What does a dominant follicle with blood flow mean? Why does the dominant follicle not mature? Lack of dominant follicle

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:

Providing nutrition and protection to the immature egg.
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:

Primary (primordial, preantral). The size of the follicle at this stage is only 50 microns, and its development stops until the girl reaches 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 shell.
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.

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.
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 carry 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:

The first is a small follicle that forms the outer shell of the 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, a specialist can examine the capillary network at their base.
Within a day, dominant follicles can be identified, which continue to grow and increase in size.
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.
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:

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.
In cases where the number of follicles does not exceed 5-8, the likelihood of pregnancy is low.
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:

Experienced stress.
Wrong choice of contraceptives.
Previous 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 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:

Frequent inflammatory processes affecting the pelvic organs.
Follicular ovaries.
Insufficient production of estrogen, which is a female sex hormone.
Disturbances in the hormonal system.
Malfunction of the pituitary gland.
Early menopause due to surgery or other reasons.
Breakdown.
Experienced stress.
Addiction to nicotine and alcohol.
Drug addiction.
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:

Severe pain in the lower abdomen.
Hormonal imbalance.
Compression of the uterus.
Thickening of the endometrial mucosa.
Sudden rejection of the endometrium.
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:

Hormonal imbalance.
Violation of the sports regime.
The presence of cancer.
Habitual stress and constant depression.
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.

INTERESTING! A dominant occurs most often, but with artificially stimulated ovulation it grows on both. And in this case, the chance of conceiving twins increases.

Why is it missing?

When the dominant does not appear, a woman becomes pregnant. The causes of this pathology are as follows:

ovarian cyst;
"sleeping" ovaries;
disturbances in the development of the dominant.

Persistence

When there is not enough progesterone and luteotropin in the body, the follicle, having assumed the desired size, cannot rupture and release the egg. In this case, it is called persistent, and the pathology is called persistence. Her signs are:

there is no fluid behind the uterine cavity;
the amount of estrogen is very high;
and the amount of progesterone is too low;
the corpus luteum does not develop.

ATTENTION! With persistence, the dominant remains on the ovary throughout the entire menstrual cycle, and sometimes it can be fixed even after the end of the cycle. Thus, the body seems to be ready for ovulation, but it does not occur.

Cyst

When the follicle fails to rupture and release an egg, but instead continues to grow, it becomes a cyst on the ovary. This cyst is a benign formation that occurs due to hormonal imbalance.

The risk of its occurrence is increased by factors such as:

chronic diseases of the pelvic organs;
frequent abortions;
genitourinary operations;
wrong diet.

Such a disorder affects a woman’s menstrual cycle, affecting its duration and regularity. Thus, the cyst interferes with the creation of a new dominant follicle. However, it rarely needs treatment, and usually goes away on its own within two, sometimes three, cycles.

"Sleeping" ovaries

In this case, we are talking about ovarian dysfunction, in which there are simply no follicles, none at all. They don't grow at all. And ovulation never occurs.

Does not ripen for other reasons

Developmental disorders are a pathology in which the follicles stop at some stage of development and suddenly begin to regress. In this case, a dominant can be formed, but it will not reach the required size by the time of the ovulation phase.

IMPORTANT! In case of developmental disorders, hormonal analysis does not show any pathologies, completely corresponding to the norm.

What to do?

If you suspect that the dominant is absent, you need to see a doctor and undergo a series of examinations. After this, the cause of the pathology will be determined and the necessary treatment will be prescribed. Self-medication should not be done so as not to aggravate the condition.

At the hospital, the doctor will conduct an examination in a gynecological chair. And since the most common reason for the absence of a dominant is hormonal imbalance, he will prescribe a blood test for hormones.

Moreover, at different stages of the cycle, because for the formation of a dominant in each phase a different amount of hormones is needed. And the doctor needs to know at what stage and which hormones are not enough.

Folliculometry is also prescribed - a procedure that includes ultrasound diagnostics throughout the entire cycle. This allows you to track the work of the ovaries in each phase.

In addition, the doctor will pay attention to the duration of the cycle, because if it is longer or shorter than normal, this is a sign of ovulation disorders.

ATTENTION! A cycle when the dominant is not formed occurs several times a year in absolutely healthy women. This is normal and means that the body is, as it were, resting.

Prevention methods

Preventive measures are aimed at supporting the process of creating follicles and preventing disturbances in the functioning of the ovaries.

