Follicle 26 mm will ovulation occur. The size of the dominant follicle from the first day of the cycle to ovulation. Deviation from the norm

The follicles are part of the gonads of a woman, that is, their integral component. These are special formations in which immature germ cells are under reliable protection. The task of the follicle is to protect the oocytes, and when the time comes, to ensure the safety of the egg during maturation and release on the day of ovulation.

How does growth happen?

Follicles are given to a woman by birthright. Newborn girls have from 500 thousand to a million primordial follicles in their ovaries, the sizes of which are negligible. With the onset of puberty, the girl starts a monthly continuous process of folliculogenesis, which will last throughout her reproductive life and end only with the onset of menopause.

For the rest of her life, a woman is assigned about 500 germ cells, it is they who will mature one at a time in each menstrual cycle, and on the day of ovulation they will leave the refuge bubble, which has reached its maximum size. After ovulation, fertilization is possible within 24-36 hours. It only takes one follicle and one egg to conceive.

With the onset of puberty, the girl begins to produce a hormone responsible for follicular growth. It is called FSH - follicle stimulating hormone. It is produced by the anterior pituitary gland. Under its influence, the primordial vesicles begin to increase, and already during the next ovulation, some of them first become preantral, and then antral, inside which there is a cavity filled with liquid.

Antral follicles at the very beginning of the female cycle can be from 5 to 25. Their number allows doctors to predict how a woman is capable of self-conception, whether pregnancy is possible without stimulation and the help of doctors. The norm is from 9 to 25 bubbles. If a woman has less than 5 antral-type follicles, then the diagnosis of "infertility" is established, in which IVF with donor eggs is indicated.

Antral follicles grow at about the same pace, at the same speed, but soon a leader begins to form, growing faster than others - such a vesicle is called dominant. The rest slow down growth and undergo reverse development. And the dominant one continues to grow, a cavity with a liquid expands in it, in which the egg matures.

By the middle of the cycle, the follicle reaches a large size (from 20 to 24 mm), with which it usually bursts under the action of the LH hormone. The egg becomes available for fertilization in the next 24-36 hours.

Ovulation Calculator

Cycle duration

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Enter the first day of your last menstrual period

Ovulation occurs 14 days before the start of the menstrual cycle (with a 28-day cycle - on the 14th day). Deviation from the mean value is frequent, so the calculation is approximate.

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

You can definitely set the day of ovulation through folliculometry (ultrasound).

Sources:

1. Losos, Jonathan B.; Raven, Peter H.; Johnson, George B.; Singer, Susan R. Biology. New York: McGraw-Hill. pp. 1207-1209.
2. Campbell N. A., Reece J. B., Urry L. A. e. a. Biology. 9th ed. - Benjamin Cummings, 2011. - p. 1263
3. Tkachenko B. I., Brin V. B., Zakharov Yu. M., Nedospasov V. O., Pyatin V. F. Human Physiology. Compendium / Ed. B. I. TKACHENKO. - M.: GEOTAR-Media, 2009. - 496 p.
4. https://ru.wikipedia.org/wiki/Ovulation

The former follicle, or rather the remains of its membranes, are grouped into a new formation - the corpus luteum, which produces progesterone. If conception does not occur, the corpus luteum dies after 10-12 days, and progesterone production decreases sharply before menstruation. During pregnancy, the corpus luteum continues to function until the end of the first trimester.

In the absence of pregnancy, a new stage of folliculogenesis follows the same pattern from the first day of the cycle, that is, from the very beginning of the next menstruation. If a woman's body is working normally, there are no problems with the hormonal background, then ovulation occurs monthly. 1-2 anovulatory cycles per year are considered acceptable. With age, the number of cycles without follicle maturation and ovulation increases to 5-6 per year, but this is normal, since the woman's genetic material ages and the follicular supply is exhausted.

It cannot be replenished - nature did not provide such an opportunity, and therefore it is important to monitor your health and take care of the ovulatory reserve.

Resizing

It is difficult to say what size a follicle should normally have at one stage or another of its development. The data that exists in the tables is only approximate, they do not take into account the individuality of a particular woman. With each day of the cycle, the size of the bubbles changes, since the process of folliculogenesis is continuous and constant.

