10 dominant follicles in the left ovary. Follicles in the ovaries: norm and deviation. 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 a variety 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, which are secreted by the dominant follicle of the right ovary.

Ovarian structure

The thing is that the ovary consists of millions of small formations, which are called follicles. Inside them there is an egg, surrounded by a layer of cells that feed it. Throughout their lives, they are all at different stages of their development:

Embryonic, or premordial follicle;
Immature, which is called preantral;
Ripening - antral;
Primary, or pre-ovulatory.

The dominant follicle of the right ovary plays a central role in the cyclic 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 tissues of the ovary are represented by thecal cells, blood vessels and connective tissue.

Dominant follicle fate

This education has two paths:

Its formation continues until its rupture is realized. This is due to the fact that the tissues that cover it are necrotic. In this case, the release of the egg on the surface of the ovary occurs. This condition is called ovulation and occurs on days 12-17 of the cycle.
Continuous growth of the dominant follicle with its transformation into a follicular ovarian cyst. This is called anovulatory menstrual cycle. If, nevertheless, ovulation has occurred, then 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 must occur alternately. But for some reason it happens that the dominant follicle in the right ovary is formed more often. This is confirmed by the fact of more frequent development of ectopic pregnancy in the right fallopian tube. Also, the right ovary is more prone to the formation of follicular cysts.

Functional role

This refers to key issues in the ovulatory and menstrual cycle. While developing, the dominant follicle in the right ovary secretes the hormone estrogen, which ensures the saturation of the body 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 ovum if it attaches to the prepared endometrium of the uterine cavity.

These data make it clear why dyshormonal disruptions in the female body are manifested by menstrual irregularities, 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 women with infertility is done in order to determine whether the egg is maturing and whether ovulation occurs. The main sign of ovulation is a dominant follicle before ovulation and its absence after it.

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

Why is it needed?

Every month, 7-8 follicles in a woman's body begin to increase in size, then their development stops and only one rarely two continue to grow - this is a dominant follicle, the rest regress, 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, which is able to fertilize.

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

Stages of development

In the fetus, premordial follicles are laid 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 the 8-9th day 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 ultrasound show?

The dominant follicle on ultrasound can normally be seen from 5-8 days of the cycle. Already at this time, he overtakes his 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 a reverse development occurs. Ovulation may not occur with sclerosis of the ovarian membrane, then it continues to develop and can turn into a cyst. After ovulation, it disappears and a yellow body can be seen in its place in the ovary. Sometimes there are overripe follicles, their size is 21-23 mm, that is, ovulation has not occurred.

It is interesting! It is noticed that the dominant follicle is more common in the right ovary. This is evidenced by the frequent detection of the corpus luteum in the right ovary and an ectopic pregnancy with a ruptured 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-handers due to increased nervous stimulation from the nervous system.

An ultrasound scan helps to find the cause of infertility. This method is called folliculometry. The patient undergoes an ultrasound examination for several days, during the alleged ovulation. You can find the absence of a dominant follicle or pathology of its development.

Developmental pathologies

The release of an egg in women is impossible in the absence of a dominant follicle. This happens in case of hormonal imbalance and various diseases:

it is not formed with a decrease in follicle-stimulating hormone or an increase in luteinizing hormone in the blood;
regression or atresia, occurs with hormonal disorders, including an increase in insulin in the blood;
a persistent follicle is observed on ultrasound if ovulation does not occur. It does not regress, is of normal size, or slightly enlarged (overripe). Sometimes in women, dominant and persistent follicles are found in different ovaries;
a follicular cyst is formed from a dominant follicle that continues to grow. Liquid accumulates inside, the size of the cyst on ultrasound is more than 25 mm, if there are a lot of them, then this condition is called polycystic;
luteinization. In place of the dominant follicle without ovulation, a 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 the woman's blood, to find the reason for its change. These can be endocrine diseases, pituitary gland pathology, and ovarian developmental abnormalities.

What to do?