These include:

quitting smoking, alcohol, drugs;
a full sex life with regular sexual intercourse;
active lifestyle, nutritious diet;
if possible, avoid stress and excessive physical activity;
taking measures to protect against STDs;
exclusion of abortion;
control of hormone levels in the blood.

And it is mandatory to undergo regular preventive examinations at the antenatal clinic.

What treatment is prescribed?

Since the most common reason for the absence of a dominant follicle is hormonal imbalance, treatment is prescribed with hormonal drugs. The schedule for their intake is drawn up by the doctor, depending on how saturated the woman’s body is with estrogen.

A week before menstruation, progesterone may be prescribed in the form of a 1% solution by injection. To stimulate the ovaries to grow and develop follicles, doctors recommend estrogen medications such as Estradiol or Hexestrol. However, you cannot start hormonal treatment on your own - this will further worsen the hormonal imbalance.

In addition, if necessary, the doctor can prescribe treatment for inflammatory diseases of the genitourinary area.

In conclusion, we can add that a healthy lifestyle is the best prevention of ovulation problems. And if the absence of a dominant follicle has already been diagnosed, do not despair: modern medicine can help in recovery.

The formation of a dominant follicle occurs in the female body every month and is a reflection of the normal function of the reproductive system. Visualization of the follicle and determination of its size make it possible to assess not only the condition of a woman’s body, but also make a forecast about the most suitable time to conceive a child.

The dominant is the most developed component of the ovarian structure, containing a large number of granulosa cells.

It can be localized both in the right and in, grows quickly during, fills with liquid and reaches a size of 20-25 mm by the time the egg is released.

The process of development of a dominant follicle takes an average of 2 weeks, while the rest undergo reverse development at the initial stages of maturation.

The dominant, under the influence of estrogens and luteinizing hormone, ovulates on the 14th day of the cycle. A sign is its disappearance and the detection of a small amount of fluid behind the uterus. At this point, subsequent formation occurs.

Most often, the dominant is localized in the right, but its detection in the left or in both ovaries is a normal variant. When diagnosing two dominant follicles, most often ovulation occurs in only one of them.

Structure

germinal vesicle (first-order oocyte);
layer of glycoproteins and granulosa cells,
basement membrane and surrounding theca cells;

Functions and meaning

Stages of folliculogenesis

Regardless of the location and number of dominants, the follicle goes through 4 stages of formation in its development:

Primordial phase. At this point in development, the follicle is an immature egg surrounded by a connective tissue membrane. It is small in size and flat in shape; during the menstrual period, one organ can contain from 5 to 20 primordial formations.
Preantral stage. In this stage, which occurs in the middle of the menstrual period, the oocytes begin to mature and increase in volume, acquiring a round or cubic shape, the connective membrane thickens and begins to produce estrogen.
The antral period is characterized by the formation of secondary elements, observed on days 8-9 of the menstrual cycle. The granulosa cell layer thickens and begins to produce follicular fluid containing large amounts of estrogen, which gradually fills the resulting cavity. Its average diameter in this period is 10-13 mm. The formations can be either single-chamber or contain several liquid cavities. Usually their number does not exceed 10.
The formation of a dominant is the final stage of folliculogenesis. Usually only one oocyte enters the dominant phase, the rest undergo reverse development (atresia). It has a round shape and reaches a size of up to 25 mm, one wall protrudes into the abdominal cavity, the other is attached to the stroma. The center contains an egg that is mature and ready for ovulation.

Ultrasound signs of a dominant

visualization of a follicle measuring 18 mm or larger;
identification of the egg-bearing tubercle in it;
thickening of the layer of granulosa cells (theca);

After the release of the egg into the abdominal cavity:

reduction in size of the dominant follicle or its complete disappearance upon previous detection;
free fluid in the retrouterine space;

Features in the left ovary

Since the formation of a dominant oocyte followed by the appearance of a corpus luteum in its place is a physiological process, there are no significant differences from ovulation in the right ovary.