At the very beginning of the cycle, the size of the follicles does not exceed 2-4 mm. But as they grow, the diameter of the antral follicles becomes larger, and the number of follicles themselves decreases. By the 8th day from the beginning of the cycle, the dominant follicle is usually allocated, and then only its size is fixed until ovulation.

Table of follicle size by day.

cycle day	Follicle size	Changes
		It is possible to determine the number of antral follicles.
		The number of antral vesicles begins to decrease.
		The dominant follicle is isolated.
		Dominant follicle grows
		Inside the dominant follicle, it is possible to determine the cavity with the oocyte.
		The cavity inside the follicle expands.
		A tubercle is formed on the surface of the follicle, the follicle itself approaches the ovarian membrane as close as possible.
		The stigma is determined on the surface of the follicle.
	21-22mm (allowable 23-24mm)	The follicle is ready for ovulation.

It is not at all necessary that on the 10-11th day of the cycle, in a particular case, the growth of the dominant vesicle is 11-18 mm, since everything is quite individual, but the size of the follicle is still used to predict the ovulation period. For example, a woman with a follicle size of 16 mm will be asked to wait for ovulation, since the size of the bubble does not suggest that the rupture will happen very soon.

It is also important that the size norms are exceeded: if on the 7th-9th day of the cycle or at any other period before ovulation the follicle is larger than 25 mm (26-27, 30-34 mm, and so on), then the doctor will most likely assume cystic formation than the normal ovulatory cycle.

Important! These norms are relevant for women who do not receive hormonal treatment. When ovulation is stimulated, sizes may vary.

How to check?

Of course, it is impossible to measure the follicles on your own. The only way to do this is to visit a doctor and do a folliculometry. This is a type of ultrasound examination (ultrasound), in which the state of a woman's ovaries is observed in dynamics. The first ultrasound is usually done immediately after the end of menstruation, usually on the 7th-8th day of the cycle there is every opportunity to estimate the number of antral vesicles. Then ultrasound is done several times with regularity in 2-3 days in order to be able not to miss the day of ovulation.

The ultrasound doctor, based on the average size of the follicle, will tell you when it is better to stimulate ovulation, when it is better to prescribe the procedure for the removal of eggs by ovarian puncture in the IVF protocol, and will also be able to say with confidence whether there was ovulation at all in the current cycle.

Folliculometry is necessarily carried out to establish the nature and causes of infertility, as well as to decide on the appropriateness of stimulation.

At the very first procedure, a woman may be surprised to hear that quite a lot of follicles are maturing in her ovaries. For antrals, this is completely normal. Anxiety is caused by situations when there are either too many or too few such bubbles. If there are 26 or more, the doctor will suspect polycystic ovary syndrome, in which conception is impossible without prior treatment.

If there are less than 5 antral vesicles (a single follicle, 2, 3, 4 follicles), this means that the woman is infertile, so the follicles do not grow even with stimulation - IVF and ovarian function stimulation are not carried out in this case. IVF with a donor oocyte is acceptable.

The optimal amount for conception without problems is 11-25 follicles. It is this amount that indicates a normal follicular reserve and fertility level. With an amount of 6-10, they speak of a reduced follicular reserve, a woman can be stimulated.

Causes of violation of folliculogenesis

The processes of folliculogenesis proceed under the guidance of the hormonal background and depend on the concentration and ratio of the hormones FSH, estradiol, luteinizing hormone, progesterone, testosterone, prolactin. Therefore, any deviation in the endocrine accompaniment can cause a disruption in the maturation of the follicles, which will lead to the fact that maturation will proceed either too slowly or rapidly. In the first case, late ovulation is possible, in the second - early. Any of them is not too favorable for normal conception.

Folliculogenesis disorders are varied. For example, during persistence, there is no rupture of the follicular membrane. This phenomenon is usually associated with insufficient levels of the hormone LH. In this case, the egg overripes, dies, and the follicle continues to be present on the surface of the sex gland for several more weeks. This causes a failure of the menstrual cycle, conception during this period is impossible.

With luteinization of the follicle, the corpus luteum begins to develop before the rupture occurs, so ovulation also does not occur. And if the follicle does not mature to the desired size, stopping its development suddenly, then they talk about follicle atresia. In all cases, the process of ovulation is disturbed - a woman cannot conceive a baby.

The reasons why the development of follicles is disturbed are numerous. There are temporary factors, after the elimination of which the cycle is restored, and a woman can become a mother without the help of doctors.

