsion of the legs and rupture of the cyst. In both cases, the woman experiences severe pain of a cutting nature, a discharge that is atypical for the phase of the cycle appears, and a sharp decrease in blood pressure is possible.
In this case, it is important to deliver the patient to a medical institution with a surgical department as soon as possible.
Luteinization
In this condition, folliculogenesis is disrupted, the corpus luteum begins to develop before the rupture of the follicle occurs. The follicles remain immature, and ovulation also does not occur.
The condition does not have any specific symptoms. the only complaints that women make are about the shortening of the cycle and infertility. Treatment is again based on hormonal therapy after analyzing the concentration of different hormones on different days of the cycle and folliculometry.
Important! Women are often interested in how to grow follicles with folk remedies, are there ways to increase the size of the ovarian reserve. In fact, there are no such methods. Neither a woman nor doctors can increase the size of a follicle.
Similarly, the follicular reserve is beyond the control of medicine. And the only way to stimulate ovulation is the introduction of certain doses of the hormone hCG or LH analogues at the moment when the dominant follicle reaches a large size. But such methods are used only in a medical institution, since the consequences of unauthorized hormone treatment can be very tragic.
As for dietary supplements and complex preparations for women, the manufacturers of which describe the miraculous effect of their products on the female reproductive system and cycle, their effect has not been proven, and experts highly doubt their effectiveness. If a woman has problems with ovulatory processes and the endocrine background, then such remedies usually do not help. If there are no problems, then there is no need to take dietary supplements.
Causes of follicular disorders
The processes of maturation of the follicles are completely dependent on the ratio and concentration of certain hormones, and therefore the most common cause of cycle disorders and ovulation is endocrine imbalance, which can be temporary or long-term. Temporary disturbances can cause:
- chronic fatigue, lack of sleep, lack of night sleep, work in night shifts;
- excessive physical activity, professional sports, hard work;
- the harmful effects of poisons, toxins, varnishes and paints, the most dangerous - chronic poisoning in small doses for a long time;
- flights and travels, business trips and tourist trips in which a woman experiences changes in her usual climate and change of time zones;
- stress, anxiety, severe emotional upheaval.
Violations for such reasons often go unnoticed at all, because the cycle is restored on its own in a short time, and few people immediately pay attention to the delay in menstruation.
Violations of folliculogenesis that develop as a result of diseases and conditions of the following nature lead to more serious and prolonged forms of endocrine infertility:
- pathologies of the pituitary gland, hypothalamus;
- diseases and dysfunction of the ovaries, violations of their morphological characteristics;
- injuries and postoperative changes in the tissue of the gonads;
- thyroid and adrenal dysfunctions.
Problems with hormonal disorders that prevent the normal maturation of follicles occur in women after childbirth and after abortions. And also in women who abuse smoking and alcoholic beverages. In addition, folliculogenesis disorders often develop against the background of long-term use of antidepressants, antibiotics, hormones, including oral contraceptives.
Follicle puncture for IVF
If a woman cannot conceive on her own and IVF is indicated for her, then she will have to go through this procedure. The more eggs the reproductologist receives, the higher the chances of successfully completing the in vitro fertilization treatment protocol. First, follicle growth is stimulated with hormones - as a result, not one, but several dominant follicles mature. As soon as their diameter reaches 17-20 mm, an injection of hCG is injected. The next day, oocyte sampling is scheduled.
The procedure takes place under anesthesia, as the puncture itself is quite painful. A puncture is made in the fornix of the vagina and access to the gonads is gained. Each mature follicle is pierced with a needle and all its contents are sucked out. Embryologists extract oocytes, evaluate their quality and perform laboratory fertilization.
Puncture is also used for egg preservation. Some women, knowing that they are about to undergo treatment for cancer, or who are not yet set on procreation for career or other reasons, want to leave good “young” eggs for the future in a cryobank.
On the function of the ovaries, see the following video.
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