The localization of the dominant follicle in the left ovary is a normal variant.

ovulation in the left ovary occurs less frequently due to its smaller size and number of eggs;
if there is a dominant in the left and right organs, the chance of conceiving twins simultaneously increases;

Common deviations

Lack of formation of a dominant oocyte. It is observed when follicle-stimulating hormone decreases in the blood or when the concentration of luteinizing hormone increases.
Follicular atresia occurs in various endocrine disorders (diabetes mellitus, impaired glucose tolerance, hyperthyroidism) due to hormonal imbalance.
Persistent follicle. Diagnosed by ultrasound and observed when ovulation does not occur. The oocyte retains normal volume or is slightly enlarged, but does not undergo reverse development. The persistent oocyte can be visualized at the same time as the dominant one.
Multifollicular ovaries are characterized by the simultaneous maturation of many oocytes, often a consequence of exposure to stress factors, chronic fatigue, and emotional stress on a woman’s body. Multiple follicles are not always a symptom of the disease and require dynamic monitoring, since after several cycles their number can normalize without drug intervention.
Luteinization is the formation of the corpus luteum in place of an egg that has not undergone ovulation. It can develop due to hormonal disorders, long-term inflammatory diseases of the pelvic organs, endometriosis.
The formation of a follicular cyst occurs when the membrane of the oocyte does not burst, and it continues to increase in volume. Diagnosed using ultrasound: detection of a formation more than 25 mm in diameter, filled with liquid. A condition in which several similar cysts form is called polycystic disease.

Risk factors for developing pathologies

inflammatory pathology of the pelvic organs;
endometriosis;
long-term use of oral contraceptives;
incorrect selection of medicinal contraception;
concomitant endocrine pathology (diabetes mellitus, thyroid disease);
breastfeeding period (increased prolactin production);

The dominant follicle, determined in the ovary in the first phase of the menstrual cycle, precedes the development of pregnancy. If you have gynecological complaints or are planning a pregnancy, you should consult a specialist.

Follicles are the structural components of the gonads in women. One of these elements, called dominant, during ovulation releases an egg that is ripe for conception. With the normal structure of the follicle, as well as its timely ripening, a woman is able to become pregnant. Any deviations from the norm can lead to the development of a cyst on the ovary or even infertility. There are many reasons that can cause these disorders, so if you experience any unusual symptoms, you should immediately seek medical help.

Functions and purpose of follicles

A follicle is an immature egg that is surrounded by a layer of epithelial cells and a double layer of connective tissue. Its main task is to protect the reproductive cell from the negative effects of various factors. It is on these elements that the correct maturation of the egg and its fertilization, and, consequently, the ability to become pregnant and bear a child depend. They are also designed to produce the female hormone estrogen.

In women, the reproductive system and follicular apparatus develop in the perinatal period, and at this stage a constant number of follicles is established, which remains unchanged throughout life (30 - 50 thousand).

There are several stages of follicle development in the ovaries:

The formation of several small immature cells.
On day 5, ultrasound allows you to see up to ten antral follicles on the periphery of the ovary (their size ranges from 2 to 4 mm).
After seven days, their size increases to 6 mm, which makes it possible to examine the network of capillaries at their base.
On the eighth day, dominant follicles are determined, which continue to grow and develop.
Around day 10, ultrasound makes it possible to identify the dominant follicle, which has the largest size (about 15 mm), while the rest will be half the size.
After two weeks, the dominant reaches a size of 25 mm. At this moment, the active production of the female hormone estrogen occurs, under the influence of which the protective membrane breaks through (allowing the egg to come out) and ovulation occurs on days 15–16.
The egg enters the fallopian tubes. As a result of its meeting with the sperm, fertilization occurs. Otherwise, during menstruation, it leaves the uterus along with the epithelium.

Violations of the norm

What is the norm of follicles in the ovary? An excess or deficiency of these elements is a violation. If there are more than ten immature eggs in one ovary and this figure remains unchanged throughout the entire cycle, we can talk about exceeding the norm (this can only be detected by ultrasound). Depending on the number of elements detected during ultrasound examination, the following conclusion can be made:

in the range from seven to sixteen – there are many follicles in the ovary and the probability of conception is high;
from four to six – low probability of pregnancy;
less than four – the probability of conception is practically absent.

However, this does not always indicate any pathology and can be caused by stress, anxiety or overwork. In this case, the number of follicles in the ovaries is normalized after the first ovulation. Therapy is carried out if disorders are caused by the following reasons:

incorrect choice of contraceptives;
dysfunction of the thyroid gland;
rapid weight gain or loss;
failure of the endocrine system;
increased levels of prolactin in the body.

The above disorders can be identified using diagnostic procedures.

An insufficient number or absence of germ cells can be caused by hormonal imbalance or early menopause. Typically, this problem is monitored on the seventh day of the menstrual cycle. In this case, hormonal drugs are prescribed to treat the woman’s reproductive function.

