10 dominant follicles in the left ovary. Follicles in the ovaries: normal and abnormalities. Is it possible to increase the number of antral follicles?

The physiology of the female reproductive system is one of the most interesting areas of medical science. Nowhere else in our body is there such diversity and complexity of cause-and-effect relationships. This is especially true for the ovulatory and menstrual cycles. Their regulation occurs under the influence of the endocrine system and hormones secreted by the dominant follicle of the right ovary.

Structure of the ovaries

The thing is that the ovary consists of millions of small formations called follicles. Inside them is an egg, surrounded by a layer of cells that provide its nutrition. Throughout life, they are all at different stages of their development:

• Germinal or premordial follicle;
• Immature, which is called preantral;
• Maturing - antral;
• Primary, or preovulatory.

The dominant follicle of the right ovary plays the central role of the cyclical changes that occur in a woman’s body. Among the many mature follicles, one is formed, from which ovulation will occur. It is called dominant. In this case, all other follicular formations are delayed with their gradual involution. All other ovarian tissues are represented by thecal cells, vessels and connective tissue.

Fate of the dominant follicle

This education has two paths:

1. Its formation occurs until its rupture occurs. This occurs as a result of the tissues that cover it becoming necrotic. In this case, the egg is released on the surface of the ovary. This condition is called ovulation and occurs on days 12-17 of the cycle.
2. Continuous growth of the dominant follicle with its transformation into an ovarian follicular cyst. This menstrual cycle is called anovulatory. If ovulation does occur, a scar called the corpus luteum forms at the site of the follicle.

It has been established that both ovaries are capable of ovulation, which should occur alternately. But for some reason it happens that the dominant follicle in the right ovary is formed more often. This is also confirmed by the fact that ectopic pregnancy develops more frequently in the right fallopian tube. Also, the right ovary is more prone to the formation of follicular cysts.

Functional role

This relates to key issues of the ovulatory and menstrual cycles. As the dominant follicle develops in the right ovary, it secretes the hormone estrogen, which ensures that the body is saturated with this substance and prepares the endometrium for the possible implantation of a fertilized egg. With the formation of the corpus luteum, progesterone begins to be produced. This hormone supports the development of the fertilized egg if it attaches to the prepared endometrium of the uterine cavity.

These data make it clear why dishormonal disturbances in the female body are manifested by menstrual cycle disorders, behavioral and autonomic reactions, and what is the role of the dominant follicle in their appearance.

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Dominant follicle: What is it and its role in conception?

An ultrasound examination of infertile women is done to determine whether the egg is maturing and whether ovulation occurs. The main sign of ovulation is the dominant follicle before ovulation and its absence after it.

Even in the fetal body, during the formation of organs in the ovaries, about 500 thousand follicles are formed, some of them regress and by the time women reach puberty, about 200 thousand remain. Of these, only a small proportion matures and can participate in fertilization. Therefore, data obtained from an ultrasound examination can help to find out the cause of infertility and begin treatment on time.

Why is it needed?

Every month in a woman’s body, 7–8 follicles begin to increase in size, then their development stops and only one, rarely two, continue to grow - this is the dominant follicle, the rest regress and undergo atresia. During the day its size increases by 2–3 millimeters. Before ovulation, it reaches 18–20 mm, and an egg is released from it, capable of fertilization.

If a dominant follicle is not formed, or its pathological development is observed, then the egg does not mature and cannot be fertilized. Therefore, when examining women with infertility, a gynecologist prescribes an ultrasound examination to see if there is any developmental pathology.

Stages of development

In the fetus, premordial follicles are formed in the ovaries; these are immature eggs surrounded by connective tissue. During the menstrual cycle, they become covered with a connective tissue membrane and begin to produce estrogens. They are called preantral. On days 8–9 from the beginning of the cycle, they are filled with fluid and their size is 10–15 mm; these are antral follicles. One of them continues to grow and becomes dominant or dominant. The rest undergo atresia.

When the follicle bursts and the mature egg begins to move through the tubes to the uterus, a corpus luteum forms in its place. The hormones produced in it prepare the uterine lining for pregnancy. If pregnancy does not occur, menstruation begins.

What can an ultrasound show?

The dominant follicle can normally be seen on ultrasound from days 5–8 of the cycle. Already at this time it is ahead of its fellows in size. Growth is due to the action of follicle-stimulating hormone. A decrease in it in the blood can cause a situation where it does not reach its normal size and reverse development occurs. Ovulation may not occur if the ovarian membrane is sclerotic, then it continues to develop and can turn into a cyst. After ovulation, it disappears and in its place a corpus luteum can be seen in the ovary. Sometimes overripe follicles are found, their size is 21–23 mm, that is, ovulation has not occurred.

This is interesting! It has been noted that the dominant follicle is more often found in the right ovary. This is evidenced by the frequent detection of the corpus luteum in the right ovary and ectopic pregnancy with rupture of the tube on the right. What this is connected with is still unknown, although there is a hypothesis that on the right they are formed more often in right-handed people due to increased nervous stimulation from the nervous system.

Ultrasound helps to detect the cause of infertility. This method is called folliculometry. The patient undergoes an ultrasound examination over several days, during expected ovulation. You can detect the absence of a dominant follicle or pathology of its development.

Developmental pathologies

Egg release in women is impossible in the absence of a dominant follicle. This happens due to hormonal imbalance and various diseases:

1. it is not formed when follicle-stimulating hormone decreases or luteinizing hormone increases in the blood;
2. regression or atresia occurs due to hormonal disorders, including an increase in insulin in the blood;
3. a persistent follicle is observed on ultrasound if ovulation does not occur. It does not undergo regression, is of normal size or slightly enlarged (overripe). Sometimes women have dominant and persistent follicles in different ovaries;
4. A follicular cyst is formed from a dominant follicle that continues to grow. Fluid accumulates inside, the size of the cyst on ultrasound is more than 25 mm, if there are many of them, then this condition is called polycystic;
5. luteinization. In place of the dominant follicle without ovulation, the corpus luteum is formed.

Important! If the follicle persists, its membrane may rupture and the egg will be released into the abdominal cavity. In this case, pregnancy cannot occur due to the inferiority of the egg.

All these pathologies require study and additional examination. It is necessary to check the hormonal level in a woman’s blood and find the reason for its change. These may be endocrine diseases, pathology of the pituitary gland, anomalies of ovarian development.

What to do?