There are more serious reasons that require mandatory treatment, the help of reproductive specialists, embryologists and other specialists who are able to give a woman the happiness of motherhood even in seemingly hopeless cases.

Temporary disruptions can cause:

• excessive physical activity, professional sports;
• passion for mono-diets, sudden weight loss or weight gain in a short time period;
• chronic stress, emotional instability, worries;
• work at an enterprise with a high level of occupational hazard (with paints, varnishes, nitrates, on a night shift, in conditions of strong vibration and enhanced electromagnetic radiation);
• trips and air travel, if they are associated with a change in climate and time zones;
• cancellation of oral contraceptives;
• diseases transferred in the current months with an increase in body temperature.

Often, women do not notice a violation of follicular maturation at all, because we do not always pay due attention to the delay in menstruation or more abundant discharge.

Among the pathological causes of impaired follicular maturation, various diseases and conditions can be noted in which the endocrine background is disturbed:

• pathology of the pituitary gland, hypothalamus;
• dysfunction of the ovaries;
• inflammatory and infectious diseases of the genital tract and pelvic organs;
• trauma to the ovarian tissue, the consequences of surgery;
• violation of the thyroid gland, adrenal cortex.

Hormonal failures are often preceded by childbirth and abortion, bad habits, long-term use of antibiotics, antidepressants, anticoagulants.

What to do?

In violation of the growth of follicles and ovulation processes, hormonal treatment is usually used. Home remedies, traditional medicine (upland uterus, sage and others) cannot solve the problem that exists at the metabolic level, increase the supply of follicles or build up the endometrium, help follicles grow.

Preparations containing FSH help to accelerate their growth and achieve a mature follicle and full ovulation. They are prescribed by a doctor in strict individual dosage("Klostilbegit", "Clomiphene" and others). The rate at which follicles grow per day is controlled by folliculometry. When the growth reaches the desired parameters, an injection of hCG 10000 is administered, after which ovulation begins 24-36 hours later.

Follicle growth stimulants You can not appoint yourself on your own and take it uncontrollably. This can lead to very sad consequences.

Every month, an egg matures in the female ovary. It emerges from a special “bubble” that is formed even before birth, gradually matures, and then bursts. This "vesicle" is the dominant follicle. Sometimes it is called dominant, but doctors prefer the first option.

The size of the follicle by day of the cycle is very important. The ability of a woman to conceive depends on this factor.

Stages of development

What is a dominant follicle? This is a "leader" who has overtaken his "colleagues" in growth and development. Only he has a chance to burst and produce a mature egg, which will then be fertilized by a sperm. Physicians distinguish four stages of its development:

What should be the follicle on different days of the cycle: medical standards

If on ultrasound you were told that there is a dominant follicle in the left ovary (or in the right, it does not really matter), you need to ask about its size. Unfortunately, it happens that the size does not correspond to the day of the cycle, that is, a full-fledged egg does not mature.

The size of the follicle on the days of the cycle depends on the length of the menstrual cycle (namely, its first phase). The longer it is, the slower the egg matures, and the smaller it is on a certain day. For example, on the 10th day of the cycle, a follicle of 10 mm can be considered a relative norm if the monthly cycle is 35 days. But with a cycle of 28 days - this is no longer the norm.

If the cycle, on the contrary, is short, then the follicle will mature faster and reach its maximum size as early as 11-12 days.

Therefore, the rules that we give below should not be taken as absolute. Much depends on your individual characteristics. But for reference they will be useful. So, here are the norms for a healthy woman with a 28-day menstrual cycle.

• From the 1st to the 4th day of the cycle on ultrasound, you can see several antral follicles 2-4 mm in size.
• Day 5 - 5-6 mm.
• Day 6 - 7-8 mm.
• Day 7 - 9-10 mm. The dominant follicle is determined, the rest “lag behind” it and no longer grow. In the future, they will decrease in size and die off (this process is called atresia).
• Day 8 - 11-13 mm.
• Day 9 - 13-14 mm.
• Day 10 - 15-17 mm.
• Day 11 - 17-19 mm.
• Day 12 - 19-21 mm.
• Day 13 - 22-23 mm.
• Day 14 - 23-24 mm.

So, from this table it can be seen that normal growth is about 2 mm per day, starting from the 5th day of the MC.