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

with a routine examination, the detection of a dominant follicle should be the norm, it depends on the time of the ultrasound scan. If there are complaints about the inability to get pregnant, you need to repeat it already in the middle of the menstrual cycle;
when there is no dominant follicle, then folliculometry should be done. It will help you figure out what is happening, especially since its absence also happens during normal development after ovulation. It is also necessary to investigate 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 the family), or diseases with which differential diagnosis must be carried out (multifollicular ovarian syndrome, polycystic);
if developmental pathologies are found (luteinization, persistence), then the examination should be continued 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 one in the other.

Cancellation of oral contraceptive use can also lead to multiple pregnancies. This is due to abrupt changes in the hormonal balance in women that occur after drug withdrawal.

This is important to know! Oral contraceptives can affect the hormone levels in a woman's blood. They not only prevent the occurrence of pregnancy, but also normalize the cycle of menstruation, therefore, they are often prescribed in the first period of treatment for infertility associated with a violation of the cycle of menstruation.

If a woman has 2-3 dominant follicles on ultrasound, and this is often observed during ovarian stimulation, in preparation for in vitro fertilization (IVF), it is 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 features of development, common abnormalities and risk factors

The dominant follicle in the right ovary is the most developed of all, ready for the ovulation process. However, the 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 are in general and what is their purpose. The specified sac, called in medicine a follicle, 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 bubble 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 depends on how good such protection is, and, consequently, the likelihood of pregnancy.

It is no secret that the reproductive system in girls is laid 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 starts - the so-called postnatal period.

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

Stages of development

Specialists 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 ripen in the female ovaries. One of them later becomes the most important. All others dissolve over time.

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

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

If all these stages have passed without any disturbances and difficulties, then an egg comes out of 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 sex gland 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 antral there is the formation of one dominant. If it ruptured and released an egg, then we can assume that the ovulation process was successful.

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

According to experts, the following factors can negatively affect the formation and development of the dominant follicle:

taking oral contraceptives. This problem can be eliminated only by refusing to take these pills. Within a few months, the ovulation process will recover;
the 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 on the entire body of a woman;
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 a woman turns to a specialist in a timely manner, who will be able to identify the cause of the violation and eliminate it.

Multiple pregnancy

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

At the time when potential mothers are ovulating, the size of the dominant follicle reaches 18-22 mm in diameter. At the moment when, under the influence of estrogen, luteinizing hormone is released into the bloodstream, it bursts 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 multiple pregnancy. Thus, the woman has a chance to become pregnant with twins.

Tracking on ultrasound

According to experts, in a normal state, the largest follicle can be determined on an ultrasound scan starting from 5-8 days of the menstrual cycle. At this point, it is larger than the others. This is due to the influence of follicle-stimulating hormone.

A decrease in the amount of this hormone is fraught with 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, he can continue further development, which will lead to the appearance of a cyst.

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

As practice shows, the development of the 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 an ectopic pregnancy, accompanied by rupture of the tubes on the right side.

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

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

It is the ultrasound scan that makes it possible to understand who is the culprit of the developed infertility. This research technique in medicine is called folliculometry. The patient undergoes an ultrasound scan for several days during the expected period. It was at this time that it was 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 happen with hormonal imbalance and the presence of a number of pathologies:

Low levels of follicle-stimulating hormone or elevated levels of luteinizing hormone can result in the absence of a leading follicle.
Hormonal disorders such as high blood insulin levels can lead to regression or atresia.
If ovulation has not happened, then it is possible to observe a persistent follicle on an ultrasound scan.
A follicular cyst can also form from the leading follicle, which will continue to grow further. If there are many such cysts, then polycystic ovary disease develops.
The process of luteinization, when instead of the so-called leading follicle without ovulation, the corpus luteum is formed.

If it happened that a woman, after repeated unsuccessful attempts to conceive a child, did not succeed in doing this, and this is caused by some of the listed pathological processes, then she needs highly qualified help from a medical specialist. It is he who will prescribe those drugs that will stimulate the ovulation process. The effectiveness of the course of therapy can be monitored by the results of ultrasound.