Ultrasound examination is carried out as a preventative measure for diseases of the reproductive system. It can assess not only the condition of the ovaries, but also the uterus. Thus, a sign of ovulation is the presence of free fluid in the abdominal cavity. Depending on the ultrasound picture, the doctor decides what to do:

• during a routine examination, the detection of a dominant follicle is normal; it depends on the time of the ultrasound. If there are complaints about the inability to get pregnant, you need to repeat it in the middle of the menstrual cycle;
• when there is no dominant follicle, then folliculometry must be done. It will help you figure out what is happening, especially since its absence also occurs during normal development after ovulation. It is also necessary to examine the level of blood hormones at different stages of the menstrual cycle, it will be different in different phases;
• if there are two or more dominant follicles, the cause may be stimulation of the ovaries with drugs, heredity (twins are often born in a family), or diseases with which differential diagnosis needs to be carried out (multifollicular ovary syndrome, polycystic disease);
• if developmental pathologies are detected (luteinization, persistence), then further examination is necessary to find out the cause. Such pathologies can be observed simultaneously with the normal development of the dominant follicle. For example, a developing follicle is found in one ovary, and a persistent follicle in the other.

Stopping oral contraceptives can also lead to multiple pregnancies. This is due to sudden changes in a woman’s hormonal balance that occur after discontinuation of the drug.

This is important to know! Oral contraceptives can affect the level of hormones in a woman’s blood. They not only prevent pregnancy, but also normalize the cyclicity of menstruation, therefore they are often prescribed in the first period of treatment for infertility associated with irregular menstruation.

If a woman has 2-3 dominant follicles visible on ultrasound, and this is often observed during ovarian stimulation, in preparation for in vitro fertilization (IVF), it can be hereditary, then under favorable conditions, both of them can be fertilized and lead to multiple pregnancies. In such cases, fraternal twins or twins are born.

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Dominant follicle in the right ovary: what is it, what are the developmental features, common abnormalities and risk factors

The dominant follicle in the right ovary is the most developed of all the others, ready for the process of ovulation. However, formation can also happen on the left side. As a rule, in the fairer sex, only one main follicle matures every month.

Functions and meaning

Before talking about dominant ones, you should understand what they generally are and what their purpose is. This sac, called a follicle in medicine, is an integral part of the ovary, where the egg is based.

What it is?

The latter is surrounded by epithelium and two-layer connective tissue. The key role of this vesicle is to protect the egg from the negative influence of external factors.

It is inside it that the egg matures. And the maturation of the egg, and, consequently, the likelihood of pregnancy, depends on how good such protection is.

It's no secret that girls' reproductive system is formed even before birth, in the womb. Actually, at the same time the development of the follicular apparatus occurs. Already at this time, a certain number of follicles was determined, which will be constant throughout life. Between 50,000 and 200,000 is considered adequate.

Reference! After the birth of a girl, a new stage in the development of her reproductive system begins - the so-called postnatal period.

As is known, in the body of each representative of the fairer sex, one egg matures once per cycle. If fertilization occurs, then conception occurs. If this does not happen, then the shell is released from the undeveloped egg, and a new menstrual cycle begins.

Stages of development

Experts divide follicles into antral and dominant. The latter are the largest and most developed in the ovary. By the very middle of the cycle, several follicles mature in the female ovaries. One of them subsequently becomes the most important. All others dissolve over time.

Before a follicle becomes dominant, it must go through several stages:

• the appearance of antral follicles;
• development and growth of small;
• maturation of dominants;
• ovulation.

If all these stages have passed without any disturbances or difficulties, then an egg is released from the mature follicle, which allows you to conceive a child.

Peculiarities

As noted above, the development of the leader occurs, as a rule, in the right ovary. This is due to the fact that in women of reproductive age the right gonad is characterized by greater activity.

However, egg formation and maturation can also occur in the left ovary. The most important thing in this case is that from the mass of antrals, the formation of one dominant one occurs. If it ruptures and releases the egg, then we can assume that the ovulation process was successful.

Irregularity of the menstrual cycle and long unsuccessful attempts to get pregnant are evidence that a woman has problems with ovulation.

As experts note, the following factors can negatively affect the formation and development of the dominant follicle:

• taking oral contraceptives. This problem can be eliminated only by stopping taking these pills. Within a few months, the ovulation process will be restored;
• development of infectious diseases in a latent form;
• pathology of the thyroid gland. If the function of the thyroid gland is reduced or, on the contrary, increased, this negatively affects not only the reproductive system, but also the entire woman’s body;
• high levels of the hormone prolactin.

All of these factors have a significant impact on a woman’s reproductive function. Fortunately, modern medicine is able to eliminate most of the disorders occurring in a woman’s body. It is important here that the woman promptly contacts a specialist who will be able to identify the cause of the violation and eliminate it.

Multiple pregnancy

Sometimes it happens that development can simultaneously occur in the ovaries on the right and left sides.

At the moment when potential mothers are ovulating, the size of the dominant follicle reaches 18-22 mm in diameter. At the moment when luteinizing hormone is released into the blood under the influence of estrogen, it ruptures and ovulation occurs.

In a situation where large follicles develop in parallel in the ovaries on both sides, two mature eggs are released simultaneously, as a result of which there is a possibility of a multiple pregnancy. Thus, a woman has a chance to become pregnant with twins.

Ultrasound tracking

According to experts, in normal condition the largest follicle can be identified by ultrasound starting from the 5-8th day of the menstrual cycle. By this point, it is larger than the others. This is due to the influence of follicle-stimulating hormone.

A reduction in the amount of this hormone risks the fact that the largest follicle does not grow to the appropriate size and the process of its development begins in the opposite direction.

It may happen that ovulation does not occur if sclerosis of the ovarian membrane has developed. In this situation, it can continue to develop further, leading to the appearance of a cyst.

After ovulation, such a follicle disappears, and the corpus luteum can be observed in this area. In some cases, overripening may occur when the size reaches 21-23 mm. This suggests that ovulation never happened.

As practice shows, the development of a dominant follicle most often occurs in the right ovary.

Evidence of this is the very frequent detection during ultrasound of the corpus luteum in the ovary on the right side and ectopic pregnancy, accompanied by rupture of the tubes on the right side.

How to explain this is still unknown. However, there is a theory that the formation of a dominant follicle on the right side occurs more often in those who write with their right hand.

Reference! This happens due to the high nervous stimulation carried out by the nervous system.

It is ultrasound that makes it possible to understand who is to blame for developing infertility. This research technique in medicine is called folliculometry. The patient undergoes an ultrasound scan over several days during the expected period. It is at this time that it is possible to identify the absence of a dominant follicle or pathology in its development.

Common deviations

As you know, the release of an egg will not happen under any circumstances if the dominant follicle is absent.

This can occur due to hormonal imbalance and the presence of a number of pathologies:

1. Low levels of follicle-stimulating hormone or elevated levels of luteinizing hormone can lead to the absence of a leading follicle.
2. Hormonal disturbances, for example, high levels of insulin in the blood, can lead to regression or atresia.
3. If ovulation does not occur, then it is possible to observe a persistent follicle on ultrasound.
4. The leading follicle can also form a follicular cyst, which will continue to grow. If there are many such cysts, then polycystic ovary syndrome develops.
5. The process of luteinization, when instead of the so-called leading follicle without the process of ovulation, the formation of the corpus luteum occurs.