If the size is not correct

If the follicle is 11 mm on the 11th day of the cycle or 13 mm on the 13th day of the cycle, then this size is not the norm. This means that the egg matures too slowly and ovulation is hardly possible. The reason for this condition is most often in hormonal abnormalities: in the malfunction of the thyroid gland, pituitary gland, ovaries, or this entire “bundle”.

This condition requires additional examination (in particular, it is necessary to find out the level of hormones) and medical correction. Often gynecologists use hormonal drugs, but this is not always the case. In some cases, there are enough vitamins, drugs that improve blood circulation, herbal medicine, physiotherapy.

Experienced doctors know that many women do not ovulate every cycle. And they are not in a hurry to prescribe hormonal drugs, based on folliculometry for only one month. Perhaps in the next cycle, the egg will mature at the “correct” rate.

Sometimes anovulation (lack of ovulation) is due to natural causes:

• Stress, fatigue, lack of sleep;
• Malnutrition (strict diets, in particular low-fat ones);
• Obesity or extreme thinness;
• Hard physical work or exhausting sports training.

If you exclude these factors, there is a chance that ovulation will return on its own.

Size for ovulation

When the follicle bursts, at what size does ovulation occur? This usually happens on the 12-16th day of the menstrual cycle. With a 28 day cycle, ovulation occurs around day 14 (plus or minus two days). With a cycle of 30 days - on day 15.

At ovulation, the size of the follicle is 24 mm. The minimum figure is 22 mm.

In order for the follicle to burst, the coordinated action of various hormones in the woman's body is necessary. Namely - estradiol, LH, FSH. After ovulation, progesterone also enters the process.

How to understand that ovulation has occurred? The following methods will help you:

• Folliculometry (a type of ultrasound). This is by far the most reliable way;
• Ovulation tests. They are quite truthful and easy to apply, but they are not 100% accurate;
• . In this case, it is necessary to build a BT schedule: the method is painstaking, not always reliable, but affordable.

Some girls (though not all) feel ovulation physically, here are the characteristic symptoms of a ruptured follicle:

• Pulls the lower abdomen and lower back;
• Small spotting in the middle of the cycle is possible;

Some experience irritation and increased fatigue. Others, on the contrary, a surge of strength and sexual energy.

Now the egg has 12-24 hours to meet the sperm. If this does not happen, she regresses, and after 12-14 days menstruation comes.

If the follicle does not burst

It happens that a follicle that has reached 22-24 mm in diameter does not burst, but turns into a follicular cyst. This is due to a deficiency of certain hormones in the body. This condition can be determined by ultrasound.

Sometimes the cyst is single, and it "resolves" itself. If this does not happen, then at first they try to eliminate it with medication. And only if it is large and does not decrease in size, then they resort to surgical intervention.

Sometimes there are many such cysts. They deform the ovaries, interfere with their proper work. This condition is called polycystic ovary syndrome and requires treatment.

If it turns out that the dominant follicle in the ovary matures, but does not burst, then doctors can apply hormonal drugs. For example, .

Where do twins come from

The "main" follicle is determined approximately on the 7-10th day of the cycle. All others shrink and naturally die off. But sometimes it happens that there are two “leaders” at once. In a natural cycle (that is, without the use of hormones to stimulate ovulation), this happens quite rarely - in one woman out of ten, and not every monthly cycle.

It happens that two dominant follicles in different ovaries (or in one - this is also possible) ovulate, that is, burst. And then there is a chance that both eggs will be fertilized. So, fraternal twins will be born.

Unlike twins (when one egg is fertilized by two sperm), twins are not the same, not the same person. They can be different sexes or the same sex, and look alike, like ordinary brothers and sisters.

So, the correct growth of the dominant follicle and subsequent ovulation are clear signs of women's health. And possible violations should alert you (and your doctor), but not scare. Indeed, in most cases, such deviations are successfully treated.

The follicle is the component of the ovary that is surrounded by connective tissues and is made up of an ovum. The follicle contains the nucleus of the oocyte - the "embryonic vesicle". The oocyte is located inside a glycoprotein layer surrounded by granulosa cells. The granulosa cells themselves are surrounded by a basement membrane, around which are theca cells.

Internal processes of follicle evolution

The primordial follicle consists of an oocyte, a stroma cell, and a follicular cell. The follicle itself is almost invisible, its size averages 50 microns. This follicle is formed before birth. It is formed due to germ cells, they are also called oogonia. The development of primordial follicles is facilitated by puberty.