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What is a dominant follicle?

When planning the birth of a baby, it is necessary to clearly know the favorable dates for conception. It is during ovulation that the sperm is ready to meet the egg. During the period of ovulation, a woman experiences changes in the uterus and appendages, since these days the body is preparing for fertilization. The preparation of the body for conception goes through several stages. At the initial stages, growth occurs, then a dominant follicle is formed, an 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, resorption of developed lymph nodules occurs. Throughout her life, a female can only reproduce about 450-550 lymph nodes in both ovaries.

Female sex hormones - estrogens, produce a bubble in which an egg is formed.

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

Dominant follicle concept

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

During 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 oocyte proceeded without disturbances, then fertilization may occur.

Follicle development stages

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

Primordial is an immature egg that is flat at this stage and surrounded by a connective membrane. For the period of menstruation, a large number of follicles can form - up to 30, but only a small part is able to move on to the next stage. At this point, their diameter is approximately 5 mm. Formed as a result of the reproduction of female germ cells. Located in the cortex of the ovary.
The preantral lymph nodules are already entering the maturation process. They are surrounded by a membrane and increase in size by almost 3 times. They also have a cube-shaped shell, consisting of quaternary proteins. The production of estrogen increases dramatically. They are located near the reproductive cell and have 2 layers. One of the layers of the preantral follicle is capable of producing three different types of steroids, with estrogen accounting for a large proportion.
Antral - the next stage of development of the now secondary follicles. They are found in the ovaries and are considered by ultrasound transvaginal ultrasound. Their number directly indicates a woman's chances of getting pregnant. If their number is up to 10, then the probability of becoming a parent is very low, while with the number 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 the secondary ones have an additional membrane. The stage is typical for the 8th week of the cycle.
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 fanular layer. It is formed from the many bubbles of the previous stage. At the beginning of the menstrual cycle, it has a diameter of about 2 mm, which increases by the time of ovulation by 10-11 times. The follicular fluid has a volume equal to 100 times.

For the period before ovulation, the following signs are characteristic:

the presence of a large bubble;
then the disappearance of this lymph node;
free fluid appears at the back of the uterus;
at the site of a mature bubble, a yellow body is formed.

Follicle development and factors affecting it

Egg development is an uncontrolled process. A change in the background can be influenced by various factors, such as taking certain medications, hormonal disruptions.

The reasons for the failures can be the following:

The use of contraceptive pills for a long time. If, after taking drugs that impair conception, there is a change in the woman's well-being for the worse, an urgent need to consult a doctor.
Malfunction of the thyroid gland. Excess or deficiency of iodinated production acid can affect female reproductive function.
An excess of lactogenic hormone in a woman's body. Prolactin inhibits egg growth. Nature provides that a woman cannot become pregnant for some time after childbirth. That is why, in the postpartum period, no bubbles form for the eggs.
Other hormonal disruptions.

Lack of a dominant follicle

On ultrasound, the dominant nodule may not be found. This means that there was no ovulation. There are several reasons why this is happening.

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

The reproductive system of a woman begins its development even 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.

Graaf's vesicles are located in the ovaries, the function of which is to produce sex hormones. Inside each follicular element is an egg cell. 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 before ovulation.

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

Several small "bubbles" begin to develop in the ovaries;
One of them (dominant) begins to grow rapidly;
All the remaining elements, on the contrary, become less and less and die after a short time;
At this time, the "strongest" follicle continues to grow;
The hormonal surge provokes follicle rupture;
Ovulation occurs;
A mature egg enters the tubes of the uterus.

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

Stages of development

Follicles originate in a girl's ovaries in utero - even when she grows 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 the threshold of menopause, the faster the natural process of depletion of elements occurs.

Let's consider the main stages of evolution of graaf bubbles in order to better understand the specifics of their "work".