If it so happens that a woman, after repeated unsuccessful attempts to conceive a child, was unable to do so, and this was caused by one of the listed pathological processes, then she needs highly qualified help from a medical specialist. It is he who will prescribe the medications that will stimulate the ovulation process. The effectiveness of the course of therapy can be monitored using ultrasound results.

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What is a dominant follicle?

When planning the birth of a baby, you need to clearly know the favorable dates for conception. It is during the period of ovulation that the sperm is ready to meet the egg. During the period of ovulation, a woman experiences changes in the uterus and appendages, as during these days the body prepares for fertilization. The body's preparation for conception goes through several stages. At the initial stages, growth occurs, then a dominant follicle is formed, the egg is released (ovulation) and ends with the development or destruction of the corpus luteum.

According to scientific data, the number of lymph nodes in a developing female embryo can reach 200 thousand. With age, changes occur in the body, and developed lymph nodes are reabsorbed. Over the course of her entire life, a female can only reproduce about 450-550 lymph nodes in both ovaries.

Female sex hormones, estrogens, are produced by a vesicle in which an egg is formed.

During puberty in a teenager, vesicles develop in which eggs develop, which triggers the onset of menstruation.

The concept of a dominant follicle

Several thousand lymph nodes can form in a woman's body. Naturally, not everyone can develop; the most strongly developed dominant follicle is formed in the left or right ovary.

During the period of ovulation, the size of the dominant vesicle can reach 19-25 mm. In the case when lymph nodes develop in both the right and left ovaries, two eggs are formed.

If the development of the egg proceeded without disturbances, then fertilization may occur.

Stages of follicle development

The development of the dominant lymph node is divided into 4 stages, each of which is characterized by its own processes and properties.

1. Primordial is an immature egg cell that has a flat shape at this stage and is surrounded by a connective membrane. During menstruation, a large number of follicles can be formed - up to 30, but only a small part is able to move on to the next stage. At this moment, their diameter is approximately 5 mm. Formed as a result of the reproduction of female reproductive cells. Located in the cortex of the ovary.
2. Preantral lymph nodes are already entering the process of maturation. They are surrounded by a membrane and increase in size by almost 3 times. They also have a shiny shell, consisting of quaternary proteins, cube-shaped. Estrogen production increases sharply. They are located near the reproductive cell and have 2 layers. One of the layers of the preantral follicle is capable of creating three different types of steroids, with estrogen accounting for a large proportion.
3. Antral - the next stage of development of now secondary follicles. They are found in the ovaries and are considered by transvaginal ultrasound. Their number directly indicates a woman’s chances of becoming pregnant. If their number is up to 10, then the probability of becoming a parent is very low, while if the number is from 15 to 25, then the probability of pregnancy is very high. At this stage, follicular fluid is produced and the cells of the granulosa layer increase. The superiority of secondary follicles over primary ones is that secondary ones have an additional membrane. The stage is typical for the 8th week of the cycle.
4. The dominant nodule is the last stage of folliculogenesis, at which the largest in size is formed, containing a huge number of cells in the fanulous layer. It is formed from many bubbles of the previous stage. At the beginning of the menstrual cycle, it has a diameter of about 2 mm, which increases by 10-11 times by the time of ovulation. Follicular fluid has a volume equal to 100 times.

The period before ovulation is characterized by:

• presence of a large bubble;
• then the disappearance of this lymph node;
• free fluid appears at the back wall of the uterus;
• In place of the mature vesicle, a corpus luteum is formed.

Follicle development and factors influencing it

Egg development is an uncontrolled process. Changes in the background can be affected by various factors, such as taking certain medications, hormonal imbalances.

The reasons for failures may be the following:

1. Using contraceptives in tablets for a long time. If, after taking medications that impair conception, a woman’s well-being changes for the worse, she should immediately consult a doctor.
2. Malfunction of the thyroid gland. Excess or deficiency of iodized production acid can affect female reproductive function.
3. Excess of lactogenic hormone in a woman’s body. Prolactin inhibits the growth of eggs. Nature provides that a woman cannot become pregnant for some time after childbirth. This is why vesicles for eggs do not form during the postpartum period.
4. Other hormonal imbalances.

Absence of a dominant follicle

During ultrasound examination, the dominant nodule may not be detected. This means that there was no ovulation. There are several reasons why this happens.

For pregnancy to occur quickly and easily, the female organs must work like a clock. Follicles in the ovaries (they are also called Graafian vesicles) are the main link in the chain of birth of new life. Their important task is to maintain the integrity of the egg during its development and maturation. It is from these “bubbles” that female cells ready for fertilization emerge. In addition, follicular elements help produce the female hormone estrogen.

A woman's reproductive system begins its development in utero. From this age until the onset of puberty, a certain number of follicles are formed, the number of which will vary depending on the stage of the cycle.

What it is

To understand what follicles are, you need to know the structural features of female organs.

Graafian vesicles are located in the ovaries, the function of which is to produce sex hormones. Inside each follicular element is an egg. As you know, it is thanks to her that conception occurs.

The follicle “protects” the egg from damage with the help of several layers: epithelial cells and connective tissue. This structure allows the egg to develop without damage until ovulation occurs.

Changes in the structure, size and number of follicles are observed monthly. Let's consider how Graafian vesicles are involved in the process of conception.

• Several small "vesicles" begin their development in the ovaries;
• One of them (dominant) begins to grow rapidly;
• All remaining elements, on the contrary, become smaller and smaller and die after a short time;
• At this time, the “strongest” follicle continues to grow;
• A hormonal surge provokes rupture of the follicle;
• Ovulation occurs;
• A mature egg penetrates the uterine tubes.

• If during the ovulation period the egg meets the sperm, fertilization will occur, that is, conception;
• If the fateful meeting does not occur, the egg will leave the uterus along with dead particles of the epithelium.

Stages of development

Follicles are born in a girl's ovaries in utero - even when she is growing in her mother's belly. Active development occurs during the girl’s puberty and ends with the onset of menopause. The closer a woman approaches menopause, the faster the natural process of depletion of elements occurs.

Let us consider the main stages of the evolution of graaffian bubbles in order to better understand the specifics of their “work”.

1. Primordial stage. Follicles of this type begin to form in girls in the embryonic state by the 6th week of pregnancy. And by the time of her birth, the ovaries contain about 1-2 million follicular elements. At the same time, they do not receive further development, awaiting puberty. By this time, their number is significantly reduced. This reserve is called ovarian reserve. During this period, the egg is just beginning to mature in the epithelium of the follicle. Additional protection is provided by two shells consisting of connective tissue. With each cycle (after puberty), the development of numerous primordial follicles begins, which gradually increase in size.
2. Preantral stage. The maturation of follicles accelerates as the pituitary gland begins to produce follicle-stimulating hormone. Immature eggs are covered with a membrane. At the same time, estrogen synthesis begins in epithelial cells.
3. Antral stage. The “injection” of a special liquid into the space of the cells begins, which is called follicular. It already contains the estrogens necessary for the body.
4. Preovulatory stage. A “leader” begins to emerge from the follicular mass: a follicle that is called dominant. It is the one that contains the most follicular fluid, which increases a hundred times by the end of its maturation. At the same time, estrogen levels reach maximum values.