A single-layer ordinary follicle consists of a basal plasty, a follicular cell that forms a transparent membrane, and a multilayer primary follicle consists of a transparent membrane, an inner cell, and granulosa cells. During puberty, follicle-stimulating hormone (FSH) begins to be produced. The oocyte grows and is surrounded by several layers of granulosa cells.

The cavitary (antral) follicle consists of a cavity, the inner layer of Theca, the outer layer of Theca, granulosa cells, a cavity containing follicular fluid. Granulosa cells are already starting to produce progestins. The diameter of the antral follicle averages 500 µm. The gradual maturation of the follicle with the formation of its layers gives rise to the production of female sex hormones, including estrogen, estradiol, androgen. Thanks to these hormones, this follicle turns into a temporary organ of the endocrine system.

A mature follicle (Graaffian vesicle) consists of an outer layer of the theca, an inner layer of the theca, a cavity, granulosa cells, a radiant crown, and an oviparous tubercle. Now the egg is located above the egg tubercle. The volume of follicular fluid increases by 100 times. The diameter of a mature follicle varies from 15 to 22 mm.

How big should a follicle be?

It is impossible to answer this question unambiguously, since the size of the follicles change during the menstrual cycle. Follicles are fully formed by an average of fifteen years. Their sizes are determined only with the help of ultradiagnostics.

We will most accurately analyze the norm for the size of the follicle by the days of the menstrual cycle.

In the first phase of the menstrual cycle (1-7 days or the beginning of menstruation), the follicles should not exceed 2-7 mm in diameter.

The second phase of the menstrual cycle (8-10 days) is characterized by the growth of follicles, mainly their diameter reaches 7-11 mm, but one follicle can grow faster (it is commonly called dominant). Its diameter reaches 12 - 16 mm. On the 11-15th day of the menstrual cycle, the dominant follicle should normally increase by 2-3 mm every day, at the peak of ovulation it should reach a diameter of 20-25 mm, after which it bursts and releases the egg. Meanwhile, other follicles simply disappear.

This is what the follicle growth looks like. This is repeated monthly until the onset of pregnancy. For a more visual and understandable definition, we provide you with a table by which you can understand whether your follicles are maturing normally.

What is a dominant follicle

The dominant follicle is considered to be the follicle that is ready for successful ovulation. With natural ovulation, it stands out for its size. As we said earlier, although all follicles begin to grow, but only one of them (in rare cases, several) grows to a size of 22 - 25mm. It is he who is considered dominant.

Generative function as a priority. Let's figure out what it is.

There are two components of ovarian function.

The generative function is responsible for the growth of follicles and the maturation of an egg capable of fertilization. The hormonal function is responsible for steroidogenesis, which changes the lining of the uterus, helps not to reject the fetal egg, and regulates the hypothalamic-pituitary system. It is generally accepted that the generative function is in priority, so if it fails, the second one loses its abilities.

At what size follicle does ovulation occur?

Ovulation is the release of an egg from a burst mature follicle. In this case, the size of the follicle during ovulation becomes 15 - 22 mm (in diameter). To make sure that you have a full-fledged follicle by the time you ovulate, you need an ultrasound.

empty follicle syndrome

Currently, two types of this syndrome are described: true and false. Distinguishes their level of hCG. It can be said that thanks to IVF technology, scientists have examined under a microscope the phenomena when the follicle is “empty”.

According to statistics, in women under 40 years of age, this syndrome occurs in 5-8% of cases. The older a woman gets, the higher the number of empty follicles. And this is no longer a pathology, but the norm. Unfortunately, it is impossible to accurately and immediately diagnose this syndrome. To do this, you will need to completely exclude damage to the ovaries (structural anomaly), lack of ovarian response to stimulation, premature ovulation, hormonal failure, defects (pathologies) in the development of the follicles, and premature aging of the ovaries. That is why there is no such diagnosis as an “empty follicle”.