Primordial stage. Follicles of this type begin to form in girls in their 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, waiting for puberty. By this time, their number is significantly reduced. This stock is called the ovarian reserve. During this period, the egg is just beginning to mature in the epithelium of the follicle. Additional protection is provided by two membranes, consisting of connective tissue. With each cycle (after puberty), the development of numerous primordial follicles begins, which gradually increase in size.
Preantral stage. Follicular maturation is accelerated as the pituitary gland begins to produce follicle-stimulating hormone. Unripe eggs become covered with a membrane. At the same time, estrogen synthesis begins in epithelial cells.
Antral stage. The "injection" into the space of cells of a special fluid, which is called follicular, begins. It already contains the estrogens the body needs.
Preovulatory stage. From the follicular mass begins to stand out "leader": a follicle, which is called dominant. It is he who contains most of the follicular fluid, which by the end of its maturation increases a hundred times. In this case, the level of estrogen reaches its maximum values.

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

Follicles on ultrasound

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

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

On the 8-9th day of the cycle, the development of small "bubbles" can be clearly seen on the monitor screen.

This is what antral follicles look like on ultrasound

The study allows you to determine the maturation of the dominant follicle, which most often develops in only one ovary. However, there are often cases when two dominants matured, both in the right and in the left ovary. In this case, the chances are also great 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 by ultrasound by its round shape and increased size - a mature "bubble" reaches 20-24 mm.

Normal amount

During the entire childbearing age of women, their ovaries synthesize a specific number of follicles. How many of them 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 studies on ultrasound revealed any deviations from normal values, we can talk about follicular disorders. They must be treated without fail.

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.

2-5 days after the start of the cycle - 11-25 pieces;
From the eighth day, a gradual dying off of 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 rest of the elements become smaller.

Deviations from the norm

Let's consider what deviations from normal indicators exist and what is the reason for this.

Increased quantity

It happens that the number of follicles is overestimated, but they are of normal size (2-8 mm). These 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 (sizes 10 mm or more), if the process has affected 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 along the entire periphery of the ovaries.

Such a number of follicles does not allow the "leader" to mature, thereby interfering with ovulation and, consequently, 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 such factors:

Endocrine system pathologies;
Excess weight;
Fast and dramatic weight loss;
Wrongly 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 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 a change in hormonal levels.

Single follicles in the ovaries reduce the chances of conception at times. To clarify the number of elements, additional research is applied. 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;
4 to 6. The likelihood of pregnancy is low;
Less than 4. The woman will not be able to get pregnant.

Persistence

Serious pathology, during the development of which the dominant "blocks" the exit of the egg, ready for fertilization. If this situation develops monthly, then it will lead to the development of a true cyst. It does not matter if this process takes place in the left or in the right ovary: ovulation will not take place.

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

Treatment

Many lifestyle factors affect the proper functioning of the ovaries:

Improper nutrition;
Uncontrolled long-term intake of medications;
Stress;
Excessive physical and emotional stress.

Sometimes it is enough to reduce these factors to a minimum, and the 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 schedule. At the slightest suspicion of deviations from the norm, you need to be examined and consult a gynecologist.

The causes of follicular problems can be many, and first of all, these are hormonal disorders. They are associated with malfunctioning of the thyroid gland, pituitary gland, ovaries or pancreas, and sometimes the whole complex.

Along with the results of ultrasound studies, analyzes that determine the amount of female sex hormones will help to understand the cause of changes in follicles (in each 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 at a certain phase of the cycle. These are not always hormonal preparations, sometimes there are enough vitamins and tablets that stimulate blood circulation. In rare cases, surgery is indicated (eg, ovarian resection).

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, whether a woman will be able to conceive and bear a child, and how long her reproductive health will remain. 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 of birth, newborn girls have the richest supply of germ cells - from half a million to a million. Each immature egg is in several membranes, which together form a kind of bubble or sac, and it is called a follicle.

As soon as a girl begins the process of puberty, the production of the hormone FSH starts in her body - 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 runs out.

Follicles are different. Those that nature generously endows a girl from birth are very small, they 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 an ultrasound scan and counted. But none of the listed types of follicles makes a woman fertile. In order for the probability of pregnancy to occur, a mature and full-fledged egg is needed, and only one type of follicle can give it - dominant or dominant.