Inside the dominant, the maturing egg moves to the egg-bearing tubercle. And the remaining follicular elements die.

Follicles on ultrasound

In order to monitor the correct development and growth of follicular elements, ultrasound diagnostics is used.

Only certain days are suitable for research. After all, it is impossible to determine the presence of elements throughout the entire week from the beginning of critical days.

On days 8-9 of the cycle, you can clearly see the development of small “bubbles” on the monitor screen.

This is what antral follicles look like on ultrasound

The study allows us to determine the maturation of the dominant follicle, which most often develops in only one ovary. However, there are frequent cases when two dominants matured, both in the right and in the left ovary. In this case, the chances are also high that the woman will be able to conceive safely. Moreover, most likely, her joy will be double: two children will be born.

The leader is recognized on ultrasound by its round shape and increased size - a mature “bubble” reaches 20-24 mm.

Normal quantity

Throughout women's reproductive years, their ovaries synthesize a specific number of follicles. How many of them there will be exactly depends on the characteristics of the woman’s body. However, there are certain standards by which the correctness of the process is determined. If diagnostic ultrasound examinations reveal any deviations from normal values, we may be talking about follicular disorders. They definitely need to be treated.

How many follicles should a healthy woman have in her ovaries? These numbers will differ dramatically depending on the stage of development of the elements.

• On days 2-5 after the start of the cycle - 11-25 pieces;
• From the eighth day, a gradual death of the elements should be observed, and only one “bubble” continues to increase in size;
• By the 10th day of the cycle, the norm is one clear “leader”, the remaining elements become smaller.

Deviations from the norm

Let's consider what deviations from normal indicators exist and what this is connected with.

Increased quantity

It happens that the number of follicles is overestimated, but they are of normal size (2-8 mm). Such ovaries are called multifollicular. However, this is not always a pathology; sometimes it is a variant of the physiological norm, but which still requires medical supervision.

If the follicles grow (size 10 mm or more), if the process affects both the right and left ovaries, if the ovaries themselves are enlarged, and there are more than 26-30 follicles, then the development of polycystic disease is diagnosed.

The disease does not live up to its name, since a cyst does not form on the ovary. The disease is characterized by the presence of a large number of elements located throughout the periphery of the ovaries.

Such a number of follicles does not allow the “leader” to mature, thereby interfering with ovulation, and therefore pregnancy.

It should be noted that such changes are not always caused by pathology and require treatment. If a woman has experienced severe stress or excessive mental or physical stress, then her indicators may be exceeded. However, after a short time the situation will return to normal.

Mandatory treatment requires polycystic disease, which is caused by the following factors:

• Pathologies of the endocrine system;
• Excess weight;
• Fast and dramatic weight loss;
• Incorrectly chosen contraceptives.

An insufficient amount

What does the absence of follicular elements mean for the body? In this case, the woman will not be able to conceive a baby, and doctors will diagnose infertility. The reasons for this pathology are different. Only a competent doctor can identify them after a detailed examination.

If few follicles are recorded, then their decrease is most often caused by changes in hormonal levels.

Single follicles in the ovaries reduce the chances of conception significantly. To clarify the number of elements, additional studies are used. Most often, the situation is analyzed with a vaginal sensor, which can accurately “count” the number of elements.

What are the chances of conception given by single follicles:

• From 7 to 10. The likelihood of pregnancy is reduced;
• From 4 to 6. The probability of pregnancy is low;
• Less than 4. The woman will not be able to get pregnant.

Persistence

A serious pathology, during the development of which the dominant “blocks” the release of an egg ready for fertilization. If this situation develops monthly, it will lead to the development of a true cyst. It does not matter whether this process occurs in the left or right ovary: ovulation will not take place.

The disease requires mandatory treatment with hormonal drugs. The course consists of several stages. Without appropriate therapy, a woman will face infertility.

Treatment

The proper functioning of the ovaries is influenced by many factors related to lifestyle:

• Poor nutrition;
• Uncontrolled long-term use of medications;
• Stress;
• Excessive physical and emotional stress.

Sometimes it is enough to reduce these factors to a minimum, and grateful ovaries begin to work perfectly. Therefore, before planning a pregnancy, it is advisable to pay special attention to your lifestyle.

It is also important to keep a monthly menstrual cycle chart. At the slightest suspicion of deviations from the norm, you need to undergo an examination and consult a gynecologist.

There can be many reasons for problems with follicles, and first of all these are hormonal disorders. They are associated with improper functioning of the thyroid gland, pituitary gland, ovaries or pancreas, and sometimes this entire complex.

Along with the results of ultrasound examinations, tests that determine the amount of female sex hormones will help to understand the cause of changes in the follicles (in each specific case the list of tests will be different).

Sometimes doctors also prescribe additional ultrasound or x-ray examinations. For example, ultrasound of the thyroid gland, MRI of the brain, etc.

Based on the data obtained, medications are prescribed to normalize the level of certain hormones in a certain phase of the cycle. These are not always hormonal drugs; sometimes vitamins and tablets that stimulate blood circulation are enough. In rare cases, surgical intervention (for example, ovarian resection) is indicated.

The female body is much more complex than it might seem at first glance. Many processes in it are controlled exclusively by hormones, and how well coordinated they are depends, for example, on whether a woman can conceive and bear a child, and how long her reproductive health will be maintained. One of these complex invisible processes is the formation of a dominant follicle in the ovaries.

What it is?

A follicle is a component of a woman's gonads. Follicles are formed even when the girl develops in the mother's womb. By the time they are born, newborn girls have the richest supply of germ cells - from half a million to a million. Each immature egg is contained in several membranes, which together form a kind of vesicle or sac, which is called a follicle.

As soon as a girl begins the process of puberty, her body begins to produce the hormone FSH - it is responsible for the growth of follicles, and folliculogenesis begins - a continuous and constant process of maturation and death of follicles. This continues until menopause, until the ovarian reserve is exhausted.

Follicles are different. Those that nature generously bestows on a girl from birth are very small and cannot be seen with the naked eye. They are called primordial. Under the influence of FSH, they begin to grow and become preantral, and then some of them will be destined to become antral, that is, having a cavity with liquid contents inside. Antral follicles are formed at the very beginning of the menstrual cycle; after menstruation, they can already be detected on ultrasound and counted. But none of the listed types of follicles makes a woman fertile. In order for there to be a chance of pregnancy, a mature and full-fledged egg is needed, and only one type of follicle can produce it - the dominant or dominant one.