But scientists have found the reasons that accompany the development of the syndrome. Namely: Turner's syndrome, incorrect time of administration of the hCG hormone, incorrect dose of hCG, incorrectly selected IVF protocol, incorrect technique for sampling and washing the material. As a rule, a competent reproductologist, before making this diagnosis, carefully collects an anamnesis.

polycystic ovary syndrome

Otherwise, it is called the Stein-Leventhal syndrome. It is characterized by dysfunction of the ovaries, the absence (or altered frequency) of ovulation. As a result of this disease, follicles do not mature in the body of a woman. Women with this diagnosis suffer from infertility, lack of menstruation. A variant is possible when menstruation is rare - 1-3 times a year. Also, this disease affects the violation of the hypothalamic-pituitary functions. And this, as we wrote earlier, is one of the functions of the proper functioning of the ovaries.

Treatment here can proceed in two ways. It is operational and medical (conservative). The operative method often involves resection with the removal of the most damaged area of ​​ovarian tissue. This method in 70% of the case leads to the restoration of a regular menstrual cycle. For a conservative method of treatment, hormonal drugs are mainly used (Klostelbegit, Diana-35, Tamoxifen, etc.), which also help regulate the menstrual process, which leads to timely ovulation and the desired pregnancy.

Folliculometry: definitions, possibilities

Under the name folliculometry, it is customary to understand the observation of the reproductive system of a woman during the menstrual cycle. This diagnostic tool allows you to recognize ovulation (whether it was or not), determine the exact day, and monitor the dynamics of follicle maturation during the menstrual cycle.

Monitoring the dynamics of the endometrium. For this diagnosis, a sensor and a scanner are used (it is more common for us to call this ultrasound). This procedure is absolutely identical to the procedure for ultrasound of the pelvic organs.

Folliculometry is prescribed for women to determine ovulation, evaluate the follicles, determine the day of the cycle, for timely preparation for fertilization, to determine whether a woman needs to stimulate ovulation, to reduce (in some cases increase) the likelihood of multiple pregnancy, to determine the reasons for the absence of a regular menstrual cycle , detection of diseases of the pelvic organs (myomas, cysts), to control treatment.

This procedure does not require strict preparation. It is recommended only during these studies (usually ultrasound is done more than once) to exclude from the diet foods that increase bloating (soda, cabbage, brown bread). The study can be carried out in two ways: transabdominally and vaginally.

The values ​​of indicators of the norm and pathology of the development of follicles

The norms of indicators both by day and during ovulation, we described above (see above). Let's talk a little about pathology. The main pathology is the lack of follicle growth.

The reason may be:

• in hormonal imbalance
• polycystic ovaries,
• dysfunction of the pituitary gland,
• inflammatory processes of the pelvic organs,
• STD,
• neoplasms,
• severe stress (frequent stresses),
• breast cancer,
• anorexia,
• early menopause.

Based on practice, health workers distinguish such a group as hormonal disorders in a woman's body. Hormones inhibit the growth and maturation of follicles. If a woman has a very small body weight (plus there are still STD infections), then the body itself recognizes that it cannot bear a child, and the growth of the follicle stops.

After normalization of weight and treatment of STDs, the body begins the proper growth of follicles, and then the menstrual cycle is restored. During stress, the body releases hormones that contribute to either miscarriage or follicle growth.

After a complete emotional recovery, the body itself begins to stabilize.

Stimulation of ovulation

Under stimulation, it is customary to understand a complex of hormonal therapy, which helps to achieve fertilization. It is prescribed for women with a diagnosis of infertility for IVF. Infertility is usually diagnosed if pregnancy does not occur within a year with regular sexual activity (without contraception). But there are also contraindications for stimulation: impaired patency of the fallopian tubes, their absence (except for the IVF procedure), if it is not possible to conduct a full-fledged ultrasound, low follicular index, male infertility.

The stimulation itself occurs using two schemes (they are usually called protocols).

First protocol: increase in minimum doses. The purpose of this protocol is the maturation of one follicle, which excludes multiple pregnancy. It is considered sparing, since when using it, ovarian hyperstimulation is practically excluded. When stimulated with drugs according to this scheme, the size of the follicle usually reaches 18-20 mm. When this size is reached, the hCG hormone is injected, which allows ovulation to occur within 2 days.

Second protocol: lowering high doses. This protocol is prescribed for women with a low follicular reserve. But there are also requirements for it that are considered mandatory indications: age over 35, previous ovarian surgery, secondary amenorrhea, FSH above 12 IU / l, ovarian volume up to 8 cubic meters. With the stimulation of this protocol, the result is already visible on the 6th - 7th day. With this protocol, the risk of ovarian hyperstimulation is high.