Antral follicles at the beginning of the cycle grow in both ovaries. 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, that bubble, which is to ensure ovulation in the current menstrual cycle. As soon as it is determined, the woman's body throws all its strength into its growth, and the development of the remaining follicles is inhibited.

This is very important to save 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) there is such a phenomenon as double ovulation, 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, an egg cell 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 action of the hormone LH and estrogen, its membrane becomes thinner, it bursts and releases the female reproductive cell. The egg cell begins to exist independently in the fallopian tube and within 24-36 hours it can be fertilized. If this does not happen, then the germ cell dies, and the probability of pregnancy will become real now only in the next menstrual cycle, after the rupture of the next dominant follicle.

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

Ovulation calculator

Cycle duration

Duration of menstruation

Menstruation
Ovulation
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Indicate the first day of your last 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 is common, 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, estrogens and progesterone.

It is possible to unambiguously establish the day of ovulation by means of 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://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, against the background of a decrease in progesterone levels, menstruation begins. Everything is repeated from the beginning.

Thus, without a dominant follicle, conception is impossible, and any violations 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 dimensions

Nature has ordered that about 450-500 sex cells were assigned to a woman for her entire life. This means that from the beginning of puberty until menopause, this supply should be enough to ensure monthly menstruation and conception of offspring. Therefore, in the overwhelming majority of cases, in one cycle in a woman who does not take hormones, 1 dominant follicle matures. If 2 such "bubbles" are found in one ovary or different ones, then there are chances 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 be able to fertilize in the laboratory and transfer embryos into the uterine cavity, more than one egg is required. Therefore, in the IVF protocol, hormonal stimulation of the ovaries is carried out. After taking certain drugs in a woman in the follicular phase, 3, and 4, and 5, or more dominant follicles are found. The more you can get them, the higher the chances of getting pregnant with the help of reproductive specialists.

The size of the dominant vesicle plays an important 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 quality is also important for the dominant follicle. The dominant vesicle begins to be determined on average on the 7th day of the menstrual cycle (if counted from the first day of menstruation). Further, its size can be quite individual, but there are also average statistical norms by which you can track the dynamics of development by days of the cycle:

Dominant diameter table

Cycle day	Dominant follicle size	Notes (edit)
		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.
		On ultrasound, it becomes 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 ovarian tubercle is formed on the surface of the follicular membrane.
		A bulge forms on the membrane of the bubble - stigma. At its location, the ultrasound doctor can tell exactly where the membrane should rupture during ovulation.
	21-22 mm (23, 24 and 25 mm are allowed)	The follicle is ready for ovulation. It can happen as soon as possible.

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

Therefore, the growth of the follicle is regarded more as the response of the ovaries to stimulation, as an indicator that the internal processes in the female body are normal. It is not worthwhile to draw conclusions about when to wait for ovulation only by the size of the follicle.

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, accelerate, and it can even stop developing on any day of the cycle at any size.

Growth measurements by day 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 14-15 days, and in women with a cycle of less than 28 days - earlier (12-13 days). 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 a woman big problems, because in pathological conditions "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 the expected ovulation, it does not break. If the follicle does not burst, the oocyte inside dies after a few days. Conception is impossible. The reasons for which the dominant follicle does not burst can be different, but they are usually based on insufficient levels of the hormone LH. The follicle continues to be determined on the ovary on the right or left, and before the next menstruation, it is delayed. Often, a cyst forms from a persistent follicle.

Cystic formation- The fluid cavity is usually formed as a result of hormonal disruption, after abortion, the use of emergency postcoital hormonal conception, as well as in violation of blood circulation in the tissues of the ovaries. Follicular cysts are benign; it is not required to rush to the surgeon for help. In 95% of cases, they generally dissolve on their own, without the help of doctors and without treatment for several menstrual cycles. Complications of cysts - ruptures and torsion of the legs can be dangerous. In this case, there is acute surgical pain, bleeding from the genital tract, the woman may need the help of a surgeon. With a follicular cyst, the size of the dominant vesicle can be higher than normal - 26, 27, 29 and 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, until the moment of ovulation. In this case, the secretion of progesterone begins inside the dominant, further maturation of the follicle becomes impossible, ovulation does not occur, conception is impossible. Treatment is hormonal.