Antral follicles grow in both ovaries at the beginning of the cycle. However, by the 7-8th day of the cycle, one of them becomes more noticeable; it grows and develops faster than its antral counterparts. This is the dominant, the vesicle that will ensure ovulation in the current menstrual cycle. As soon as it is determined, the woman’s body devotes all its strength to its growth, and the development of the remaining follicles is slowed down.

This is very important for saving the ovarian reserve, because the number of follicles given to a woman by nature for her entire life is not replenished.

The dominant follicle can be located in the right or left ovary. Sometimes (quite rarely) a phenomenon called double ovulation occurs, in this case there are two such follicles and they are located either in one or in different ovaries. Inside the dominant vesicle, a cavity filled with liquid expands every day, and an egg grows in it. An egg-bearing tubercle forms on the surface of the “sac”.

By the middle of the cycle, when the follicle reaches its maximum size, under the influence of the hormone LH and estrogen, its shell becomes thinner, it bursts and releases the female reproductive cell. The egg begins to exist independently in the fallopian tube and within 24-36 hours it can be fertilized. If this does not happen, then the reproductive cell dies, and the likelihood of pregnancy will become real only in the next menstrual cycle, after the rupture of the next dominant follicle.

The process of rupture of the follicular membrane and release of the germ cell is ovulation.

Ovulation calculator

Cycle duration

Duration of menstruation

• Menstruation
• Ovulation
• High probability of conception

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 average value occurs frequently, so the calculation is approximate.

Also, together with the calendar method, you can measure basal temperature, examine cervical mucus, use special tests or mini-microscopes, take tests for FSH, LH, estrogens and progesterone.

You can definitely determine the day of ovulation using folliculometry (ultrasound).

Sources:

1. Losos, Jonathan B.; Raven, Peter H.; Johnson, George B.; Singer, Susan R. Biology. New York: McGraw-Hill. pp. 1207-1209.
2. Campbell N. A., Reece J. B., Urry L. A. e. a. Biology. 9th ed. - Benjamin Cummings, 2011. - p. 1263
3. 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.
4. https://ru.wikipedia.org/wiki/Ovulation

The remnants of the follicular membranes after ovulation are grouped and begin to form the corpus luteum - a temporary gland designed to produce progesterone. If pregnancy does not occur, the corpus luteum resolves after 10-12 days, and after another 2 days, menstruation begins against the background of a decrease in progesterone levels. Everything repeats itself from the beginning.

Thus, without a dominant follicle, conception is impossible, and any disturbances in the stages of folliculogenesis that do not lead to the development of a dominant, cause a violation of its rupture, can cause infertility.

Quantity and sizes

Nature has decreed that a woman will be allocated about 450-500 germ cells throughout her life. This means that from the beginning of puberty until menopause, this reserve should be enough to ensure monthly menstruation and the conception of offspring. Therefore, in the vast majority of cases, in one cycle in a woman who does not take hormones, 1 dominant follicle matures. If 2 such “vesicles” are found in one ovary or in different ones, then there is a chance of multiple pregnancy.

There are situations when one dominant follicle is not enough. These include assisted reproductive technologies, such as IVF. In order for doctors to carry out fertilization in the laboratory and transfer embryos into the uterine cavity, more than one egg is required. Therefore, the IVF protocol involves hormonal stimulation of the ovaries. After taking certain medications, a woman has 3, 4, 5 or more dominant follicles in the follicular phase. The more of them you can get, the higher your chances of getting pregnant with the help of fertility specialists.

The size of the dominant bubble plays a big role. If for antral follicles, which are assessed by ultrasound at the very beginning of the cycle, such an indicator as quantity is more important, then for the dominant follicle quality is also important. The dominant vesicle begins to be determined on average on the 7th day of the menstrual cycle (if you count from the first day of menstruation). Further, its dimensions can be quite individual, but there are also average statistical norms by which one can track the dynamics of development by day of the cycle:

Diameter table "dominant"

Cycle day	Dominant follicle size	Notes
		For the first time since the beginning of the menstrual cycle, the dominant is clearly visible, the antral follicles begin to disappear, they are no longer needed.
		The dominant vesicle continues to grow; it already stands out strikingly among the few remaining antral vesicles.
		An ultrasound makes it possible to examine the cavity with fluid inside the dominant follicle. So far it occupies less than half of its area.
		The internal follicular cavity expands.
		An egg-bearing tubercle is formed on the surface of the follicular membrane.
		A protrusion forms on the membrane of the vesicle - stigma. Based on its location, the ultrasound doctor can tell exactly where the membrane should rupture during the period of ovulation.
	21-22 mm (acceptable 23, 24 and 25 mm)	The follicle is ready for ovulation. It can happen in the shortest possible time.

Of course, a lot depends on the individual characteristics of the female body, but folliculometry (a type of ovarian ultrasound) will help answer the main question: is it worth waiting for ovulation in this cycle. Size is also important for monitoring the effectiveness of hormonal treatment if a woman undergoes it.

Therefore, the growth of the follicle is regarded more as a response of the ovaries to stimulation, as an indicator that the internal processes in the female body are normal. You shouldn’t draw conclusions about when to expect ovulation based on the size of the follicle alone.

With a size of 15 mm, according to statistics, ovulation will occur only after 4-5 days, but in practice everything is possible, because the growth rate of the bubble can slow down, speed up, and it can even stop developing on any day of the cycle at any size.

Daily growth measurements are presented for women not receiving hormonal treatment with a regular standard cycle of 28 to 30 days.

In women with a cycle of more than 30 days, ovulation occurs later than on days 14-15, and in women with a cycle of less than 28 days, ovulation occurs earlier (on days 12-13). Therefore, you need to undergo the first folliculometry immediately after the end of menstruation, and then the frequency of measurements will be prescribed by the attending physician.

Possible problems

A small follicle can cause big problems for a woman, because with pathological conditions of the “dominant”, a woman not only cannot conceive a baby, but also experiences a variety of inconveniences due to irregularities in her menstrual cycle.

Here are the most common problems.

Persistence- the dominant bubble appears on time, is well defined, and grows normally. But on the day of expected ovulation, it does not rupture. If the follicle does not burst, the oocyte inside dies within a few days. Conception is impossible. The reasons why the dominant follicle does not burst may be different, but they are usually based on insufficient levels of the LH hormone. The follicle continues to be identified on the ovary on the right or left, and before the next menstruation there is a delay. Often a cyst forms from a persistent follicle.