The ovarian follicle is a structural component of the ovary, the main functions of which are to protect the egg from negative effects and the formation of the corpus luteum during ovulation. At early development, there are approximately 4 million follicles in the ovary of the fetus, during the process of birth the figure decreases to 1 million, and during puberty it drops to 400 thousand. As a result, only about 400 follicles will have a chance to finally mature at the time of ovulation and form a corpus luteum.

Menstrual cycle

Early phase

At the beginning of the menstrual cycle, the ovary contains 5-8 follicles less than 10 mm in size. In the process of maturation, one of them (in rare cases, two) becomes dominant, reaching a size of 14 mm. On the 10th day of the cycle, it begins to distance itself and increase daily by about 2 mm until the moment of rupture. The remaining follicles begin to undergo a slow process of involution (atresia), their small fragments can be seen on ultrasound throughout the entire menstrual cycle.

Follicle maturation time

The blood supply to the ovaries is significantly increased during the onset of ovulation under the influence of the pituitary hormones - gonadotropins FSH and LH. The formation of new blood vessels leads to the appearance of a follicle shell called the theca, which gradually begins to surround it from the outside and inside.

Ovulation period

Two criteria that allow you to determine the maturity of the follicle and impending ovulation with ultrasound:

• the size of the dominant follicle should be from 20 to 25 mm;
• the cortical plate of the follicle, under the influence of an increase in the internal fluid, slightly deforms one of the walls of the shell.

As ovulation occurs, the follicle stretches in size, protrudes slightly above the surface of the ovary and bursts - ovulation occurs.

luteal phase

After ovulation, the walls of the empty follicle thicken, and its cavity is filled with blood clots - a red body is formed. In case of unsuccessful fertilization, it quickly overgrows with connective tissue and turns into a white body, which disappears after a while. In case of successful fertilization, the red body under the influence of the chorionic hormone slightly increases in size and turns into a corpus luteum, which begins the production of a hormone called progesterone. It increases the growth of the endometrium and prevents the release of new eggs and the onset of menstruation. The corpus luteum disappears at the 16th week of pregnancy.

empty follicle syndrome

In a small number of cases, during the process of ovarian stimulation in the treatment of infertility, patients may experience the so-called empty follicle syndrome. It manifests itself with adequate levels of estradiol (a hormone produced by follicle cells) and normally growing follicles, while “dummy” can only be identified by examining them under a microscope.

The exact cause of the symptom is unknown. However, experts managed to find out that the frequency of the appearance of empty follicles increases with the age of a woman. In most cases, the appearance of the syndrome does not reduce the patient's fertility: follicular maturation and the number of eggs remain normal.

polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a set of symptoms caused by abnormal ovarian function, high levels of insulin in the blood, estrogens and androgens (male hormones) in women. PCOS causes menstrual irregularities, excess weight, acne and age spots, pelvic pain, depression, and excess body hair.

Currently, the most common definition of polycystic ovary syndrome is the 2003 consensus wording of European experts. According to its content, the diagnosis is made if the examination is carried out during the first six days of the cycle and the woman simultaneously has two of the three symptoms:

1. enlarged ovaries: surface area greater than 5.5 sq.cm, volume greater than 8.5 kb.cm;
2. the presence of at least twelve immature follicles less than 10 mm in size, most often located on the periphery of the ovary;
3. the presence of stromal hypertrophy.

The examination is performed using an ultrasound machine and 3D ultrasound. The latter with greater accuracy will help determine the volume of the ovaries and count the number of immature follicles.

The main treatments for the syndrome are: lifestyle changes, medication, and surgery. Treatment goals fall into four categories:

• decrease in the level of insulin resistance;
• restoration of reproductive function;
• getting rid of excess hair growth and acne;
• restoration of a regular menstrual cycle.

Within each of these goals, there is significant controversy regarding optimal treatment. One of the main reasons for this is the lack of large-scale clinical trials comparing different treatments. However, many experts recognize that reducing insulin resistance and body weight can affect all treatment goals, as they are the main cause of the syndrome.

Answers on questions

How big does a follicle need to be for ovulation to occur? The size of the follicle should be between 20 and 25 mm. If there is a dominant follicle in the ovary, will there be ovulation? Ovulation will occur if an egg develops in the follicle and it is not empty. Can ovulation occur without a dominant follicle? No, he can not. In this case, it occurs in which fertilization and pregnancy is impossible. When does ovulation occur with a follicle size of 14 mm? Approximately after 4-5 days when this size is reached. How many follicles does it take to ovulate? One dominant follicle, in rare cases two.