Atresia- a disorder of folliculogenesis, in which the dominant follicle, having reached a certain stage, does not grow, the process of oocyte maturation stops inside it (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 IVF will be decided.

Can it be absent?

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, ovulation is absent no 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 have up to 5-6 such cycles in the norm.

Can a "dominant" be empty?

This phenomenon is called "empty follicle syndrome" or SPF. With it, an egg cell is not found at all inside the dominant follicles with normal growth. According to statistics, up to 7% of in vitro fertilization protocols end in failure for this very reason - in the follicular fluid taken during follicular puncture, not a single egg cell suitable for fertilization is found.

In fact, many specialists in the field of reproductive medicine are skeptical about SPF, since they believe that the reason for the absence of eggs should be looked for in the protocol itself, incorrectly selected dosages of drugs, as well as common mistakes during puncture. After changing the drugs, their dosages, and a good rest between the protocols, the situation is usually corrected, and a repeated 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 violation 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, the most complex processes are regularly repeated, thanks to which the emergence of a new life becomes possible. The egg cell develops inside the capsule, which protects it from damage and provides nutrition. It depends on the number and quality of follicles in the ovaries whether conception can occur, how the hormonal background will change, what health complications may arise. There are methods that allow you to establish the size, number, degree of maturity of such capsules, to determine the chances of pregnancy.

Content:

What are follicles, their role in the body

Follicles are sacs of immature eggs. Each woman has her own ovarian supply of eggs, which is laid even during the period of embryonic development, starting at 6 weeks. The formation of follicles in the ovaries stops at the moment of birth. Their total number in the ovaries can be 500 thousand or more, however, over the entire reproductive period (on average 35 years), only 300-500 follicles fully mature, the rest die.

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

In the first phase of the cycle, under the influence of FSH (follicle-stimulating hormone of the pituitary gland), several follicles begin to grow at once. The strong-walled capsule protects the egg until full maturity, which occurs in the middle of the cycle. The volume of the liquid gradually increases, while the walls are stretched. 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 a meeting with the sperm occurs.

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 a fluid containing proteins, salts and other elements necessary for the development of eggs.

Follicle types

There are the following types of follicles:

dominant;
persistent;
antral.

Dominant Is the main ovarian follicle reaching maturity, ruptured by ovulation. Most often it is the only one. Much less often, they appear on both sides at the same time. This happens, for example, in the treatment of infertility by stimulating ovulation. In this case, the birth of twins is possible.

Persistent. They say about its appearance, if the capsule does not rupture, the egg cell in it dies. This cycle is called anovulatory cycle. Conception is impracticable in this case.

Antral. This is the name for the 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

Whether it is possible for a woman to become pregnant depends on the number of antral follicles in the ovaries.

Normally, they 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 of them, conception naturally for a woman is impossible. In this case, only artificial insemination (IVF) can help.

If there are no follicles in the ovaries at all, they talk about 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 number is counted using a transvaginal ultrasound probe. The study is carried out on the 2-3 day of the cycle. This indicator can be affected by changes in hormonal levels, the presence of diseases of the uterus and ovaries (polycystic, endometriosis).

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

How does the size of the follicles 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:

From 1 to 4 days of the cycle (with an average duration of 28 days), the size of the antral follicles increases to an average of 4 mm.
From day 5 to day 7, they grow at a rate of 1 mm / day.
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.
By the 14th day (the moment of ovulation), the size of the dominant follicle is 24 mm.

What is folliculometry, what is it for

To determine the number and size of follicles, to 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, observations are made of how the follicles in the ovaries develop 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, establish on which day conception is most likely, control multiple pregnancies, determine the cause of cycle disorders and the nature of hormonal disruption, monitor the course of treatment for ovarian diseases.