• Cystic formation– a fluid cavity is usually formed as a result of hormonal imbalance, after an abortion, the use of emergency postcoital hormonal contraception, as well as when blood circulation in the ovarian tissues is impaired. Follicular cysts are benign; there is no need to rush to a surgeon for help. In 95% of cases, they generally resolve on their own, without the help of doctors and without treatment over several menstrual cycles. Complications of cysts - ruptures and torsion of the legs - can be dangerous. In this case, acute surgical pain occurs, bleeding from the genital tract, and the woman may require the help of a surgeon. With a follicular cyst, the size of the dominant vesicle may be higher than normal - 26, 27, 29 or more millimeters. There are known cases of cysts about 80 mm in diameter.

• Luteinization- a situation in which the corpus luteum begins to form before the rupture of the follicular membrane itself occurs, that is, before the moment of ovulation. In this case, progesterone secretion begins inside the dominant, further maturation of the follicle becomes impossible, ovulation does not occur, and conception is impossible. Treatment is hormonal.

Atresia- a disorder of folliculogenesis, in which the dominant follicle, having reached a certain stage, does not grow, and the process of oocyte maturation inside it stops (the egg does not mature). This also means that a woman cannot conceive a child in this cycle. If atresia becomes chronic, they speak of persistent infertility. The question of the advisability of stimulating ovulation with hormonal agents or conducting IVF will be decided.

Could it be missing?

The absence of a dominant follicle should not always be considered a pathology. Normally, every woman has cycles without ovulation, in which none of the antral follicles becomes dominant. If at the age of 20-30 years there is no ovulation more than 1-2 times a year, this is considered normal. With age, the frequency of anovulatory cycles increases, and after 35 years a woman can already experience up to 5-6 such cycles normally.

Can "dominant" be empty?

This phenomenon is called “empty follicle syndrome” or EFS. With it, no eggs are found at all inside dominant follicles with normal growth. According to statistics, up to 7% of in vitro fertilization protocols end in failure precisely for this reason - not a single egg suitable for fertilization is found in the follicular fluid taken during puncture of the follicles.

In fact, many specialists in the field of reproductive medicine are skeptical about SPF, because they believe that the reason for the absence of eggs should be sought in the protocol itself, incorrectly selected dosages of drugs, as well as trivial errors during puncture. After changing medications, their dosages, and proper rest between protocols, the situation usually improves, and repeat SPF is given only in 1% of cases.

This 1% is a topic of special conversation. Usually, the true absence of oocytes is a genetic problem associated with a disorder in the X chromosome. There is no cure.

But even with such a diagnosis, you can become a mother - IVF with a donor egg will help. Today, such a service is in great demand, and not only because women suffer from genetic abnormalities. Many build a career and miss a favorable age, and then face depletion of ovarian reserve and SPF.

In the reproductive organs of a woman, complex processes are regularly repeated, thanks to which the birth of a new life becomes possible. The egg develops inside a capsule that protects it from damage and provides it with nutrition. The number and quality of follicles in the ovaries determine whether conception can occur, how hormonal levels will change, and what health complications may arise. There are methods that allow you to determine the size, quantity, and degree of maturity of such capsules, and determine the chances of pregnancy.

Content:

What are follicles, their role in the body

Follicles are sacs containing immature eggs. Each woman has her own ovarian reserve of eggs, which is laid during the period of embryonic development, starting from the 6th week. The formation of follicles in the ovaries stops at birth. Their total number in the ovaries can be 500 thousand or more, but during the entire reproductive period (an average of 35 years), only 300-500 follicles fully mature, the rest die.

They have 2 main roles: protecting the maturing egg from external influences and producing estrogen.

In the first phase of the cycle, under the influence of FSH (follicle-stimulating hormone of the pituitary gland), the growth of several follicles begins at once. A capsule with strong walls protects the egg until full maturity, which occurs in the middle of the cycle. The volume of liquid gradually increases, while the walls stretch. At the moment of ovulation, when the egg is ready for fertilization, the capsule bursts, giving it the opportunity to exit and move into the fallopian tube, where it meets the sperm.

In each cycle, only one follicle (dominant) usually reaches full maturity. The rest intensively produce estrogens, which are responsible for the development of the endometrium, the formation of female mammary glands and many other processes.

The follicles in the ovaries are filled with fluid containing proteins, salts and other elements necessary for the development of eggs.

Types of follicles

The following types of follicles are distinguished:

• dominant;
• persistent;
• antral.

Dominant- This is the main follicle in the ovary that reaches maturity and ruptures during ovulation. Most often he is the only one. Much less often they appear on both sides at the same time. This happens, for example, when treating infertility by stimulating ovulation. In this case, the birth of twins is possible.

Persistent. Its appearance is indicated when the capsule does not rupture, the egg in it dies. This cycle is called anovulatory. Conception in this case is impossible.

Antral. This is the name given to those few follicles that begin to grow at the beginning of each cycle under the influence of FSH. After one of them becomes dominant, the rest stop growing and then die.

What is the significance of the number of antral follicles?

The number of antral follicles in the ovaries determines whether a woman can become pregnant.

Normally, there should be from 11 to 26. In this case, the probability that ovulation will occur is 100%. The chances of conception are maximum.

If their number is 6-10, then the probability of ovulation is 50%. In the case when there are less than 6, it is impossible for a woman to conceive naturally. In this case, only artificial insemination (IVF) can help.

If there are no follicles in the ovaries at all, they speak of the onset of early menopause and final infertility. However, a woman will be able to give birth if a fertilized donor egg is transplanted into her uterus.

The quantity is calculated using a transvaginal ultrasound sensor. The study is carried out on days 2-3 of the cycle. This indicator can be affected by changes in hormonal levels, the presence of diseases of the uterus and ovaries (polycystic disease, endometriosis).

If a woman has a deviation that indicates the impossibility of conception, this is not a death sentence. The situation may change next month even without any treatment if, for example, the cause of a hormonal imbalance is stress. In case of persistent infertility, a woman needs examination and, possibly, stimulation of ovulation with the help of special medications.

How do follicle sizes normally change during the cycle?

At the beginning of each menstrual cycle, if everything is normal, under the influence of FSH, the development of new follicles in the ovaries begins (folliculogenesis). The process develops as follows:

1. From days 1 to 4 of the cycle (average duration 28 days), the size of the antral follicles increases to an average of 4 mm.
2. From days 5 to 7 they grow at a rate of 1 mm/day.
3. On day 8, one of them becomes the main one, continues to increase at a rate of 2 mm/day, and the rest regress and disappear.
4. By day 14 (the moment of ovulation), the size of the dominant follicle is 24 mm.

What is folliculometry and why is it performed?

To determine the number and size of follicles and control their development, transvaginal ultrasound (using a vaginal sensor) is used. This method is called folliculometry. In the first half of the cycle, the state of the endometrium and eggs is studied, and in the second half, observations are made of how the follicles develop in the ovaries after ovulation.