26.09.2007, 15:31

I do folliculometry. There were a few questions about the latest ultrasound.
On Friday, the follicle in the ultrasound in the left ovary was 15 mm, and on Monday, according to the ultrasound, there was already a corpus luteum in its place, can it grow and burst so quickly? So you ovulated on Sunday?
And yet, the doctor said that the thin endometrium is 0.54 cm and this will be a problem for fixing the fertilized egg, but before that everything with the endometrium (according to ultrasound) was normal, bother about this or could it be a mistake?
Oh, and one more question, maybe completely stupid - when the doctor drove a sensor in me, at some point it hurt, but it quickly passed, the second day I go to the toilet very often, all the time the urge to urinate: ah: could she tell me is there anything to hit? Thank you.

26.09.2007, 17:46

Dear Flo,
If on Friday the follicle is 15 mm, and on Monday (after 2 days) the corpus luteum is already determined (ovulation has occurred), then this situation, given the daily "growth" of the follicle, is normal.
The thickness of the endometrium in the periovulatory phase should be greater, at least 8 mm. Insufficient thickness of the endometrium can indeed prevent the implantation ("fixing") of a possible fetal egg.
Soreness with TV ultrasound can be in some situations, but, of course, nothing can be damaged.

27.09.2007, 13:33

Thanks a lot doctor. And here's another question: every month I do an ultrasound scan 2-3 times to track ovulation - is it harmless?

27.09.2007, 15:06

Ultrasound is harmless.

16.10.2007, 13:24

Ultrasound again and new diagnosis saddle uterus :ac: Every ultrasound new diagnosis :cool: 5 years ago I had a laparoscopy and my uterus was normal. I have been doing ultrasound for the last six months 2 times a month, everything is OK with the shape of the uterus. I don't understand anything. This is the first time this doctor has worked in a planning center, she determined the shape of the uterus by asking her to put her fists under the sacrum. Should I take this diagnosis for granted or should I go for an MRI or X-ray? And could this be a factor in my secondary infertility?

16.10.2007, 14:15

[Only registered and activated users can see links]
Tell me why you are diagnosed with secondary infertility and how long you have not been using protection. Yes, and also your husband, was examined?

16.10.2007, 14:33

I'm 36 years old. In November 1992, an abortion for a period of 8 weeks (unplanned pregnancy). For 9 years (married) I can not get pregnant. During this time, examinations were carried out at the family planning center, and lapara was also performed there. There are no visible problems. I quit twice, I got tired of going to the doctors and taking tests. Now 3 attempts. I hope it brings results.

16.10.2007, 17:18

Until you describe all the results of the examination and the conclusion, it is simply not possible to answer you. It is not visible through the Internet :).
Husband handed over a spermogram?

16.10.2007, 17:26

If they did laparoscopy and the extract does not indicate that the uterus is saddle-shaped, then this saddle-shaped form is not there. So you don't have to worry about this topic. Apparently the ultrasonographer is a big dreamer.
For other questions - you need to write a history of your disease in accordance with the questionnaire. A colleague linked to it above.

16.10.2007, 18:16

Thank you. We are now renting everything again, and suddenly this saddle-shaped uterus, and last time a thin endometrium. I just don’t even know whether to start doing something right after all these ultrasound diagnoses, or let everything go on as usual.

18.10.2007, 19:43

Well, I again went to the ultrasound, it was necessary to find out if ovulation occurred or not. And again, "good" news - on the last ultrasound in the right ovary, the follicle was 16 mm (there was all hope for it), and in the left follicle was 11 mm. On this ultrasound in the left ovary there is already a corpus luteum with a diameter of 17 mm, there is fluid in the retrouterine space, which means there was ovulation, and in the right ovary (my God) the follicle is still growing - 26 mm !! I also missed the cyst. They always burst well like that - with a yellowish body and liquid in the retrouterine :ab:
What is the maximum size? And yet, I could not provoke such growth with a large intake of folic acid. The insert said 1 mg 1-2 times a day for 20 days, and I drank 2 tablets and plus 2 more vitamin E tablets. And then I read here that folic needs only 400 mcg per day.