To obtain 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 the content of homones (FSH, LH, estradiol, progesterone, anti-Müllerian 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 take and study the fluid contained in the capsule.

Note: The egg is removed in the same way before the IVF procedure. Stimulation of the ovaries is preliminarily carried out to obtain several high-quality eggs.

Disorders with abnormal 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. In the future, the following processes can occur:

Atresia - growth freezing and subsequent reduction of the dominant follicle in the ovary. If a woman has this happening all the time, then she is infertile, while her menstruation may be absent, but bleeding similar to them appears 2-3 times a year.
Persistence. The follicle grows, but does not burst, remains unchanged in the ovary until the end of the cycle, then dies.
Follicular cyst formation. The unopened follicle overflows with secretory fluid, its wall stretches, forms a bubble 8-25 cm in size. Within several cycles, the cyst can dissolve, as the follicle gradually decreases and dies.
Luteinization is the formation of a corpus luteum in an unruptured ovarian follicle. This happens if too much LH is produced in the pituitary gland. The reason is the disruption of the hypothalamic-pituitary system of the brain. In this condition, a woman with a normal cycle and menstruation is infertile.

The causes of disorders can be diseases of the thyroid gland and other organs of the endocrine system, the use of hormonal contraceptives. Anovulatory cycles are often observed in adolescents at the beginning of puberty, as well as in women during the premenopausal period with a sharp fluctuation in the state of the hormonal background.

A warning: To eliminate such a pathology, in no case can you use folk remedies. You should not try to artificially cause rupture of the follicle using gymnastics or increased physical activity. All these measures are not only useless, but can also cause great harm to the body, cause a complete disorder of the cycle, and contribute to the formation of cysts.

Video: The reasons for the appearance of anovulatory cycles, how the treatment is carried out

Regulation of the follicle maturation process

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

Stimulating ovulation

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

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

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

Decreased number of antral follicles

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

Treatment is with combined oral contraceptives (COCs). Depending on the nature of the deviations, drugs containing estrogens (estradiol), progesterone (dyufaston) or their mixture (angelic, climonorm) are used.

Clostilbegite is also used. It regulates estrogen levels by acting on ovarian estrogen receptors. Depending on the dose, the drug can also weaken or increase 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 drugs or other means. It depends only on the genetic characteristics of the organism and the woman's age.

If she has health and conception problems 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 ovaries. For this, preparations are used containing biologically active substances, as well as vitamins, agents that have an anti-inflammatory effect, improve blood circulation.

Video: Polycystic disease, its consequences and treatment in the "Living 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 depends on the functionality of this element, its ability to produce estrogens and to ensure reliable protection of the egg from the negative influence of some factors depends on whether a woman can become pregnant and then bear a child.

The egg cell, being in the ovary, is located inside a kind of capsule, which not only protects it, but also provides the necessary nutrition. Such a capsule is a follicle. This formation resembles a sac, inside of which there is an immature egg. The production of follicles does not stop, but about 500 out of 5,000 developed over the entire reproductive period, which lasts for every woman, on average, 34-37 years, can ensure the maturation of the egg.

The ovary is a paired organ of the female reproductive (reproductive) system. It is he who is responsible for the development and maturation of a woman's sex 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 be safely 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:

Providing nutrition and protection for an immature egg.
Estrogen production.

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

Primary (primordial, preantral). The size of the follicle at this stage is only 50 microns, and its development freezes until the girl's full puberty.
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 shells.
Tertiary (final, pre-ovulatory). During this period, androgens produced in the ovaries penetrate into the follicular membrane, where they are transformed into estrogens.

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

An immature type of egg is called an oocyte. To understand that the follicle grows and develops, one can notice 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 by a glycoprotein, and on the inner surface 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.