To summarize, we can distinguish two existing options for follicle development:

The course of the menstrual cycle with one dominant in the left or right ovary.
Its absence, as a result, the egg does not mature, and the menstrual cycle is disrupted. In this case, conception is impossible.

Dominant follicle

In the middle of the cycle, several follicles usually mature, and the rest dissolve. The largest and most developed protective element is dominant. It protects the egg ready for fertilization. Directly during the period of ovulation in the right or left ovary, it can reach a size of several centimeters. Under the influence of hormones, it ruptures, as a result of which the egg is released and rushes to the fallopian tubes, which means that the possibility of pregnancy arises.

In rare cases, simultaneous maturation of dominants occurs in both ovaries. This makes it possible to conceive twins.

There is also a reserve of follicles that are ready for fertilization. They are called antral. When preparing for in vitro fertilization, specialists determine how many follicles are formed and, based on this data, make predictions about the likelihood of pregnancy.

Violation of follicular development

Any disturbances in the development of follicles lead to serious consequences, including infertility. The following deviations may contribute to this:

follicular ovaries;
inflammatory processes of the pelvic organs;
insufficient production of the female hormone - estrogen;
endocrine system disorders;
problems with ovulation;
dysfunction of the pituitary gland;
premature menopause (surgical or natural);
stress, depression, nervous tension.

Also a very important point is the state of the dominant follicle, which may be absent, not reach the required size, be late in maturation, or not develop at all.

Persistent follicles

With age-related changes or in adolescence, a disruption of the activity of the follicular apparatus, called persistence, often occurs. The main symptoms of the disease are menstrual irregularities, heavy menstrual flow, and bleeding. In this case, reverse development of the follicle in the ovaries occurs, which can lead to the formation of a cyst. To prevent the cyst from bursting, hormonal therapy is prescribed. If the tumor size is significant, hormonal treatment is ineffective and surgery is required. The phenomenon of persistence is accompanied by:

hormonal disorders;
thickening of the endometrial mucosa;
endometrial rejection;
compression of the uterus;
pain in the lower abdomen, accompanied by spotting or bleeding.

Primordial folliculosis

The ovarian reserve (the supply of eggs in women) is formed in the womb. The primary stage of development of the protective follicle is primordial. In this case, the egg primordia are located on the inner surface of the ovaries and are protected by granulosa cells. This picture is observed until the onset of menstruation. Puberty is characterized by:

production of a hormone that stimulates follicle development:
growth of the egg nucleus under the influence of follicle-stimulating hormone;
maturation of the protective shell of the egg;
the monthly development of several follicles that protect the reproductive cell.

Antral folliculosis

Antral follicles in the ovaries are no more than 8 mm in size. They develop on the seventh – eighth day of the menstrual cycle. Monitoring their number in women is important at the stage of determining her ability to become pregnant artificially. The number of protective elements can be determined by ultrasound and, based on the data obtained, the reserve of eggs capable of fertilization can be determined.

If the antral elements reach a size of up to 5 mm, the likelihood of pregnancy is low. If the follicle size is 5–8 mm, a woman is likely to become pregnant without the help of doctors. It is worth noting that during pregnancy, follicles do not form in the ovaries.

Preovulatory follicle

At the last stage of its maturation, the egg is ready for fertilization. In this case, the follicle is almost completely filled with fluid, the day before ovulation, estrogen production increases and the following phenomena are observed:

stimulates the release of lutein, which promotes the onset of ovulation;
the preovulatory follicle forms a protrusion on its wall, at the site of which a breakthrough later occurs (ovulation);
after ovulation, the production of progesterone is activated, preventing endometrial rejection;
a corpus luteum is formed, which subsequently forms a network of blood vessels and contributes to the appearance and development of the placenta.

Single follicles

A single follicle is considered ovarian depletion syndrome. In this case, the functioning of the ovaries stops and the woman cannot become pregnant. If there are few follicles and they do not reach normal sizes, menopause occurs instead of ovulation. The causes of menopause at a young age can be:

hormonal disorders;
metabolic disease;
intense sports activities.

Follicular ovaries

The term "follicular ovaries" is used by ultrasound specialists to describe the features of the ovaries. As a rule, this diagnosis does not indicate the presence of pathology, however, if these signs are accompanied by other symptoms, additional examination is required. At the same time, in the ovarian stroma there is a larger number of immature eggs than there should be. The right and left follicular ovaries look the same. Signs of multiple follicles:

the presence of anovulatory cycles as a result of the appearance of a cyst or non-ripening of the dominant follicle;
infertility;
Irregular menstruation, the menstrual cycle usually increases to 50 days.