The method is used to examine women suffering from various menstrual disorders or infertility. With its help, you can accurately determine the date of ovulation, determine on what day conception is most likely, monitor multiple pregnancies, determine the cause of cycle disorders and the nature of hormonal imbalance, and monitor the progress of treatment for ovarian diseases.

To get a complete picture, the study is carried out repeatedly, on different days of the cycle.

At the same time, other diagnostic methods are used, such as a blood test for hormone content (FSH, LH, estradiol, progesterone, anti-Mullerian hormone), ultrasound of the pelvic organs to determine the size of the ovaries and detect various diseases of the uterus and appendages. If necessary, a puncture is performed to select and examine the liquid contained in the capsule.

Note: In the same way, the egg is retrieved before the IVF procedure. The ovaries are first stimulated to obtain several high-quality eggs.

Disorders due to improper development of the dominant follicle

The reason for a woman's infertility is often the lack of ovulation in the cycle, when the follicle grows to a certain size and then does not rupture. Subsequently, the following processes may occur:

1. Atresia is a stunting of growth and subsequent reduction of the dominant follicle in the ovary. If this happens to a woman constantly, then she is infertile, and she may not have menstruation, but similar bleeding appears 2-3 times a year.
2. Persistence. The follicle grows, but does not burst, remains unchanged in the ovary until the end of the cycle, and then dies.
3. Formation of a follicular cyst. The unruptured follicle is filled with secretory fluid, its wall stretches, forms a bubble 8-25 cm in size. Over the course of several cycles, the cyst can resolve, as the follicle gradually decreases and dies.
4. Luteinization is the formation of the corpus luteum in an unruptured ovarian follicle. This occurs when the pituitary gland produces too much LH. The cause is a disruption of the hypothalamic-pituitary system of the brain. With this condition, a woman who has a normal cycle and menstruation experiences infertility.

The causes of disorders may be diseases of the thyroid gland and other organs of the endocrine system, and the use of hormonal contraceptives. Anovulatory cycles are often observed in adolescents at the beginning of puberty, as well as in premenopausal women with sharp fluctuations in hormonal levels.

Warning: To eliminate such a pathology, folk remedies should never be used. You should not try to cause rupture of the follicle artificially through gymnastics or increased physical activity. All these measures are not only useless, but can also cause great harm to the body, cause complete cycle disruption, and contribute to the formation of cysts.

Video: Causes of anovulatory cycles, how treatment is carried out

Regulating the process of follicle maturation

The goal of treatment is to restore the menstrual cycle and get rid of infertility. This is achieved by stimulating ovulation and regulating the process of maturation of follicles in the ovaries.

Stimulation of ovulation

It is carried out to reduce the number of anovulatory cycles and increase the likelihood of pregnancy. Contraindications are complete depletion of the ovarian reserve (the onset of early menopause), as well as obstruction of the fallopian tubes.

Drugs (for example, clomiphene) are used, which are taken according to a strictly defined regimen. In the initial phase of the cycle, the production of estradiol and follicle growth are stimulated, and then the drug is abruptly discontinued, which increases the production of LH and rupture of the follicular capsule.

In order to prevent the formation of cysts, an injection is given of the drugs pregnin or gonacor, containing the hormone hCG, which inhibits the growth of the follicle membrane.

Decreased number of antral follicles

If the content of antral follicles in the ovaries is increased, therapy is carried out to normalize hormonal levels (regulate the production of FSH, LH, estrogens, prolactin and progesterone).

Treatment is carried out using combined oral contraceptives (COCs). Depending on the nature of the deviations, drugs containing estrogens (estradiol), progesterone (Duphaston) or a mixture of them (Anzhelik, Klimonorm) are used.

Clostilbegit is also used. It regulates estrogen levels by acting on the estrogen receptors of the ovaries. Depending on the dose, the drug may also weaken or enhance the production of pituitary hormones.

Is it possible to increase the number of antral follicles?

The number of follicles depends only on the content of anti-Müllerian hormone (AMH) in the body, which is produced by ovarian cells regardless of the general hormonal background. It is impossible to enhance the production of the hormone with medications or other means. It depends only on the genetic characteristics of the body and the age of the woman.

If her health and conception problems arise due to a lack of antral follicles in the ovaries (and, accordingly, eggs), then you can only increase the chances of their successful maturation by stimulating the work of the ovaries. For this purpose, drugs containing biologically active substances are used, as well as vitamins, agents that have an anti-inflammatory effect and improve blood circulation.

Video: Polycystic disease, its consequences and treatment in the “Live Healthy” program

This structural element of the ovary, without which conception would be impossible, plays the role of a protective capsule that protects the egg. Many young women are interested in: what is the follicle in the ovary for, what is it and what is its main function? A qualified gynecologist can answer these and many other questions correctly and in detail. The doctor explains the importance and significance of the follicle, describes its functions and structural features. It is the functionality of this element, its ability to produce estrogens and provide reliable protection of the egg from the negative influence of certain factors that determines whether a woman can become pregnant and then bear a child.

The egg, being in the ovary, is located inside a kind of capsule, which not only protects it, but also provides it with the necessary nutrition. This capsule is the follicle. This formation resembles a sac, inside of which there is an immature egg. The production of follicles does not stop, but about 500 of the 5000 produced during the entire reproductive period, which lasts for each woman on average 34-37 years, can ensure the maturation of the egg.

The ovary is a paired organ of the female reproductive (childbearing) system. It is he who is responsible for the development and maturation of a woman’s reproductive cells, produces sex hormones and belongs to the endocrine glands. Here the eggs mature in preparation for fertilization, which results in pregnancy.

Despite the fact that the number of follicles in the ovaries of a healthy woman of reproductive age can safely be called huge, only one of them ensures the maturation of the egg. This is the so-called single or dominant follicle.

The most important functions of these components are:

1. Providing nutrition and protection to the immature egg.
2. Estrogen production.

The capsule or follicle consists of a layer of epithelial cells and two layers of connective tissue. As the egg matures, the capsule fills with nutrient fluid, the amount of which gradually increases, and the walls of the follicle stretch. Each follicle goes through several stages in its development:

1. Primary (primordial, preantral). The size of the follicle at this stage is only 50 microns, and its development stops until the girl reaches puberty.
2. Secondary (antral). At this stage of follicle development, a cavity is formed, which is gradually filled with follicular fluid. As the capsule grows and forms, its cells divide into elements of the inner and outer shell.
3. Tertiary (final, preovulatory). During this period, the androgens hormones produced in the ovaries penetrate into the follicular membrane, where they are transformed into estrogens.

The culminating moment in follicle development is ovulation. About a day before, the capsule increases significantly in size, estrogen production increases, which stimulates the release of LH (luteinizing hormone). At the moment when the capsule should burst, ovulation occurs.

The immature type of egg is called an oocyte. You can understand that the follicle is growing and developing by noticing certain changes (more precisely, growth) of the oocyte.