Secondary stage, during which the formation of a cavity filled with fluid, consisting of plasma transudate and secretion of granular cells, occurs. At the same time, the cells of the capsule are divided into internal and external ones.
The pre-ovular 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 genitals that are capable of guaranteeing full conception and pregnancy.

Determining the health level of a woman of reproductive age and her ability to become pregnant and bear a baby allows a study aimed at counting the number of follicles. 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 to establish the level of development of organs and their components. During the procedure, the doctor determines the stages of follicular development:

First, a small follicle forms the outer shell of an oocyte (immature egg). There may be several such immature eggs.
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.
After a week, the follicles enlarge, and their size reaches 6 mm. During an ultrasound examination, the specialist can examine the capillary mesh at their base.
Within a day, you can determine the dominant follicles, which continue to grow and increase in size.
On the 10th day of the cycle, using ultrasound, a single follicle can be isolated, the size of which is twice the parameters of the remaining capsules and reaches 1.5 cm.
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 sets in.

At this moment, the matured egg leaves the capsule, enters the uterine (fallopian) tubes, through the lumen of which it moves into the uterine cavity, where fertilization takes place. If this process is impossible for any reason, the egg is removed from the uterine cavity along with the detached endometrium.

An excess or deficiency of follicles in the ovaries is a significant violation of the functionality of the organ. It is possible to speak about exceeding the norm only if the 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 performed instrumental examination:

If the number of follicles is from 8 to 16 in one ovary, then we can safely speak of a high probability of conception.
In cases where the number of follicles does not exceed 5-8, the likelihood of pregnancy is low.
If 4 or less follicles are found in one ovary, doctors say that conception is impossible.

The dominant follicle develops in one ovary. It can be both the right and left genitals. Its (follicle) absence indicates the impossibility of conception and pregnancy. This is a dangerous indicator, the reasons for which can only be established by a qualified gynecologist.

Menstrual irregularities can be provoked by:

Experienced stress.
Wrong choice of contraceptives.
Postponed infectious or inflammatory disease.
Hormonal imbalance.
Rapid weight loss.
Development of obesity.
Addiction to nicotine, alcohol or drug addiction.
The presence of malignant neoplasms.

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

A detailed instrumental examination will help to 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 ripen in the ovary, and all the rest dissolve without a trace. The largest of the remaining is dominant. Its large capsule provides reliable protection for a 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, bear and give birth to twins. It is the presence of several dominants that makes it possible for multiple pregnancies to occur.

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

Frequent inflammatory processes affecting the pelvic organs.
Follicular ovaries.
Insufficient production of estrogen, which is the female sex hormone.
Disorders in the hormonal system.
Failure of the pituitary gland.
Early menopause due to surgery or for another reason.
Breakdown.
Experienced stress.
Addiction to nicotine and alcohol.
Drug addiction.
Obesity of any degree.

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

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

profuse spotting;
failure in the frequency of the onset of menstruation;
uterine bleeding.

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

Severe pain in the lower abdomen.
Hormonal imbalance.
Compression of the uterus.
Thickening of the endometrial mucosa.
Sudden endometrial rejection.
Uterine bleeding or profuse spotting.

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

The consequence of the termination of the functioning of the ovaries 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, an early menopause occurs. The development of this process in women at a young age is caused by:

Hormonal imbalance.
Violation of the sports regimen.
The presence of cancer.
Habitual stress and constant depression.
Lack of regular full sex life (in adult women).

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

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

In the absence of the results of the hormone therapy, the patient is stimulated ovulation. A woman is prescribed treatment with drugs that help to enlarge the sex cells. All manipulations and procedures are carried out under the control of ultrasound (ultrasound). The procedure is performed every two days.

Modern medicine knows many effective techniques that allow you to quickly and efficiently eliminate the problem that has arisen. In many cases, this therapy results in multiple pregnancies.

Pregnant women need not worry about diagnosed follicular ovaries. They do not adversely affect the bearing of the fetus and its development.

After delivery, the patient will have to undergo hormone therapy in order to conceive another child. It is important to check the state of hormonal levels before starting treatment and bring all hormones back to normal.