Symptoms during ultrasound:

enlarged ovaries;
the echogenicity of the ovaries is less than the echogenicity of the uterus;
there are more than twenty antral germ cells, their diameter does not exceed 9 mm, located diffusely in the stroma;
the membrane of the dominant follicle is thin.

A similar phenomenon can be diagnosed in healthy women, as well as in patients suffering from polycystic disease. Therefore, the concept of “follicular ovaries” cannot act as an independent diagnosis. If the patient develops cysts, polycystic syndrome occurs.

The problem can be eliminated with the help of hormonal correction, which not only brings the cycle back to normal, but also makes it possible to get pregnant without any problems. Treatment is carried out by a gynecologist-endocrinologist and is aimed at normalizing the production of the following hormones:

estradiol;
progesterone;
testosterone.

If taking hormones does not produce results, ovulation stimulation will be carried out. The patient is given drugs to enlarge the reproductive cells, an ultrasound scan is performed every two days, and when their growth peaks, the woman is injected with hCG to destroy the follicle membrane and release the egg. At the same time, the probability of multiple pregnancy is high.

In pregnant women, the follicular ovaries have absolutely no effect on pregnancy. However, after childbirth, anovulatory cycles may recur. If you want to plan another pregnancy, you can start taking hormones again and conceive a child. It is worth noting that with this syndrome it is necessary to analyze the hormonal levels and, if deviations are detected, to normalize the level of all hormones responsible for the process of maturation of the egg and the maintenance of pregnancy.

The dominant follicle in the ovary is determined at the stage of active maturation of the egg.

Its safety and, as a consequence, the likelihood of conception directly depends on how reliably it is protected from external influences.

In addition, by monitoring the growth dynamics of the follicular vesicle, doctors assess the general condition of the woman’s body and predict the possibility of successfully bearing a baby.

All women have a fixed ovarian reserve - a genetically determined number of oocytes (eggs) capable of fertilization. In their immature state, they are surrounded by functional cells that form sacs - follicles.

The maturation of the egg occurs under the influence of follitropin: the volume of liquid in the capsule constantly grows and stretches the walls. When the egg is completely ready, the capsule will burst, opening access to the fallopian tube, where it should be fertilized by a sperm.

Development of follicle in the ovary

First, several follicular formations develop at once. Subsequently, the main one is determined, i.e. the dominant follicle and as it grows, involution (return to the previous state) of the others occurs.

Dominant follicle - This is the largest and most developed vesicle, the size of which before ovulation is about 20 mm. Its main function is to protect the egg ready for fertilization from the negative influence of various factors. The remaining formations produce estrogens necessary for the formation of the endometrium, the growth of mammary glands, etc.

At the time of birth, the total number of immature follicles is about 1-2 million, but by the beginning of puberty only 300-400 thousand remain.

Over the entire reproductive period, no more than 200-500 pieces manage to mature; the rest die and are excreted from the body during menstrual bleeding.

Dominant follicle in the right ovary and in the left ovary

It has been established that both ovaries should ovulate equally - alternately, but, according to medical practice, the formation of the main follicle is most often diagnosed in the right one.

Perhaps this is due to different levels of functional load: the right side of the body is more actively involved in vital processes, providing a more intense blood supply to the right ovary.

A dominant follicle can form in two ovaries at the same time, which is also considered normal. In this case, the formation of two or more developed oocytes occurs, i.e. there is a high probability of multiple pregnancy.

Also, in the case of the development of several dominant follicles, there is a slight risk of superfecundation - fertilization of eggs by sperm from different men, provided that all oocytes ovulated at once.

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Read what polycystic disease is and why it is dangerous.

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Stages of development

Folliculogenesis (follicular oogenesis) is a continuous process of growth and maturation of the follicle.

Its result is ovulation followed by fertilization, which reaches only a small part of the follicles (1-3 pieces): at each stage, most of them die as a result of the natural cell regulation program - atresia (apoptosis).