At this time, the formation of cytoplasmic products begins, which will later be consumed by the developing embryo. The outer surface of the oocyte (immature egg) is covered with a glycoprotein, and on the inner surface there is a coating of several layers of granular cells, which form a protective capsule. These processes are characteristic of the primary stage of follicle development.

1. The secondary stage, during which the formation of a cavity filled with fluid occurs, consisting of plasmatic transudate and the secretion of granular cells. At the same time, the division of capsule cells into internal and external occurs.
2. The preovular stage of follicle development is the time of active growth of the capsule.

The follicular ovary is not the cause of infertility; rather, on the contrary, it is these genital organs that can guarantee full conception and pregnancy.

A study aimed at counting the number of follicles can determine the level of health of a woman of reproductive age and her ability to become pregnant and bear a baby. The development of the follicular apparatus occurs in the perinatal period. At this time, a certain number of follicles is established, and it remains constant throughout the woman’s life. Their number varies from 30 to 50,000.

Ultrasound (ultrasound) helps determine the level of development of organs and their components. During the procedure, the doctor determines the stages of follicle development:

1. The first is a small follicle that forms the outer shell of the oocyte (immature egg). There may be several such immature eggs.
2. The next study is carried out on day 5 and allows you to see small antral follicles, the size of which does not exceed 4 mm.
3. After a week, the follicles enlarge and their size reaches 6 mm. During an ultrasound examination, a specialist can examine the capillary network at their base.
4. Within a day, dominant follicles can be identified, which continue to grow and increase in size.
5. On the 10th day of the cycle, using ultrasound, it is possible to identify a single follicle, the dimensions of which are twice as large as the parameters of the other capsules and reach 1.5 cm.
6. By the 14th day, the size of the capsule is 2.5 cm. On the 15-16th day of the cycle, the follicle should burst. Ovulation occurs.

At this moment, the mature egg leaves the capsule, enters the uterine (fallopian) tubes, along the lumen of which it moves into the uterine cavity, where fertilization occurs. If this process is impossible for some reason, the egg is removed from the uterine cavity along with the exfoliated endometrium.

An excess or deficiency of follicles in the ovaries is a significant impairment of the functionality of the organ. We can talk about exceeding the norm only if an ultrasound examination confirms the presence of more than 10 oocytes (immature eggs) in the ovary throughout the entire menstrual cycle. The doctor makes the final conclusions based on the instrumental examination:

1. If the number of follicles is from 8 to 16 in one ovary, then we can safely say that there is a high probability of conception.
2. In cases where the number of follicles does not exceed 5-8, the likelihood of pregnancy is low.
3. If 4 or fewer follicles are detected in one ovary, doctors say it is impossible to conceive.

The dominant follicle develops in one ovary. This can be either the right or left genital organ. Its (follicle) absence indicates the impossibility of conception and pregnancy. This is a dangerous indicator, the causes of which can only be determined by a qualified gynecologist.

Menstrual irregularities can be caused by:

1. Experienced stress.
2. Wrong choice of contraceptives.
3. Previous infectious or inflammatory disease.
4. Hormonal imbalance.
5. Rapid weight loss.
6. Development of obesity.
7. Addiction to nicotine, alcohol or drug addiction.
8. The presence of malignant neoplasms.

Another reason for the insufficient number of germ cells or their complete absence is early menopause.

A detailed instrumental examination will help determine the exact cause, which is carried out only in a specialized medical institution using modern equipment and the latest technologies.

In the middle of the menstrual cycle, several follicles mature in the ovary, and all the rest dissolve without a trace. The largest of the remaining ones is dominant. Its large capsule provides reliable protection for the mature egg. The dominant follicle is located either in the right or left ovary. In rare cases, several mature dominants remain, which makes it possible to conceive, carry and give birth to twins. It is the presence of several dominants that ensures the possibility of multiple pregnancies.

Any deviations from the norm in the development of follicles can lead to infertility. There are several reasons for this failure:

1. Frequent inflammatory processes affecting the pelvic organs.
2. Follicular ovaries.
3. Insufficient production of estrogen, which is a female sex hormone.
4. Disturbances in the hormonal system.
5. Malfunction of the pituitary gland.
6. Early menopause due to surgery or other reasons.
7. Breakdown.
8. Experienced stress.
9. Addiction to nicotine and alcohol.
10. Drug addiction.
11. Obesity of any degree.

An important factor is the state of the dominant follicle. It may not reach the required size, lag behind in development, or be completely absent.

Often in adolescence or during age-related changes that occur in the female body after reaching 45-50 years, some disorders related to the follicular apparatus develop. Such changes are called persistence. They provoke not only menstrual irregularities - often women and girls turn to doctors with complaints of:

• profuse bleeding;
• failure in the frequency of menstruation;
• uterine bleeding.

All of these manifestations are associated with the reverse development of the follicle. In order to cope with the problem, patients are prescribed hormonal therapy. Persistence is accompanied by:

1. Severe pain in the lower abdomen.
2. Hormonal imbalance.
3. Compression of the uterus.
4. Thickening of the endometrial mucosa.
5. Sudden rejection of the endometrium.
6. Uterine bleeding or heavy spotting.

If the functioning of the female genital organs stops, the doctor, using an instrumental examination, clarifies the cause of what is happening. Often the pathology is associated with ovarian depletion syndrome or a single follicle.

The consequence of cessation of ovarian function is the inability to become pregnant (infertility). In cases where there is an insufficient number of mature follicles in the ovaries or the existing elements do not mature, early menopause occurs. The development of this process in women at a young age is caused by:

1. Hormonal imbalance.
2. Violation of the sports regime.
3. The presence of cancer.
4. Habitual stress and constant depression.
5. Lack of regular, full-fledged sex life (in adult women).

No less dangerous is a condition that specialists conducting ultrasound examinations identify as follicular ovaries. In this case, both in the left and in the right ovary, during an instrumental examination, a large number of immature follicles are detected.

The pathology is accompanied by a lack of ovulation due to the presence of a cyst, failure or increase in the menstrual cycle, and infertility. Hormonal therapy helps to cope with the problem, the choice of drugs for which is carried out exclusively by a highly qualified specialist.

If there are no results from hormonal therapy, the patient undergoes ovulation stimulation. The woman is prescribed treatment using drugs that help enlarge reproductive cells. All manipulations and procedures are carried out under ultrasound (ultrasound) control. The procedure is performed every two days.

Modern medicine knows many effective techniques that allow you to quickly and efficiently eliminate the problem. The result of such therapy in many cases is multiple pregnancy.

Women who are pregnant need not worry about being diagnosed with follicular ovaries. They do not have a negative effect on gestation and its development.

After delivery, in order to conceive another child, the patient will have to undergo a course of hormonal therapy. Before starting treatment, it is important to check your hormonal levels and bring all hormones back to normal.