According to the stage of development, several types of follicles are distinguished:

Primordial(embryo) - diameter 50 µm (0.05 mm). Immature germ cells capable of reproduction (oogonium) through reduction (meiotic) division are transformed into primary oocytes, after which they are enveloped in 1-2 layers of cuboidal epithelium and take the form of established germ follicles.
Preantral(primary) - diameter 150-200 microns (0.15-0.2 mm). During puberty, the pituitary gland produces folliculotropin, under the influence of which the size of the eggs increases 3-4 times, their membrane is covered with a shiny glycoprotein membrane (zona pellucida), 2-4 layers of granulosa cells and a protective layer is formed from connective tissue around the follicle.
Antral(secondary) - diameter up to 500 microns (0.5 mm). During this period, under the pressure of estrogen-containing fluid, the internal cavity increases: the cells of the vascular layer (theca) synthesize androgens, which diffuse (penetrate) through the basement membrane, converting into estrogens, mostly estradiol. The secondary follicle is considered a temporary hormone-producing organ of the endocrine system.
Dominant(main) - diameter up to 16000 microns (16 mm). From among the precursors, one (less often several) largest and most developed follicle is determined, containing a huge number of granulosa cells. Its main task is to ensure the safety of the oocyte until ovulation. The rest continue to produce estrogens, which allows the main follicle to develop quickly.
Preovulatory(tertiary) - diameter up to 24,000 microns (24 mm). Its second name is Graaffian bubble (named after the discoverer R. de Graaff). At this point, the volume of follicular fluid exceeds the initial value by 100 times (compared to the antral period), and the egg is located on the functional tubercle awaiting the onset of ovulation.

The day before ovulation, increased synthesis of estrogen begins. This provokes the pituitary gland to release luteotropin, which triggers the process of the egg leaving the follicle: its membrane stretches and ruptures - the egg moves freely into the fallopian tube for subsequent fertilization.

From day 9-10 of the cycle, regular monitoring of the stages of growth of the dominant element begins. If it matures slowly, treatment is prescribed to increase the rate of follicle development.

Violation of the development of the dominant follicle

Violation of the ovulation process is the most common cause of infertility.

It occurs due to improper development of the dominant follicle, against the background of pathological changes in the body (most often hormonal).

If the follicle matures to the preovulatory stage, but rupture does not occur, various anovulatory conditions occur:

late atresia- cessation of growth and subsequent death of the already formed dominant formation;
persistence- retention of an unruptured follicle in the ovary until the last day of the cycle in an unchanged form and, as a result, its death;
luteinization- formation of the corpus luteum while maintaining the integrity of the follicular membrane, due to the production of an excess amount of luteotropin by the pituitary gland;
cyst formation- the appearance of a benign tumor-like neoplasm that occurs as a result of increased stretching (more than 25 mm) of a non-ovulated follicle.

The causes of such disorders, as a rule, are various endocrine diseases, incl. pathologies of the thyroid gland, taking oral contraceptives and sharp fluctuations in hormonal levels.

Multiple follicles

The possibility of fertilization directly depends on the number of antral follicles. The norm (11-26 pieces) guarantees the onset of ovulation with 100% probability.

If the number of follicular formations exceeds the norm, then this often indicates the development of polycystic disease. In this case, the anatomical structure is deformed, the functional potential of the ovaries is inhibited, and it is very difficult (almost impossible) for a woman to become pregnant and carry a baby without appropriate treatment.

On the 10th day of the menstrual cycle, multiple follicles 3-6 mm in diameter are detected along the periphery of the ovary

Multiple formations do not always signal the presence of serious problems: if the cause of the deviation from the norm is stress, overwork or strong psycho-emotional stress, then, as a rule, their number is restored on its own after the next cycle.

Lack of dominant follicle

If the number of follicles is about 6-10, then the chance of developing a dominant formation is 50%.

If there are less than 6 immature formations, the main follicle will not form, i.e. Natural conception is not possible. In this case, the only option for a woman is artificial insemination (IVF).

The absence of follicles at all does not indicate premature ovarian depletion (menopause) and complete cessation of reproductive functions. A woman still has the opportunity to give birth on her own if already fertilized donor biomaterial is implanted into her uterus.

Determination of the number and size of follicles is carried out using the method of transvaginal ultrasound examination - folliculometry. If necessary, diagnostics are carried out using additional methods: examination of the pelvic organs, blood tests and puncture.

Hemorrhage or may occur due to hormonal pathologies and other diseases in women, and the likelihood of a recurrence of an attack is quite high.

You will learn about the prognosis of ovarian granulosa cell tumor.

The successful formation of a dominant follicle guarantees stable growth of the egg, its release, ovulation and further fertilization. Any deviations in this area must be diagnosed in a timely manner. After establishing the causes of infertility, the gynecologist and endocrinologist will prescribe the necessary treatment, which will help restore the reproductive abilities of the body.